California Code of Regulations › Title 17 - Public Health › Division 2 - Health and Welfare Agency-Department of Developmental Services Regulations › Chapter 3 - Community Services › Subchapter 7 - Nonresidential Service Vendor Rate-Setting Provisions › Article 1 - Definitions › Section 57210 - Additional Terms Defined

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) As
					 used in Sections
					 57300 through
					 57948, the following words and
					 phrases have the following meanings:
(1)
					 "Allowable Range" means the distance from the lower limit to the upper limit in
					 a distribution of amounts among like programs determined pursuant to Step four,
					 Section 57513;
(2) "Cost-of-Living Adjustment" or "COLA"
					 means an amount of funds appropriated in the Budget Act for increases in rates
					 established by the Department which is representative of an overall increase in
					 the cost of providing services to consumers;
(3) "Direct Service Hours" means the number
					 of hours during which direct services are provided to consumers by direct care
					 staff to meet the objectives of the program design pursuant to Section
					 56712 or
					 56762 and, for vendors reimbursed
					 for absences pursuant to Section
					 54326(a)(11), the
					 number of direct service hours for which reimbursement was received shall also
					 be included;
(4) "Fiscal Year"
					 means the 12-month period which begins July 1 of one calendar year and ends
					 June 30 the following calendar year;
(5) "Gap" means the difference between the
					 amount determined for each vendor in Step five, Section
					 57514(a)(1) and
					 the amount determined for each vendor in Step two, Section
					 57511(a)(1) based
					 upon allowable cost and consumer attendance reported to the
					 Department;
(6) "Gap Funding" means
					 an amount of funds appropriated in the Budget Act pursuant to Section
					 57820;
(7) "Like Programs" means programs that are
					 assigned the same service code and have the same approved staffing
					 ratios;
(8) "Level of Payment"
					 means the total amount which a regional center reimburses a vendor for services
					 provided to its consumers;
(9)
					 "Lower Limit" means the lowest amount allowed in the distribution of amounts
					 among like programs, without an increase in the amount pursuant to Step six,
					 Section 57515;
(10) "Permanent Payment Rate" means a rate
					 established by the Department subsequent to the effective date of Sections
					 57200 through
					 57948, which is based upon each
					 vendor's program, allowable cost, consumer attendance, vendor income, and as
					 applicable, regional center payment information;
(11) "Profit", for profit organizations, or
					 "Surplus", for not-for-profit organizations, means the amount remaining after
					 all allowable costs related to services for consumers are deducted from a
					 vendor's reimbursement received for those consumers;
(12) "Public Agency" means federal, state,
					 and local government, including school districts, colleges and/or universities
					 supported by public funds;
(13)
					 "Regional Center Payments" means the total amount of income which the vendor
					 received from the vendoring regional center and/or utilizing regional
					 center(s), if any, for services provided to consumers;
(14) "Schedule of Maximum Allowances (SMA)"
					 means the schedule of the maximum allowable rate for the service provided as
					 established by the Department of Health Services (DHS) for services
					 reimbursable under the Medi-Cal program. If the vendor's usual and customary
					 rate is less than the maximum rate allowed pursuant to the SMA, the regional
					 center shall pay the vendor's usual and customary rate.
(15) "Staff Relief Time" means time worked by
					 substitute staff for direct care staff who are absent because of vacation,
					 illness, staff training, jury duty, military leave or administrative
					 leave;
(16) "Straight-line
					 Depreciation" means a depreciation method where the cost of property or
					 equipment is deductible in equal annual amounts over the estimated useful life
					 of the property or equipment;
(17)
					 "Temporary Payment Rate" means a rate established by the Department subsequent
					 to the effective date of Sections
					 57200 through
					 57948, for vendors who do not have
					 an actual cost history which the Department can use to establish a permanent
					 payment rate;
(18) "Upper Limit"
					 means the highest amount allowed in the distribution of amounts among like
					 programs, without a decrease in the amount pursuant to Step six, Section
					 57515;
(19) "Usual and Customary Rate" means the
					 rate which is regularly charged by a vendor for a service that is used by both
					 regional center consumers and/or their families and where at least 30% of the
					 recipients of the given service are not regional center consumers or their
					 families. If more than one rate is charged for a given service, the rate
					 determined to be the usual and customary rate for a regional center consumer
					 and/or family shall not exceed whichever rate is regularly charged to members
					 of the general public who are seeking the service for an individual with a
					 developmental disability who is not a regional center consumer, and any
					 difference between the two rates must be for extra services provided and not
					 imposed as a surcharge to cover the cost of measures necessary for the vendor
					 to achieve compliance with the Americans With Disabilities Act. New programs
					 applying for vendorization shall provide a written declaration to the vendoring
					 regional center that it is their intent to comply with this subsection, and
					 will be allowed up to 12 months to achieve compliance. The vendoring regional
					 center may audit a vendor's records to determine compliance with this
					 subsection and, if the vendor is found not to be in compliance, shall revoke
					 the vendor's usual and customary rate and negotiate a rate pursuant to Section
					 57300; and
(20) "Vendor Income" means all income
					 received from any public agency, with the exception of the Department, regional
					 centers, or the Department of Rehabilitation and/or the Department of Health
					 Services if the vendor reported costs pursuant to Section
					 57422(c)(2), for
					 services to consumers pursuant to Section
					 57438.