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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.41 - Computation of basic rates for day health care services for AIDS/HIV patients

Current through Register Vol. 46, No. 28, July 10, 2024
Computation of basic rates for day health care services
						provided by freestanding ambulatory care facilities to patients with acquired
						immune deficiency syndrome (AIDS), other human immunodeficiency virus (HIV)
						related illnesses and other high-need populations that, regardless of their HIV
						status and in the discretion of the commissioner, would benefit from receiving
						adult day health care services. Effective April 1, 1994 and thereafter,
						reimbursement for adult day health care services that are provided to
						registrants with acquired immune deficiency syndrome (AIDS), other human
						immunodeficiency virus (HIV) related illnesses and, effective April 1, 2017,
						that are provided to registrants who are otherwise considered at the discretion
						of the commissioner to be part of a high-need population that, regardless of
						their HIV status, would benefit from receiving these adult day health care
						services shall be established pursuant to this section.
(a) For payments made pursuant to this
					 section for day health care services rendered to patients who have AIDS or
					 HIV-related illness and other high-need registrants, reimbursement shall be a
					 single price per visit, with not more than one reimbursable visit per day per
					 patient. For 1993 an initial price shall be determined taking into
					 consideration reasonable projections of necessary costs, and the costs and
					 statistics contained in proposed annual budgets for this service as defined in
					 section
					 759.1(d) 
					 of this Title, including, but not limited to, utilization, staffing and
					 salaries. For subsequent rate periods the price established pursuant to this
					 section shall be adjusted by the trend factor described in subdivision (e) of
					 this section after considering the actual allowable expenditures and statistics
					 for the year which ended 15 months prior to the rate period.
(b) To be eligible to receive reimbursement
					 pursuant to this section, a free-standing ambulatory care facility must be
					 certified to provide general medical services and day health care services for
					 AIDS/HIV patients and, effective April 1, 2017, to other high-need
					 registrants.
(c) The price
					 established pursuant to this section shall be full reimbursement for the
					 following:
(1) physician services, nursing
					 services, and other related professional expenses directly incurred by the
					 licensed facility, including the provision of triage or sick call
					 services;
(2) space occupancy and
					 plant overhead costs;
(3)
					 administrative personnel, business office, data processing, recordkeeping,
					 housekeeping, food services, transportation, and other related facility
					 overhead expenses;
(4) all
					 ancillary services described in section
					 759.8  of this
					 Title and laboratory tests and diagnostic X-ray services appropriate to the
					 level of primary medical care required by the patient;
(5) all medical supplies, immunizations, and
					 drugs directly related to the provision of services.