reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.8 - Specialized template populations

Current through Register Vol. 46, No. 28, July 10, 2024
Notwithstanding any other provision of this Subpart, rates
					 for individuals identified by OPWDD as qualifying for specialized template
					 populations funding shall be as follows. As used in this section, "Downstate"
					 means the counties of New York, Kings, Bronx. Queens, Richmond, Nassau,
					 Suffolk, Westchester, Rockland, Orange, Sullivan, Putnam and Dutchess, and
					 "Upstate" means all other counties in New York State.
(a) For individuals initially identified as
				  qualifying for specialized template populations funding between November 1,
				  2011 and March 31, 2014
Residential - Specialized Level of
								  Care
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$166,400
Upstate
$150,500
Residential - Highly Complex Level of
								  Care
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$189,500
Upstate
$171,500
Residential - Auspice Change
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$136,500
Upstate
$123,500
Day Hab - Specialized Level of
								  Care
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$41,730
Upstate
$37,562
Day Hab - Highly Complex Level of
								  Care
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$46,433
Upstate
$43,063
(b) For individuals initially identified as
				  qualifying for specialized template populations funding after March 31, 2014
Residential - Highly Complex Level of
								  Care
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$189,500
Upstate
$171,500
Residential - Auspice Change
Region
Gross Annual Funding Allocation Per
								  Individual (Operating Only)
Downstate
$136,500
Upstate
$123,500
Day Hab - Highly Complex Level of
								  Care
Region
Gross Annual Funding Allocation Per
								  Individual (Operating only)
Downstate
$46,433
Upstate
$43,063
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.9 - Severability

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Subpart or its application to any
					 person or circumstance is held to be invalid, the remainder of this Subpart and
					 the application of that provision to other persons or circumstances will not be
					 affected.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
Rates of reimbursement for intermediate care facilities
					 for persons with developmental disabilities (ICF/DD), other than those operated
					 by OPWDD, shall be determined in accordance with 10 NYCRR Part 86-11. The rates
					 of payment made for services rendered to title XIX recipients established in
					 accordance with the methodology contained in 10 NYCRR Part 86-11 shall be
					 contingent upon Federal financial participation (FPP) and approval.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.2

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.3

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.4

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.5

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.6

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.7

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.8

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.9

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-2 - Rates For Non-state Providers Of Intermediate Care Facilities For Persons With Developmental Disabilities › Section 641-2.10

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-3 - Direct Support and Clinical Compensation Increases › Section 641-3.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
On or after January 1, 2015, rates of reimbursement for
					 providers that operate eligible programs as defined in this Subpart will be
					 revised to incorporate funding for compensation increases to their direct
					 support professional employees. Such rate increases will be effective January
					 1, 2015. The compensation increase funding will be included in the provider's
					 rate issued for January 1, 2015 or in a subsequent rate with the inclusion of
					 funding in the amount necessary to achieve the same funding impact as if the
					 rate had been issued on January 1, 2015. The compensation increase funding will
					 be inclusive of associated fringe benefits.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-3 - Direct Support and Clinical Compensation Increases › Section 641-3.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart, the following terms shall have the
					 following meanings:
(a) Direct support
				  professionals are those defined as Direct Care and Support per Consolidated
				  Fiscal Report (CFR) Appendix R and reported on the CFR under the Position Title
				  code identifiers of 100 or 200. Contracted staff salary information will not be
				  utilized.
(b) Clinical staff are
				  those defined as Clinical per CFR Appendix R and reported on the CFR under the
				  Position Title code identifier of 300. Contracted staff salary information will
				  not be utilized.
(c) Eligible Rate
				  Based Programs shall mean any of the following services: supervised community
				  residences (including supervised IRAs), supportive community residences
				  (including supportive IRAs), ICFs/DD or group day habilitation
				  programs.
(d) Other Eligible
				  Programs shall mean community habilitation, day treatment, supported
				  employment, agency sponsored family care, respite and free standing respite,
				  and prevocational services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-3 - Direct Support and Clinical Compensation Increases › Section 641-3.4 - Rates and Fees for Specialty Hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For a provider that operates any Other
				  Eligible Programs, the provider's rate or fee for each such program will be
				  revised to incorporate funding for compensation increases to their direct
				  support professional employees. Such rate or fee increases will be effective
				  January 1, 2015. The compensation increase funding will be included in the
				  provider's rate or fee issued for January 1, 2015 or in a subsequent rate or
				  fee with the inclusion of funding in the amount necessary to achieve the same
				  funding impact as if the rate or fee had been issued on January 1, 2015. The
				  compensation increase funding will be inclusive of associated fringe
				  benefits.
(b) April 1, 2015
				  Increase. In addition to the compensation funding effective January 1, 2015, a
				  provider that operates any Other Eligible Programs will receive a compensation
				  increase targeted to direct support professional and clinical employees to be
				  effective April 1, 2015. The April 1, 2015 direct care compensation funding
				  will be the same, on an annualized basis, as that which was calculated for the
				  January 1, 2015 compensation increase and will be an augmentation to the
				  January 1, 2015 increase.
(c)
				  Calculations.
(1) The portion of the rate or
				  fee that is identified as direct care and support will be increased by 2% and
				  multiplied by the rate or fee sheet fringe benefit percentage to calculate the
				  additional direct care compensation increases for January 1, 2015 and April 1,
				  2015.
(2) The portion of the rate
				  or fee that is identified as clinical will be increased by 2% and multiplied by
				  the rate or fee sheet fringe benefit percentage to calculate the additional
				  clinical compensation increase for April 1, 2015.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-3 - Direct Support and Clinical Compensation Increases › Section 641-3.5 - Rates and Fees for Specialty Hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) January 1, 2015 Increase. The rates of
				  reimbursement for specialty hospitals as defined in Part 680 of this Title will
				  be revised to incorporate funding for compensation increases to direct support
				  professional employees. Such rate increases will be effective January 1, 2015.
				  The compensation increase funding will be included in the provider's rate is-
				  sued for January 1, 2015 or in a subsequent rate with the inclusion of funding
				  in the amount necessary to achieve the same funding impact as if the rate had
				  been issued on January 1, 2015. The compensation increase funding will be
				  inclusive of associated fringe benefits.
(b) April 1, 2015 Increase. In addition to
				  the compensation funding effective January 1, 2015, providers that operate
				  specialty hospitals will receive a compensation increase targeted to direct
				  support professional and clinical employees to be effective April 1, 2015. The
				  compensation increase funding will be inclusive of associated fringe benefits.
				  The April 1, 2015 direct support professional compensation funding will be the
				  same, on an annualized basis, as that which was calculated for the January 1,
				  2015 compensation increase and will be an augmentation to the January 1, 2015
				  increase.
(c) Calculations. The
				  basis for the calculation of direct care, support and clinical salary averages
				  will be the data from the provider's January 1, 2011 - December 31, 2011 CFR.
				  The fringe benefit percentage will be that fringe benefit percentage utilized
				  in the provider's December 31, 2014 specialty hospital rate.
(1) The January 1, 2015 and April 1, 2015
				  Direct Support Professional compensation increase funding formula will be:
(i) The annual impact of a two percent
				  increase to 2011 salaried direct care and salaried support dollars and
				  associated fringe benefits will be calculated.
(ii) The annual impact of the two percent
				  increase for salaried direct care dollars, salaried support dollars and
				  associated fringe will be added to the appropriate operating components in the
				  provider's specialty hospital rate.
(iii) The rate add-on, as calculated in (ii)
				  above, shall be added to total allowable costs and those allowable costs shall
				  be divided by the total patient days in the December 31, 2014 rate.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 643 - Certificate of Relief from Disabilities (Prohibitions) Related to Firearms Possession › Section 643.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part applies to any person who has been or may be
				  disqualified from possessing a firearm pursuant to
				  18
				  USC section 922(d)(4) and
				  (g)(4), due to being involuntarily committed
				  to an OPWDD facility pursuant to article 15 of the Mental Hygiene Law, or
				  article 730 or section 330.20  of the Criminal Procedure Law, or
				  section 322.2 or 353.4  of the Family Court Act and whose records were submitted
				  to NICS by OPWDD in accordance with section 13.09 (f)  of the Mental
				  Hygiene Law.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 643 - Certificate of Relief from Disabilities (Prohibitions) Related to Firearms Possession › Section 643.4 - Records

Current through Register Vol. 46, No. 28, July 10, 2024
OPWDD, on being made aware that the basis under which a
				  record was made available by OPWDD to NICS does not apply or no longer applies,
				  shall, as soon as practicable:
(a)
				update, correct, modify or remove the record from any database that the Federal
				or State government maintains and makes available to NICS, consistent with the
				rules pertaining to that database; and
(b) notify the United States Attorney General
				that such basis no longer applies so that the record system in which the record
				is maintained is kept up to date.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 671 - HCBS Waiver Community Residential Habilitation Services for Persons with Developmental Disabilities › Section 671.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
				contains requirements and specifications relative to the provision of the home
				and community-based services (HCBS) waiver community residential habilitation
				services delivered in certified community residences as authorized by the
				Secretary of the United States Department of Health and Human Services pursuant
				to section 1915(c) of the Social Security Act (see glossary).
(b) All providers of home and community-based
				waiver services shall be authorized pursuant to a Medicaid provider agreement
				issued and approved by the New York State Department of Social Services
				specific to the type of services being offered.
(c) In addition, all authorized HCBS waiver
				community residential habilitation providers shall comply with the requirements
				of Parts 624 and 633 of this Title.
(d) In order to receive authorization from
				OPWDD to provide community residential habilitation services, a provider shall:
(1) hold a valid operating certificate from
				OPWDD as a supervised or supportive community residence; and
(2) be issued a specific authorized provider
				medical assistance reimbursement number.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 671 - HCBS Waiver Community Residential Habilitation Services for Persons with Developmental Disabilities › Section 671.3 - Statutory authority

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Sections 13.01 and
				13.07  of the Mental Hygiene Law authorize
				the OPWDD to develop an effective, integrated, comprehensive system for the
				delivery of services to people with developmental disabilities and to create
				financing procedures and mechanisms to support such a system of
				services.
(b) Section 13.09  of the Mental Hygiene Law grants the
				commissioner the power to adopt rules and regulations which are necessary and
				proper to implement any matter under his or her jurisdiction.
(c) Article 16 sets forth provisions enabling
				the commissioner of the OPWDD to regulate and assure the consistent high
				quality of services provided within the State to its citizens with
				developmental disabilities. The commissioner may adopt and promulgate any
				regulation reasonably necessary to implement and effectively exercise the
				powers and perform the duties conferred by this article.
(d) Section 16.11  of the Mental Hygiene Law authorizes
				the commissioner or an authorized representative to conduct investigations and
				inspections, and permit review of the facility and all its books and
				records.
(e) Section 16.13  of the Mental Hygiene Law requires
				holders of operating certificates issued by the commissioner to cooperate
				during inspections by permitting review of the facility and all its books and
				records.
(f) Section 43.02 (a)  of the Mental
				Hygiene Law requires that payment made under the Medicaid program for services
				provided by any facility licensed or operated by OPWDD be at levels of
				reimbursement certified by the commissioner of OPWDD and approved by the
				Director of the Division of the Budget.
(g) Section 43.02 (b)  of the Mental
				Hygiene Law gives the commissioner the authority to request operators of
				facilities certified by the Office for People With Developmental Disabilities
				to submit financial, statistical and program information as the commissioner
				may determine to be necessary.
(h)
				Section 43.02 (c)  of the Mental
				Hygiene Law requires the commissioner of OPWDD to adopt rules and regulations
				to effectuate the provisions of section 43.02.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 671 - HCBS Waiver Community Residential Habilitation Services for Persons with Developmental Disabilities › Section 671.4 - Eligibility requirements and authorization for service

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Principles of compliance.
(1) Eligible facility. In order to receive
				medical assistance or other OPWDD reimbursement for community residential
				habilitation services, the provider shall:
(i) be authorized pursuant to the
				requirements of section
				671.2(d) 
				of this Part; and
(ii) have
				retained, either through employment or contractual arrangement, sufficient
				qualified staff appropriate for the delivery of community residential
				habilitation services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 671 - HCBS Waiver Community Residential Habilitation Services for Persons with Developmental Disabilities › Section 671.7 - Reimbursement and fiscal reporting for providers of service

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective July 1, 2014:
(1) reimbursement for residential
				habilitation services provided in non-state operated IRAs and CRs shall be in
				accordance with the provisions of Subpart 641-1 of this Title. Subpart 641-1
				supersedes the provisions of subdivision (b) of this section for reimbursement
				of residential habilitation services provided in non-state operated supervised
				and supportive IRAs and CRs on or after July 1, 2014;
(2) the unit of service for residential
				habilitation services provided in non-state operated supervised IRAs and CRs
				shall be a daily unit of service. The requirements of this paragraph supersede
				the provisions of paragraph (b)(3)(ii) of this section for residential
				habilitation services provided in non-state operated supervised IRAs and CRs on
				or after July 1, 2014;
(3)
				residential habilitation services in non-state operated supervised CRs shall be
				provided and documented in accordance with subparagraphs 635-10.5(b)(11)(i) and
				(12)(i)-(ii) of this Title; and
(4)
				residential habilitation services in non-state operated supportive CRs shall be
				provided and documented in accordance with paragraph 635-10.5(b)(10) and
				subparagraphs (11)(iv)-(v) of this Title.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.4 - Organization and administration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each
				diagnostic and research clinic shall have a governing body.
(1) In the case of a diagnostic and research
				clinic operated by OPWDD as part of an established OPWDD research institute,
				OPWDD shall function as governing body.
(2) The governing body for such clinics not
				operated by OPWDD may be an individual or a group. For clinics operated as part
				of an OPWDD institute, OPWDD may appoint a director of the overall institute
				who shall act as OPWDD's designee and who is responsible to OPWDD.
(3) The governing body or the OPWDD-appointed
				director shall be responsible for the diagnostic and research clinic's general
				direction, operations policies, and shall:
(i) be legally responsible for the clinic's
				overall operation and management;
(ii) ensure that the clinic has adequate and
				modern administrative support to efficiently meet the needs of the individuals
				with developmental disabilities served by its facilities; administrative
				support includes clinical, communication, financial, housekeeping, laundry,
				personnel, physical plant safety and security, supplies, and purchasing
				services;
(iii) ensure that the
				facility has a plan for a management audit, and that such audit is conducted at
				least annually; this audit shall determine if the clinic complies with all
				applicable State laws, regulations and policies;
(iv) ensure that the health, safety, welfare,
				well-being and civil, human and legal rights of individuals with developmental
				disabilities served by the diagnostic and research clinic are protected, upheld
				and fostered;
(v) ensure that
				agreements with other providers and with community groups have been developed
				to ensure that individuals with developmental disabilities receive the
				specialized assessments and clinical laboratory tests required to perform
				comprehensive diagnosis and evaluations; and assist such persons to receive the
				programs, treatment and care appropriate to their disabilities; and
(vi) maintain minutes of its official
				meetings and the decisions made in relation to the operation of the diagnostic
				and research clinic, and maintain a record of follow-up actions accomplished
				based on such decisions.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.5 - Admission criteria

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Referral and admission.
(1) All
				persons seeking admission to the diagnostic and research clinic, for any of the
				services specified in section
				676.6 
				of this Part, shall first be referred to the clinic by at least one of the
				following:
(i) another diagnostic and
				evaluation clinic;
(ii) a health
				care professional;
(iii) a
				QIDP;
(iv) a case
				manager;
(v) a recognized advocate
				for the persons with developmental disabilities;
(vi) a committee on persons with a
				handicap;
(vii) a school guidance
				counselor;
(viii) an
				outpatient-inpatient hospital; and
(ix) a State- or voluntarily operated program
				or agency.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.6 - Services and recommended treatment plan

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Core diagnostic and evaluation services
				are mandatory for each person admitted to the clinic for the comprehensive
				evaluation; these services are available discretely for any person admitted for
				a particular diagnostic and evaluation service under subparagraph (a)(4)(ii) of
				section
				676.5  of this
				Part. It shall be mandatory that each person receiving the package of core
				diagnostic and evaluation services shall also have the services specified in
				subdivisions (e) and (f) of this section.
(1)
				Admission and screening devices shall be provided by the admission committee
				covering such items as:
(i) visits by the
				health care professional staff to the person, when required, to determine
				appropriateness of receiving services at the diagnostic and research clinic
				and/or referral of the person and family to other appropriate
				agencies;
(ii) background
				information on the person: name, address, referring agent, reason for referral,
				tentative diagnosis, symptomatology, activity of daily life;
(iii) prenatal history;
(iv) perinatal history;
(v) delivery;
(vi) developmental history;
(vii) past medical history;
(viii) family history; and
(ix) social service history including
				familial relations and financial factors, capacity for independent living and
				self-direction, need for self-care, personal care services and person's level
				of interpersonal functioning.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.7 - Utilization review

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each
				diagnostic and research clinic shall have a utilization review committee and a
				written utilization review plan for evaluation of the need for services
				provided to persons with developmental disabilities. The same utilization
				review plan and the utilization review committee for internal utilization
				reviews shall address and review the diagnostic and research clinic's
				nonresidential component and its residential unit (i.e., the ICF/DD), so as to
				review the person's eligibility for services (resident/nonresident) at this
				level of care. The utilization review committee and the utilization review plan
				shall comply with the following requirements:
(1) Committee composition.
(i) The utilization review committee shall be
				composed of professionals including at least:
(a) one physician;
(b) one person who is a qualified
				intellectual disability professional; or
(c) other professional staff representing the
				disciplines at the diagnostic and research clinic.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.8 - Buildings and equipment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				entire physical plan of a diagnostic and research clinic shall be constructed
				and maintained so as to be structurally sound, physically safe, sanitary,
				convenient and comfortable.
(b) The
				diagnostic and research clinic shall comply with the following codes and
				regulations:
(1) chapter 10, 1973 edition,
				Life Safety Code of the National Fire Protection Association (NFPA No.
				101);
(2) the State Building
				Construction Code (9 NYCRR Subtitle S, Chapter I) applicable to occupancy group
				C6.2;
(3) New York State Building
				Construction Code applicable to plumbing;
(4) the New York State Energy Conservation
				Code;
(5) New York State Lighting
				Power Standard;
(6) National
				Electrical Code;
(7) American
				National Safety Code for Elevators;
(8) Food Service Sanitation Publication 934
				of the United States Department of Health, Education and Welfare;
(9) ASA Z66.1 "American Standards
				Specifications to Minimize Hazards to Children from Residual Surface Coating
				Material";
(10) American National
				Standards Institute (ANSI) Standards No. A 117.1 (1961). "American Standard
				Specifications for Making Buildings and Facilities Accessible to and Usable by
				the Physically Handicapped";
(11)
				New York State Department of Environmental Conservation requirements for waste
				disposal and air quality;
(12) New
				York State Department of Health requirements for water supply and sewage
				disposal;
(13) buildings which do
				not house bedrooms shall meet all requirements of the applicable sections of
				the State Building Construction Code (9 NYCRR Subtitle S, Chapter I);
				and
(14) the building in which the
				diagnostic and research clinic is located shall meet all applicable
				requirements of the State Building Construction Code (9 NYCRR Subtitle S,
				Chapter I, Occupancy Group B1) applicable to multiple dwellings.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.9 - Staffing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A description
				of and rationale for the diagnostic and research clinic's staffing pattern
				shall be included in the clinic's policies and procedures manual. Any changes
				in the staffing pattern, job descriptions, and/or minimal qualifications of the
				staff shall be reviewed and approved by OPWDD.
(b) The diagnostic and research clinic shall
				have appropriately qualified medical, clinical laboratory, professional, and
				administrative staff on duty in sufficient numbers to carry out the clinic's
				policies, responsibilities and services, and to maintain the premises in a safe
				and sanitary condition. A staff of sufficient size shall be employed so that
				the clinic does not have to depend on individuals or volunteers to provide
				services. However, interns and students assigned for formal work experience are
				encouraged to participate in the clinic's programs, but shall no be used as
				substitutes for staff.
(c) The
				diagnostic and research clinic shall have a director of its clinical laboratory
				certified by the New York State Department of Health (see paragraph [2] of this
				subdivision), who may also serve as the clinical director of the diagnostic and
				research clinic.
(1) The certified director
				of the clinical laboratory shall be responsible for administration of the
				technical and scientific operation of the clinical laboratory and/or blood
				bank, including supervision of procedures, reporting of results, and ensuring
				the validity of the results.
(2)
				The clinical laboratory director shall be certified under the State Sanitary
				Code as contained in 10 NYCRR Part 19.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 676 - Diagnostic and Research Clinics › Section 676.12 - Glossary

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Adaptive
				behavior.
Results of an assessment based on a standardized instrument
				  as appropriate to the area being assessed which indicate the individual
				  evidences one or more of the following characteristics:
(1) Communication.
(i)
Moderate deficit.
The
				individual has some expressive and/or receptive communication skills but needs
				staff assistance and/or training to communicate self-care needs.
(ii)
Severe deficit.
The
				individual has no expressive and/or receptive communication skills.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.2 - Statutory authority

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				following sections of the Mental Hygiene Law authorize the commissioner to
				establish separate classes of operating certificates for facilities serving
				persons with developmental disabilities and to establish the standards
				governing such facilities.
(1) Section 13.07  of the Mental Hygiene Law makes it
				the responsibility of OPWDD to assure the development of comprehensive plans,
				programs, and services in the areas of research, prevention, care, treatment,
				rehabilitation, education, and training of persons with developmental
				disabilities. The OPWDD also has the responsibility to ensure that such care,
				treatment, and other appropriate services provided under its aegis are of high
				quality and effectiveness and that the personal and civil rights of persons
				receiving services are adequately protected.
(2) Sections 13.09 and
				16.00  of the Mental Hygiene Law sets forth
				provisions enabling the commissioner to regulate and assure the consistent high
				quality of services provided to persons with developmental disabilities. The
				commissioner may adopt and promulgate any regulation reasonably necessary to
				implement and effectively exercise the powers and perform the duties conferred
				by this article.
(3) Prior to April
				13, 2015, section 43.02  of the Mental Hygiene Law authorized
				the commissioner to establish rates or methods of payment for services at
				facilities subject to licensure by OPWDD. Effective April 13, 2015, section 43.02  of the Mental Hygiene Law authorizes
				the Department of Health to establish such rates and methods for payment,
				subject to the approval of OPWDD. Section 43.02  of the Mental Hygiene Law also
				authorizes the commissioner of OPWDD to require financial, statistical, and
				program information as the commissioner may determine necessary.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.3 - Principles of compliance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) There
				shall be a governing body (see glossary) with the policy making authority for
				the clinic treatment facility and legal responsibility for its operation and
				management. Each member of the governing body shall be identified by name and
				address in the agency/facility (see glossary under
Agency/Facility
) records. No one shall serve as both a member
				of the governing body and of the paid staff of the clinic treatment
				facility.
(b) The governing body
				shall be responsible for the operation of the clinic treatment facility
				according to the principles and standards established in this Part and other
				applicable rules, regulations and statutes. This includes, but is not limited
				to, Parts 620, 624, 633 and 635 of this Title.
(c) The governing body shall be responsible
				for the development, implementation, revisions when necessary, and use of a
				written policy and procedure (see glossary under
Policies/Procedures
) manual(s). The manual shall specify the
				facility's operational procedures and the staff titles operationally
				responsible for various clinic activities in at least the following areas:
(1) services available, treatment planning,
				service delivery;
(2) treatment
				coordination;
(3) staffing,
				qualifications, and personnel policies;
(4) administration;
(5) admission and discharge
				criteria;
(6) quality assurance
				including program and individual service evaluation;
(7) program goals;
(8) recordkeeping and reporting;
				and
(9) budgeting and expenditure
				controls.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.4 - Standards of certification

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				OPWDD shall verify (see glossary) that each operator of a Part 679 clinic
				treatment facility has annually submitted the names and addresses of the
				current members of its governing body to the commissioner in accordance with
				the requirements of section 13.39  of the Mental Hygiene Law.
(b) OPWDD shall verify that the governing
				body has established, maintained, and implemented a plan of organization for
				the facility which accurately indicates lines of accountability, the nature of
				professional responsibility to be exercised, and the professional
				qualifications required.
(c) OPWDD
				shall verify that since the last survey:
(1)
				any new/revised policies have been approved by the governing body;
(2) said new/revised policies have been
				distributed to staff, and they have been advised or trained regarding their
				responsibilities; and
(3) said
				staff are knowledgeable regarding their responsibilities under any new/revised
				policies/procedures.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.5 - Units of service-definitions and restrictions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The unit of service shall be a clinic
				visit as defined below whether the service is delivered at the main certified
				site, or at a certified satellite site or, prior to April 1, 2016,
				off-site.
(b) A clinic visit is or
				defined as all the approved clinical services provided for a person, his/her
				collateral or potential admittee on a common date of service by practitioners
				of the healing arts and/or other authorized parties, except as follows:
(1) If a diagnostic and evaluation service is
				conducted over more than one day, the date of service for claiming purposes is
				the last day the service is provided.
(2) If an on-site clinic visit is provided
				and claimed for reimbursement on the same day as an off-site clinic visit (as
				allowed prior to April 1, 2016), reimbursement for each visit is considered a
				separate clinic visit.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.7 - Billing standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In order
				for the clinic treatment facility to be reimbursed for any service, the
				following conditions must be met:
(1) The
				clinic treatment facility shall have a valid Medicaid provider agreement with
				the New York State Department of Health at the time of service
				delivery.
(2) If the facility is
				authorized to provide any medical or dental care as a person's principal source
				of such care, the facility shall become a Medicare provider and submit for
				Medicare reimbursement as appropriate.
(3) Clinic services shall be delivered in
				accordance with the person's clinic treatment plan (see section
				679.4[j] and
				[k]  of this Part), except for a clinic intake
				and diagnostic and evaluation services.
(4) Initial clinic treatment plans shall
				reflect coordination with all of the person's other individualized written
				plans of services that are required by law or regulation. In addition, for
				persons who reside in an OPWDD-certified residence, such initial clinic
				treatment plans shall identify any clinic services to be delivered prior to
				April 1, 2016 in the OPWDD-certified residence and the justification for the
				delivery of the specific clinic services in the residence.
(5) Documentation of each clinic service
				shall specify the location of service delivery.
(6) Billing claims for services (except for a
				clinic intake) shall include the National Product Identifier (NPI) of the
				clinician delivering the clinic service or the clinician supervising the
				delivery of service, except for rehabilitation counselors and those employed by
				the State of New York who are not licensed but meet the civil service
				qualifications at the professional level appropriate to their
				discipline.
(7) Clinic treatment
				facilities shall assign ICD diagnostic codes and CPT/HCPCS procedure codes to
				all clinic services as appropriate and shall submit such information to DOH or
				to DOH's designee in accordance with written billing and reporting instructions
				issued by OPWDD and DOH.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.8 - Reimbursement methodology

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Definitions.
Definitions pertaining to the ambulatory patient croup
				  classification and reimbursement methodology can be found in 10 NYCRR section
				  86-8.2. Additional definitions are as follows:
(1) Coding improvement factor. A numeric
				value which OPWDD may use to adjust for more complete and accurate coding for
				visits upon implementation of the APG reimbursement system.
(2) Evaluation and management (E&M)
				services. Services and/or consultations as designated by CPT provided by a
				physician, nurse practitioner or an appropriately supervised physician
				assistant.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.9 - Transition to full APG payment methodology

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Clinic treatment facilities will
				transition to full payment under the APG reimbursement methodology over a
				multi-year period beginning on July 1, 2011. Reimbursement during this
				transition period shall consist of a blended payment comprised of:
(1) a partial operating payment determined by
				the clinic's average operating payment under the pre-existing reimbursement
				methodology (average legacy fee); plus
(2) a complementary partial operating payment
				calculated under the APG reimbursement methodology; plus
(3) a capital cost component, if
				any.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.10 - Incorporation by reference

Current through Register Vol. 46, No. 28, July 10, 2024
Materials incorporated by reference in 10 NYCRR section
				  86-8.11(b) are also incorporated by reference in this Part.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 679 - Clinic Treatment Facilities › Section 679.99 - Glossary

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Administrator.
That party, by whatever title known, designated in an
				  agency's administrative structure with responsibility for:
(1) the day-to-day operation of the clinic
				treatment facility;
(2) ensuring
				the conformance of the facility and its services to the requirements of all
				applicable statutes and regulations;
(3) ensuring that arrangements are made for
				the timely delivery of treatments to persons admitted to the facility;
				and
(4) ensuring adherence to the
				overall policies of the agency/facility as approved by the governing
				body.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 680 - Specialty Hospitals › Section 680.1 - Background and intent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Within the
				continuum of human services offered by OPWDD (see section
				680.13  of
				this Part), the specialty hospital (see section
				680.13)  is
				designed as the most intensive provider of care for individuals with
				developmental disability and health care problems (see section
				680.13) 
				through an integrated combination of assessment services, active programming,
				continuing medical treatment, and residential arrangements.
(b) The specialty hospital serves as a
				transitional setting which has as its primary goal the prevention, amelioration
				or limitation of health care problems for individuals with developmental
				disabilities to enable the movement of such individuals to less restrictive
				environments.
(c) Because active
				programming, medical treatment and residence are combined in a single setting,
				the specialty hospital is considered as the most restrictive environment which
				offers 24-hour care to people with developmental disabilities whose health
				problems, rather than developmental disability
per se,
prevent
				placement in an alternative, less restrictive placement.
(d) Individuals admitted to a specialty
				hospital shall have a previously established diagnosis of developmental
				disability (see section
				680.13)  and
				shall require:
(1) active programming (see
				section
				680.13)  for
				their developmental disabilities; and
(2) individualized attention for more than
				three hours per day for health care problems.