Washington State Home Care Agency Fee Schedule & Rate Sheet Template

WHAT'S INCLUDED — COMPREHENSIVE FEE SCHEDULE SECTIONS: PERSONAL CARE AND SUPPORT SERVICES RATE TABLE — Personal Care (ADLs): Bathing, dressing, grooming, toileting, transferring, ambulation, eating assistance, positioning — Homemaker / IADL Services: Meal prep, light housekeeping, laundry, shopping, errands — Companion / Socialization: Conversation, activities, supervision, appointment accompaniment — Respite Care: Temporary caregiver relief with full personal care scope — Medication Assistance: Remind, hand, open, read label, observe self-admin per WAC 246-335-420(4) — Combined Personal Care + Homemaker: Full scope ADL + IADL services per Plan of Care — Each service includes columns for Rate, Min Hours, Min Charge, and Services Included EXTENDED AND SPECIALTY SERVICES — Live-In Care (24-hour): Daily rate with WA L&I sleep time rules, 2-caregiver rotation option — Overnight Care (awake): Shift-based rate, caregiver remains awake and available — Overnight Care (sleeping): Shift-based rate, caregiver sleeps but available for needs — Weekend Differential: Added to base hourly rate for Saturday-Sunday — Holiday Differential: Added to base hourly rate for observed holidays — Short-Notice / Emergency: Less than 24 hours notice, subject to availability — Nurse Delegation Tasks: Per WAC 246-335-420(14), requires contracted RN — Vital Signs Assistance & Passive ROM Exercises: Included per Plan of Care MEDICAID / DSHS CONTRACT RATES SECTION — Disclosure that Medicaid rates are set by contracting entity (DSHS or AAA) — Client not responsible for costs covered by authorization — Direction to DSHS case manager or AAA for questions PAYMENT POLICIES — Accepted Payment Methods: Medicaid, Private Pay, LTC Insurance, VA Benefits, Workers' Comp — Billing Frequency options: Weekly, Bi-Weekly, Monthly — Invoice delivery: Mail, Email, or Both — Payment terms with Net days, late payment fees, and service suspension per WAC 246-335-420(1)(b) — Returned check fee provision CANCELLATION AND NO-SHOW POLICY — Greater than 24 hours notice: No charge — Less than 24 hours notice: Cancellation fee or hourly rate (whichever is less) — No-show: Full charge for minimum hours — Holiday schedule with holiday rate application TRAVEL AND MILEAGE — Travel surcharge options for distance-based clients — Mileage rate for client errands/transportation (IRS standard rate reference) LONG-TERM CARE INSURANCE CLIENTS — Agency claims submission on client's behalf — Client responsibility for unpaid amounts — Elimination period disclosure ADMINISTRATOR APPROVAL & CLIENT ACKNOWLEDGMENT — Administrator signature and date block — Client/Authorized Representative signature and date block — Effective date statement superseding all previous fee schedules