New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-9 - Provision of Required Supplies and services › Section 635-9.1 - Requirements for residential facilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Principles of compliance.
(1) Intermediate care facilities for persons
				  with developmental disabilities (ICF/DDs), community residences including
				  Individualized Residential Alternatives (IRAs), private schools, and specialty
				  hospitals shall assume the cost of:
(i) Any
				  item or service for which local, State, or Federal funds are provided; or for
				  which reimbursement is made through a rate, fee, or grant-in-aid.
(ii) All staff personal service costs and
				  staff expenses incurred in the provision of services and activities which are
				  specified in a person's plan of service or part of the facility's recreation
				  program.
(iii) Physical plant
				  maintenance and improvements.
(iv)
				  All utilities including heat, light, power, water, and sewer.
(v) Phone service. Persons at the facility
				  shall not be charged for local phone calls. Long distance calls made by a
				  person residing in the facility may be paid for from his or her personal
				  allowance.
(vi) The purchase,
				  operation, and maintenance of all equipment and furniture necessary to operate
				  the facility in accordance with regulations of the applicable facility class,
				  and any other applicable regulations.
(vii) Special equipment necessary to meet the
				  developmental needs of persons at the facility.
(viii) Items required to meet the special,
				  clinically determined, individual needs of persons where such items are costly
				  and/or are used on an ongoing basis (
e.g.,
adult diapers) and
				  are not covered by Medicaid, Medicare, or other health insurance.
(ix) Environmental adaptions made to the
				  facility to meet the needs of persons at the facility.
(x) Three well-balanced meals, or equivalent,
				  and an appropriate number of snacks and any special foods required to meet the
				  nutritional needs of persons in the facility. An exception to the meal/snack
				  requirement is made where a person attends a day program which receives
				  specific funds to cover the cost of a specified daily meal and/or snack. An
				  exception to the meal/snack requirement is also made where, and to the extent
				  that, a person and the community residence or IRA in which the person lives
				  agree that the person will pay for, obtain and prepare some or all of his or
				  her own food.
(xi) Basic bedding
				  and towels (see glossary).
(xii)
				  The purchase, operation, and maintenance of all laundry equipment and supplies,
				  as well as laundromat and laundry service charges and the cost of basic dry
				  cleaning (see glossary).
(xiii)
				  Hygiene supplies and services.
(a) ICF/DDs and
				  specialty hospitals are responsible for all basic grooming and personal hygiene
				  items and services. This includes, but is not limited to toilet paper, tissues,
				  soap, deodorant, shampoo, paper cups, band-aids, and other first aid supplies,
				  as well as such personal items as shaving equipment, toothbrush, comb and
				  brush, haircuts, and sanitary napkins. The exception to this would be when a
				  preference for personal selection is indicated by a resident (see section
				  633.15[c][5] 
				  of this Title).
(b) Community
				  residences and private schools are responsible for those grooming and personal
				  hygiene items customarily shared by a family. This includes, but is not limited
				  to, toilet paper, tissues, soap, shampoo, a supply of sanitary napkins,
				  band-aids, and other items for home first aid. The exception to this would be
				  when a preference for personal selection is indicated by a resident (see
				  section
				  633.15[c][5] 
				  of this Title).
(xiv)
				  For persons who are Medicaid recipients, all necessary medical/dental/clinical
				  supplies and services (see glossary) not available under Medicaid.
(xv) For persons who are not Medicaid
				  recipients, all necessary medical/dental/clinical supplies and services not
				  available under Medicare or other health insurance. An exception is made where
				  a person has excess resources (see glossary) which, based on a medical/dental
				  payment review (see glossary), have been determined to be available for this
				  use.
(xvi) Basic clothing (see
				  glossary).
(a) ICF/DDs, private schools, and
				  specialty hospitals assume the cost of basic clothing, except where the
				  following funds are available:
(1) Personal
				  allowance (see glossary) not required for a person's current and foreseeable
				  future individualized needs. In all cases, a $100 personal allowance balance
				  must be reserved for purposes other than basic clothing purchases.
(b) Community residences assume the
				  cost of basic clothing, except where the following funds are available:
(1) section 41.36(n) funds (see glossary);
				  and
(2) personal allowance not
				  required for a person's current and foreseeable future individualized needs. In
				  all cases, a $100 personal allowance balance must be reserved for purposes
				  other than basic clothing purchases.
(xvii) Travel expenses, except those:
(a) covered by Medicaid;
(b) payable from a person's work-related
				  exemption (see glossary) for the month; and
(c) associated with a person's individual
				  participation in social or recreational activities, where such activities are
				  neither specified in his or her plan of services, nor part of the facility's
				  recreational program.
(xviii) Materials and all other expenses
				  associated with the facility's programmatic recreational activities, whether
				  conducted in-house or out in the community.
(xix) All items required to meet treatment
				  needs specified in a person's plan of services.
(xx) Work-related expenses
				  (
e.g.,
taxes, union dues, health insurance, uniforms, lunches
				  and transportation) not covered by the person's work-related exemption for the
				  month.
(xxi) Damage caused by a
				  person residing in a facility, other than that portion of the expense:
(a) covered by insurance; and
(b) received from a person as part of a
				  meaningful restitution process as devised by the program planning team (see
				  glossary); approved in writing by the person's payee, if any; and approved by a
				  committee, or part thereof, charged with protecting the rights of persons
				  residing in the facility.
(xxii) Supervised community residences (CRs)
				  and supervised individualized residential alternatives (IRAs) are responsible
				  for the cost of:
(a) services that are
				  necessary to meet the needs of individuals while in the residence;
(b) services that, prior to August 1, 2004,
				  could have been met by home health aide or personal care services separately
				  billed to Medicaid; and
(c)
				  services specified in section
				  635-10.4(b)(1)(xvi) 
				  of this Part and section
				  671.5(a)(7) 
				  of this Title that, prior to October 1, 2015, may have been separately billed
				  to Medicaid.
(xxiii)
				  Supportive CRs and supportive IRAs are responsible for the cost of services
				  that, prior to October 1, 2015, could have been met by a home health aide or
				  personal care services separately billed to Medicaid, as specified in section
				  635-10.4(b)(1)(xvii) 
				  of this Part and section
				  671.5(a)(8) 
				  of this Title.