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 680.12 - Rate setting and financial reporting

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purposes of this section the
				following definitions shall apply:
(1)
Specialty hospital
or
facility
shall mean
				that program and site for which OPWDD has issued an operating certificate,
				pursuant to Mental Hygiene Law article 16, to operate as a specialty hospital,
				and for which the New York State Department of Social Services has issued a
				Medicaid provider agreement.
(2)
Provider
shall mean the individual, corporation, partnership
				or other organization to which the OPWDD has issued an operating certificate,
				pursuant to Mental Hygiene Law, article 16, to operate a specialty hospital,
				and to which the New York State Department of Social Services has issued a
				Medicaid provider agreement for such facility.
(3)
Alternate care determined
				individual
or
ACD individual
shall mean an individual
				who has been determined not to require specialty hospital care after completion
				of an independent utilization review, pursuant to section
				680.9  of this
				Part.
(4)
A newly certified
				facility
shall mean a facility which has been in operation less than
				two years and has not yet submitted a cost report which covers a full 12 months
				of operation for any rate period January 1st to December 31st or any other
				12-month period designated by the commissioner according to section
				680.12(b)(1)(ii)  (
b
) of this Part.
(5)
Actual cost
shall mean
				the costs that were audited and stepped-down by OPWDD or its agent for the
				specialty hospital and which are taken from the financial reports filed
				annually in accordance with section 680.12(b)(1)(ii)  of this Part and which
				cover a full 12-month period of operation beginning 24 months prior to the
				effective date of the rate period in question. For the rate period from June
				10, 1988 to December 31, 1988, as stated in section 680.12(d)(3)  of this Part,
				the actual costs defined in the preceding sentence shall be taken from the
				annual financial information filed by the provider for the calendar year 1985
				with Blue Cross/Blue Shield of Greater New York.
(6)
Budget costs
shall man
				the financial information submitted by a provider in accordance with section
				680.12(b)(1)(i)  of this Part.
(7)
Reimbursable costs
shall mean those actual or budget costs
				which are determined, based on a line item review/desk audit process by OPWDD
				or Blue Cross/Blue Shield of Greater New York, to be allowable in accordance
				with section 680.12(d)(8)  of this Part.
(8)
Operating costs
shall
				mean a facility's costs, other than capital costs or start-up costs, which
				include personal service costs, administrative and general services costs, and
				other than personal service (OTPS) costs.
(i)
				Personal service costs include costs such as salaries, fringe benefits and
				accrued vacation costs for employees of the specialty hospital; and costs of
				persons performing services under contract to the specialty hospital. Services
				refers to the provisions of routine and ancillary care of individuals admitted
				to the specialty hospital in accordance with the provisions of this
				Part.
(ii) Administrative and
				general service costs refer to departments, divisions or other units which are
				operated for the benefit of the specialty hospital as a whole, and includes
				activities such as management, housekeeping, laundry, dietary services and
				operation and maintenance of grounds and physical plant.
(iii) OTPS costs include, but are not limited
				to, the costs of items such as food, minor equipment, supplies and materials,
				travel, medications and utilities.
(9)
Capital costs
shall mean
				property costs subject to the limitations contained in this section, Subpart
				635-6 of this Title and Medicare principles of reimbursement, except that costs
				of ownership of real property shall not include principal or provider
				equity.