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 86-1 - Medical Facilities › Section 86-1.13 - Certified home health agency rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective January 1, 1988, reported costs
					 and statistics for a facility's annual fiscal period ending two years prior to
					 the rate period, trended pursuant to section
					 86-1.58  of
					 this Subpart, shall be used in computing Medicaid rates for care provided by
					 community-based home health agencies. No amount may be included in a rate that
					 is in excess of the agency charges or in excess of 110 percent of the weighted
					 average cost of all community-based agencies in their group. For hospital-based
					 home health agencies, no amount may be included in a rate that is in excess of
					 110 percent of the weighted average cost of community-based agencies in their
					 area.
(b) The commissioner shall
					 establish separate payment rates for home care nursing services provided by
					 Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs
					 (LTHHCPs) to patients diagnosed with Acquired Immune Deficiency Syndrome (AIDS)
					 as defined by ICD-9 codes 042, 043 and 044. Such rates shall be regional
					 service prices increased by a case mix adjustment factor to reflect the
					 additional resource utilization needed in home care treatment of AIDS patients
					 in excess of resource utilization needed for an average mix of home care
					 patients.
(1) Regional nursing service prices
					 shall be computed based upon average nursing costs per visit calculated by
					 aggregating the base year allowable costs and statistics reported by community
					 based certified home health agencies located within each of four regions;
					 provided, however, that effective with rate periods commencing January 1, 1990,
					 the calculation of regional nursing service prices pursuant to this paragraph
					 shall also incorporate base year allowable costs and statistics for LTHHCPs.
					 The regions shall be New York City Region which is comprised of New York,
					 Kings, Queens, Richmond, Bronx, Westchester, Rockland and Putnam Counties;
					 Nassau-Suffolk Region which is comprised of Nassau and Suffolk Counties; Rural
					 Region which is comprised of all Non-Standard Metropolitan Statistical Area
					 counties; All Other Metropolitan Region which is comprised of all counties not
					 included in the other regions.
(2)
					 For agencies in the All Other Metropolitan Region group only, the base price
					 will be adjusted by Wage Index Factors. Wage Index Factors shall be calculated
					 for and applied to each of the Standard Metropolitan Statistical Areas (SMSA)
					 within the All Other Metropolitan Region. The SMSA's are:
(i) Albany-Schenectady-Troy;
(ii) Syracuse;
(iii) Binghamton;
(iv) Buffalo;
(v) Elmira;
(vi) Glens Falls;
(vii) Niagara Falls;
(viii) Orange County;
(ix) Poughkeepsie;
(x) Rochester;
(xi) Utica-Rome;
The wage index factor shall be determined by weighting
						the registered nurse, licensed practical nurse and nurse's aide salary
						categories based upon the proportion of skilled and aide visits. The labor
						portion of the base price shall be multiplied by the respective wage index
						factor for each of the eleven SMSA's in the All Other Metropolitan Region
						group.
(3) The
					 base regional service prices computed in accordance with this subdivision shall
					 be increased by a trend factor developed in accordance with section
					 86-1.58  of
					 this Subpart.
(4) The trended
					 regional nursing service prices shall be increased by an AIDS case mix
					 adjustment factor of 1.2988 to arrive at regional nursing service rates for
					 homecare services provided by CHHAs and LTHHCPs to patients diagnosed with
					 AIDS.
(5) Adjustments to regional
					 nursing service prices established by this subdivision shall be limited to
					 annual adjustments made pursuant to paragraphs (1) and (3) of subdivision (b)
					 of this section.