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 86-10 - Rates for Non-state Providers of Residential Habilitation in Community Residences, Including Individualized Residential, Including Individualizad Residential Alternatives (iras) and for Non-state Providers of Day Habilitation › Section 86-10.2 - 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) Allowable
					 capital costs. Capital costs that are allowable under 14 NYCRR Subpart
					 635-6.
(b) Allowable operating
					 costs. In the case of residential habilitation services, operating costs that
					 are allowable under 14 NYCRR paragraph 635-10.4 (b)(1) and subdivision
					 686.13(b); in the case of day habilitation services, operating costs that are
					 allowable under 14 NYCRR paragraph 635-10.4(b)(2).
(c) Acuity factor. Factor developed through a
					 regression analysis utilizing components of Developmental Disabilities
					 Profile-2 (DDP-2) scores, average residential bed size, Willowbrook class
					 indicators and historical utilization data to predict direct care hours needed
					 to serve individuals. Factors are available on the Department's website:
http://www.health.ny.gov/health_care/medicaid/rates/mental_hygiene/
(d) Allowable Agency Administration. For
					 Non-State Government and Voluntary Providers, from the CFR for the base year,
					 divide the Agency Administration Allocation (from CFR1 Line 65) by the Total
					 Operating Costs (from CFR1 Line 64) to determine the agency administration
					 percentage.
(e) Authorized Rate
					 Period Units, or Authorized Units. Units approved by OPWDD Budget Office to
					 deliver Day Habilitation Services. OPWDD Budget Office adjusts the units based
					 on addition or subtraction of individuals as well as addition or subtraction of
					 sites. These units are tracked on an ongoing basis and reported to DOH on a
					 semi-annual basis (January and July). Based on the unit update the operating
					 portion of the final target rate will not change. The capital portion will be
					 adjusted by the change in units, which will change the overall Day Habilitation
					 rate.
(f) Base Period CFR, or Base
					 Year CFR. The Consolidated Fiscal Report (CFR) used to update
					 methodologies.
(g) Budget
					 Neutrality Adjustment. Factor applied to the end of the methodology, by
					 service, to ensure the total annual target reimbursement is equivalent to the
					 total annual base reimbursement. The factors can be found on the Department's
					 website at
					 http://www.health.ny.gov/health_care/medicaid/rates/mental_hygiene/
(h) Capital Costs. Allowable costs that are
					 related to the acquisition, lease and/or long-term use of land, buildings and
					 construction equipment, leasehold improvements and vehicles.
(i) Community residence. A facility operated
					 as a community residence under 14 NYCRR Part 686, including an individualized
					 residential alternative.
(j)
					 Consolidated Fiscal Report (CFR). The reporting tool utilized by all government
					 and nongovernment providers to communicate annual costs incurred as a result of
					 operating OPWDD programs and services, along with related patient utilization
					 and staffing statistics. The CFR is the report and associated instructions as
					 of April 1, 2013, identified by the New York State Education Department, and
					 found at: http://www.oms.nysed.gov/rsu/Manuals_Forms/
(k) Day habilitation services. Day
					 habilitation services provided under the home and communitybased services
					 waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10.
(l) Department of Health (DOH) regions.
					 Regions as defined by the Department, assigned to providers based upon the
					 geographic location of the provider's headquarters as reported on the
					 consolidated fiscal report. Such regions are as follows:
(1) Downstate: five boroughs of New York
					 City, Nassau, Suffolk, Westchester;
(2) Hudson Valley: Dutchess, Orange, Putnam,
					 Rockland, Sullivan, Ulster;
(3)
					 Upstate Metro: Albany, Erie, Fulton, Genesee, Madison, Monroe, Montgomery,
					 Niagara, Onondaga, Orleans, Rensselaer, Saratoga, Schenectady, Warren,
					 Washington, Wyoming;
(4) Upstate
					 Non-Metro: Any counties not listed in paragraph (1), (2) or (3) of this
					 subdivision.