(a) Hospitals desiring rates for HHS services must:

1. (1) Provide the Home Health Agency NYS Operating Certificate Number; and

2. (2) Ratio of Charges to Charges Applied to Costs (RCCAC) information.

   (b) RCCAC information.

3. (1) Statistics required:

   1. (i) Number of hours of service.
   2. (ii) Number of home health visits.
   3. (iii) Charge per visit at the hospital's established rates.
   4. (iv) Multiply number of home visits by the charge per visit.

4. (2) Specific home health services for which statistics above are required:

   1. (i) Skilled Nursing Care (account 6910).
   2. (ii) Medical Social Services (account 6920).
   3. (iii) Home Health Aides (account 6930).
   4. (iv) Physical Therapy (account 7510).
   5. (v) Occupational Therapy (account 7530).
   6. (vi) Speech/Language Pathology (account 7550).
   7. (vii) Other Home Health Services (account 6990).
5. (3) The total charges calculated in paragraph (b)(1) of this section must be summed for all services in paragraph (b)(2) of this section.
6. (4) A percentage of each service in paragraph (b)(2) of this section to the total charges in paragraph (b)(3) of his section must be calculated (to the nearest tenth of a percent).

(d) Does your hospital contract for any HHA services?

1. (1) If so, is charge dependent on the amount charged by the contracting agency?
2. (2) If so, detail the visits and charges according to each contract under paragraph (b)(2) of this section.