Personal Care Rates (PCR) January 2023 Rate Sheet
- Rates are also available in (PDF)
New York State Department of Health
Medicaid Personal Care Rates - Effective January 01, 2023
Agency:
MMIS ID: xxxxxxxx
Locator Code: xxx
County:
Region:
| Rate Components | Personal Care Services | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Level One | Level Two | Level Two Hard To Serve | Live-in | Shared Aide Level One | Shared Aide Level Two | Nursing Supervision | Nursing Assessment | |||
| Direct Care & Training | ||||||||||
| (1) | Direct Care & Training Costs | |||||||||
| (2) | Direct Care & Training Regional Ceiling (capped at 115% of regional average) | |||||||||
| (3) | Direct Care & Training Rate (Lower of Direct Care & Training Costs or Regional Ceiling) [Lower of (1) or (2)] | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| Administration | ||||||||||
| (4) | Admin Cost (excluding Capital and Background & Fingerprinting) | |||||||||
| (5) | Admin Ceiling (capped at 28% of Total Costs) | |||||||||
| (6) | Direct Care & Training Regional Ceiling | |||||||||
| (7) | Lower of Admin Cost or Admin Ceiling or DC&T Ceiling [Lower of (4), (5) or (6)] | |||||||||
| (8) | Capital Costs | |||||||||
| (9) | Background & Fingerprinting Costs | |||||||||
| (10) | Admin Cost (including Capital and Background & Fingerprinting) [(7) + (8) + (9)] | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| (11) | Admin and Direct Care & Training Rate [(3) + (10)] | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| Rate Add-Ons | ||||||||||
| (12) | Profit / Surplus | |||||||||
| (13) | Total Rate [(11) + (12)] | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| (14) | Public Charge Rate | |||||||||
| (15) | Lower of Total Rate or Public Charge Rate (if > $0) | |||||||||
| (16) | Minimum Wage | |||||||||
| (17) | Worker Recruitment & Retention [(15) + (16)] * 4.56% | |||||||||
| (18) | 1% Medicaid ATB Increase (eff. 4/1/2022) [(15) + (16) + (17)] * 1% | |||||||||
| (19) | Final Rate [(15) + (16) + (17) + (18)] | |||||||||
| One Client | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||
| Two Clients | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||
| One Client 1/4 hour | $0.00 | $0.00 | $0.00 | |||||||
| Two Clients 1/4 hour | $0.00 | $0.00 | $0.00 | |||||||
Supporting Calculation for Medicaid Personal Care Rates Effective January 01, 2023
Agency:
MMIS ID: xxxxxxxx
Locator Code: xxx
County:
Region:
| Rate Components | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Level One | Level Two | Level Two Hard To Serve | Live-in | Shared Aide Level One | Shared Aide Level Two | Nursing Supervision | Nursing Assessment | |||
| 1. Direct Care & Training Costs | ||||||||||
| (1) | Direct Care & Training cost by service (Sch 3b col 005/006 & 007-010) | |||||||||
| (2) | Hours/Visits by service (Sch 5b col 023 or 024) | |||||||||
| (3) | Direct Care & Training cost per hour/visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| 2. Admin Cost (excluding Capital and Background & Fingerprinting) | ||||||||||
| (1) | Program admin cost by service (Sch 3b col 004) | |||||||||
| (2) | Total program admin cost across Sch 3b (Sch 3b col 004 line 010) | |||||||||
| (3) | Admin Percent [(1) / (2)] | |||||||||
| (4) | Hours/Visits by service (Sch 5b col 023 or col 024) | |||||||||
| (5) | Admin Cost per hour/visit [(1) / (4)] | |||||||||
| (6) | Capital Cost across Sch 4b (Sch 4b total of col 004 lines 002-003 & 005-011 & 015) | |||||||||
| (7) | Capital Cost per hour/visit by service [(3) * (6) / (4)] | |||||||||
| (8) | Background & Fingerprinting across Sch 4b (Sch 4b col 003 line 001) | |||||||||
| (9) | Background & Fingerprinting Cost per hour/visit by service [(3) * (8) / (4)] | |||||||||
| (10) | Admin Cost (excluding Capital and Background & Fingerprinting) [(5) - (7) - (9)] | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| 3. Admin Ceiling | ||||||||||
| (1) | Allowable Cost by service (Sch 3b col 003) | |||||||||
| (2) | Hours/Visits by service (Sch 5b col 023 or 024)) | |||||||||
| (3) | Admin Ceiling [28% * (1) / (2)] | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| 4. Profit / Surplus Add-On | ||||||||||
| (1) | Admin and Direct Care & Training Rate | |||||||||
| (2) | Allowable costs for aide wages and benefits across Sch 3b (Sch 3b col 005/006 & 008-010) | |||||||||
| (3) | Total Allowable cost across Sch 3b (Sch 3b col 003) | |||||||||
| (4) | 6 Months T-Bill rate (As on 30 Sept 2022) | |||||||||
| (5) | Profit / Surplus Percentage Adjustment [(2) / (3) * (4)] | |||||||||
| (6) | Profit / Surplus Add-On [(1)*(5)] |
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| 5. Public Charge Rate | ||||||||||
| (1) | Public Charge Rate (Sch 7b col 001) | |||||||||
| 6. Minimum Wage Adjustment | ||||||||||
| 2023 | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | ||||
| (1) | Base Rate Increase | |||||||||
| Downstate | $1.50 | $1.50 | $1.00 | $1.00 | $1.00 | $1.00 | $0.00 | |||
| Upstate | $2.50 | $1.20 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | |||
| (2) | Fringe Benefits | |||||||||
| Downstate | $0.26 | $0.26 | $0.18 | $0.18 | $0.18 | $0.28 | $0.00 | |||
| Upstate | $0.43 | $0.21 | $0.12 | $0.12 | $0.12 | $0.20 | $0.20 | |||
| (3) | MW Increase | |||||||||
| Downstate (Base Rate + Fringe Benefits) | $1.76 | $1.76 | $1.18 | $1.18 | $1.18 | $1.28 | $0.00 | |||
| Upstate (Base Rate + Fringe Benefits) | $2.93 | $1.41 | $0.82 | $0.82 | $0.82 | $0.90 | $0.90 | |||
| 2023 MW Adjustment | Live-in (13 hours) | Other Personal Care Services | ||||||||
| Downstate | $108.33 | $8.33 | ||||||||
| Upstate | $111.73 | $8.59 | ||||||||
