New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-11 - Rate Setting for Non-state Providers: Intermediate Care Facilities for Persons with Developmental Disabilities › Section 86-11.3 - Rates for providers of ICF/DD services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) There shall be one provider-wide rate for
					 each provider, except that rates for ICF/DD services provided to individuals
					 identified as specialized populations by OPWDD shall be determined under
					 section
					 86-11.9 
					 of this Subpart. Adjustments may be made to the rate resulting from any final
					 audit findings or reviews.
(b)
					 Rates shall be computed on the basis of a full 12 month base year CFR, adjusted
					 in accordance with the methodology as provided in this section. The rate shall
					 include operating cost components, and capital cost components as identified in
					 applicable subdivisions. Such base year may be updated periodically, as
					 determined by the department.
(c)
Components of rates for ICF/DD services.
(1) The operating component shall be based on
					 allowable costs identified in the consolidated fiscal reports. The operating
					 component shall be inclusive of the following components:
(i)
Regional average direct care
					 wage
, which shall mean the quotient of base year salaried direct care
					 dollars for each provider in a Department of Health region, aggregated for all
					 such providers in such region, for all residential habilitation-supervised IRA,
					 residential habilitation-supportive IRA, day habilitation services and ICF/DD,
					 divided by base year salaried direct care hours for each provider in a
					 Department of Health region, aggregated for all such providers in such region,
					 for all residential habilitation-supervised IRA, residential habilitation-
					 supportive IRA, day habilitation services and ICF/DD services.
(ii)
Regional average
					 employee-related component
, which shall mean the sum of vacation leave
					 accruals and total fringe benefits for the base year for each provider of a
					 Department of Health region, aggregated for all such providers in such region,
					 such sum to be divided by base year salaried direct care dollars for each
					 provider of a Department of Health region, aggregated for all such providers in
					 such region, and then multiplied by the applicable regional average direct care
					 wage as determined by subparagraph (i) of this paragraph.
(iii)
Regional average program
					 support component
, which shall mean the sum of transportation
					 related-participant staff travel, participant incidentals, expensed adaptive
					 equipment, sub-contract raw materials, participant wages-non-contract,
					 participant wages-contract, participant fringe benefits, staff development,
					 supplies and materials-non-household, other-OTPS, lease/rental vehicle,
					 depreciation-vehicle, interest-vehicle, other-equipment, other than to/from
					 transportation allocation, salaried support dollars (excluding housekeeping and
					 maintenance staff) and salaried program administration dollars for the base
					 year for each provider of a Department of Health region, aggregated by all such
					 providers in such region. Such sum shall be divided by the total base year
					 salaried direct care dollars of all providers in a Department of Health region,
					 and then multiplied by the applicable regional average direct care wage as
					 determined pursuant to subparagraph (i) of this paragraph.
(iv)
Regional average direct care
					 hourly rate-excluding general and administrative
, which shall mean the
					 sum of the applicable regional average direct care wage as determined pursuant
					 to subparagraph (i) of this paragraph, the applicable regional average
					 employee-related component as determined pursuant to subparagraph (ii) of this
					 paragraph, and applicable regional average program support component as
					 determined pursuant to subparagraph (iii) of this paragraph.
(v)
Regional average general and
					 administrative component
, which shall mean the sum of the
					 insurance-general and agency administration allocation for the base year for
					 each provider in a Department of Health region, aggregated for all such
					 providers in such region, divided by (the sum of total program/site costs and
					 other than to/from transportation allocation, less the sum of food, repairs and
					 maintenance, utilities, expensed equipment, household supplies, telephone,
					 lease/rental equipment, depreciation equipment, total property-provider paid,
					 housekeeping and maintenance staff, salaried clinical dollars, and contracted
					 clinical dollars for the base year for each provider of a Department of Health
					 region, aggregated for all providers in such region). The regional average
					 direct care hourly rate-exclusive of general and administrative costs, as
					 determined pursuant to subparagraph (iv) of this paragraph, shall then be
					 divided by (one minus the applicable regional average general and
					 administrative quotient), from which the applicable regional average direct
					 care wage hourly rate-excluding general and administrative, as computed in
					 subparagraph (iv) of this paragraph shall be subtracted.
(vi)
Regional average direct care
					 hourly rate
, which shall mean the sum of the applicable regional
					 average direct care wage, as determined pursuant to subparagraph (i) of this
					 paragraph, the applicable regional average employee-related component as
					 determined pursuant to subparagraph (ii) of this paragraph, the applicable
					 regional average program support component as determined pursuant to
					 subparagraph (iii) of this paragraph, and the applicable regional general and
					 administrative component computed in subparagraph (v) of this
					 paragraph.
(vii)
Provider
					 average direct care wage
, which shall mean the quotient of base year
					 salaried direct care dollars divided by the base year salaried direct care
					 hours of a provider.
(viii)
Provider average employee-related component
, which shall mean
					 the sum of vacation leave accruals and fringe benefits for the base year for
					 each provider, divided by base year salaried direct care dollars of a provider,
					 such quotient to be multiplied by the provider average direct care wage as
					 computed in subparagraph (vii) of this paragraph.
(ix)
Provider average program support
					 component
, which shall mean the sum of transportation
					 related-participant, staff travel, participant incidentals, expensed adaptive
					 equipment, sub-contract raw materials, participant wages-non-contract,
					 participant wages-contract, participant fringe benefits, staff development,
					 supplies and materials-non-household, other-OTPS, lease/rental vehicle,
					 depreciation-vehicle, interest-vehicle, other-equipment, other than to/from
					 transportation allocation, salaried support dollars (excluding housekeeping and
					 maintenance staff) and salaried program administration dollars for the base
					 year for a provider. Such sum shall be divided by the base year salaried direct
					 care dollars of such provider and such quotient shall be multiplied by the
					 provider average direct care wage as computed in subparagraph (vii) of this
					 paragraph.
(x)
Provider
					 average direct care hourly rate-excluding general and administrative
,
					 which shall mean the sum of the provider average direct care wage as determined
					 pursuant to subparagraph (vii) of this paragraph, the provider average
					 employee-related component as determined pursuant to subparagraph (viii) of
					 this paragraph, and the provider average program support component as
					 determined pursuant to subparagraph (ix) of this paragraph for each
					 provider.
(xi)
Provider
					 average general and administrative component
, which shall mean the sum
					 of insurance-general and agency administration allocation for the base year for
					 a provider, such sum to be divided by (the sum of total program/site costs and
					 other than to/from transportation allocation less the sum of food, repairs and
					 maintenance, utilities, expensed equipment, household supplies, telephone,
					 lease/rental equipment, depreciation equipment, insurance "" property and
					 casualty, total property-provider paid, housekeeping and maintenance staff,
					 salaried clinical dollars, and contracted clinical dollars for a provider) for
					 the base year. The provider average direct care hourly rate-excluding general
					 and administrative, as computed in subparagraph (x) of this paragraph, shall
					 then be divided by (one minus the applicable provider average general and
					 administrative quotient), from which the provider average direct care wage
					 hourly rate-excluding general and administrative, as computed in subparagraph
					 (x) of this paragraph, shall be subtracted.
(xii)
Provider average direct care
					 hourly rate
, which shall mean the sum of the provider average direct
					 care wage, as determined pursuant to subparagraph (vii) of this paragraph, the
					 provider average employee-related component as determined pursuant to
					 subparagraph (viii) of this paragraph, the provider average program support
					 component as determined pursuant to subparagraph (ix) of this paragraph, and
					 the provider average general and administrative component as determined
					 pursuant to subparagraph (xi) of this paragraph.
(xiii)
Provider direct care
					 hours
, which shall mean the sum of base year salaried direct care
					 hours and base year contracted direct care hours, such sum to be divided by the
					 rate sheet capacities for the base year. Such quotient to be multiplied by rate
					 sheet capacities for the initial period.
(xiv)
Regional average clinical
					 hourly wage
, which shall mean the quotient of base year salaried
					 clinical dollars for each provider of a Department of Health region, aggregated
					 for all such providers in such region, divided by base year salaried clinical
					 hours for each provider of a Department of Health region, aggregated for all
					 such providers in such region.
(xv)
Provider average clinical hourly wage
, which shall mean the
					 quotient of base year salaried clinical dollars of a provider divided by base
					 year salaried clinical hours of such provider.
(xvi)
Provider salaried clinical
					 hours
, which shall mean the quotient of base year salaried clinical
					 hours of a provider, divided by the rate sheet capacities for the base year,
					 such quotient to be multiplied by the rate sheet capacities for the initial
					 period for such provider.
(xvii)
Regional average contracted clinical hourly wage
, which shall
					 mean the quotient of contracted clinical dollars divided by the base year
					 contracted clinical hours for each provider of a Department of Health region,
					 aggregated for all such providers in such region.
(xviii)
Provider contracted clinical
					 hours
, which shall mean the quotient of a provider's contracted
					 clinical hours for the base year divided by the rate sheet capacities for the
					 base year, such quotient to be multiplied by rate sheet capacities for the
					 initial period.
(xix)
Provider direct care hourly rate- adjusted for wage equalization
					 factor
, which shall mean the sum of the provider average direct care
					 hourly rate, as determined pursuant to subparagraph (xii) of this paragraph
					 multiplied by 0.75 and the applicable regional average direct care hourly rate,
					 as determined pursuant to subparagraph (vi) of this paragraph multiplied by
					 0.25.
(xx)
Provider
					 clinical hourly wage "" adjusted for wage equalization factor
, which
					 shall mean the sum of the provider average clinical hourly wage, as determined
					 pursuant to subparagraph (xv) of this paragraph, multiplied by 0.75 and the
					 applicable regional average clinical hourly wage, as computed in subparagraph
					 (xiv) of this paragraph multiplied by 0.25.
(xxi)
Provider reimbursement from
					 direct care hourly rate
, which shall mean the product of the
					 calculated direct care hours, as determined pursuant to subparagraph (xiii) of
					 this paragraph, and the provider direct care hourly rate-adjusted for wage
					 equalization factor, as computed in subparagraph (xix) of this
					 paragraph.
(xxii)
Provider
					 reimbursement from clinical hourly wage
, which shall mean the product
					 of the provider salaried clinical hours, as determined pursuant to subparagraph
					 (xvi) of this paragraph and the provider clinical hourly wage- adjusted for
					 wage equalization factor, as determined pursuant to subparagraph (xx) of this
					 paragraph.
(xxiii)
Provider
					 reimbursement from contracted clinical hourly wage
, which shall mean
					 the product of the provider contracted clinical hours, as determined pursuant
					 to subparagraph (xviii) of this paragraph and the applicable regional average
					 contracted clinical hourly wage, as determined pursuant to subparagraph (xvii)
					 of this paragraph.
(xxiv)
Provider facility reimbursement
, which shall mean the sum of
					 food, repairs and maintenance, utilities, expensed equipment, household
					 supplies, telephone, lease/rental equipment, depreciation equipment, insurance
					 "" property and casualty, housekeeping and maintenance staff, and program
					 administration property the base year for a provider and such sum to be divided
					 by provider rate sheet capacities for the base year. Such sum to be multiplied
					 by rate sheet capacities for the initial period.
(xxv)
Provider operating
					 revenue
, which shall mean the sum of provider reimbursement from
					 direct care hourly rate, as determined pursuant to subparagraph (xxi) of this
					 paragraph, the provider reimbursement from clinical hourly wage, as determined
					 pursuant to subparagraph (xxii) of this paragraph, the provider reimbursement
					 from contracted clinical hourly wage, as determined pursuant to subparagraph
					 (xxiii) of this paragraph, and the provider facility reimbursement, as
					 determined pursuant to subparagraph (xxiv) of this paragraph.
(xxvi)
Statewide budget neutrality
					 adjustment factor for operating dollars
, which shall mean the quotient
					 of all provider rate sheets in effect on June 30, 2014, divided by provider
					 operating revenue, as determined pursuant to subparagraph (xxv) of this
					 paragraph, for all providers.
(xxvii)
Total provider operating
					 revenue- adjusted
, which shall mean the product of the provider
					 operating revenue, as determined pursuant to subparagraph (xxv) of this
					 paragraph and the statewide budget neutrality adjustment factor for operating
					 dollars, as determined pursuant to subparagraph (xxvi) of this paragraph.
The final daily operating rate shall be determined by
						dividing the total provider operating revenue-adjusted, as determined by
						subparagraph (xxvii) of this paragraph, by the applicable provider rate sheet
						capacity for the initial period and such quotient to be further divided by
						365.