reglab/statecodes huggingface dataset:
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 86-4.26 - Sales, leases and realty transactions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a facility is sold or leased or is the
					 subject of any other realty transaction before a rate for the facility has been
					 determined and certified by the commissioner, the capital cost component of
					 such rate shall be determined in accordance with the provisions of sections
					 86-4.20,
					 86-4.23,
					 86-4.24  and
					 86- 4.25 of this Subpart.
(b) If a
					 facility is sold or leased or is the subject of any other realty transaction
					 after a rate for the facility has been determined and certified by the
					 commissioner, the capital cost component of such rate shall continue with the
					 same force and effect as if such sale, lease or other realty transaction had
					 not occurred. This subdivision shall not be construed as limiting the powers
					 and rights of the commissioner to change rate computations based upon previous
					 error, deceit or any other misrepresentation or misstatement that has let the
					 commissioner to determine and certify a rate which he would otherwise not have
					 determined or certified. Further, this subdivision shall not be construed as
					 limiting the powers and rights of the commissioner to reduce rates when one or
					 more of the original property right aspects related to a facility is
					 terminated.
(c) If a facility
					 enters into a sale and leaseback agreement with a nonrelated purchaser
					 involving plant facilities or equipment prior to October 23, 1992 the incurred
					 rental specified in the agreement shall be included in allowable costs if the
					 following conditions are met:
(1) the rental
					 charges are reasonable based on consideration of rental charges of comparable
					 equipment and market conditions in the area; the type, expected life, condition
					 and value of the equipment rented and other provisions of the rental
					 agreements;
(2) adequate alternate
					 equipment which would serve the purpose are not or were not available at lower
					 cost; and
(3) the leasing was based
					 on economic and technical considerations.
(4) If all these conditions were not met, the
					 rental charge cannot exceed the amount which the facility would have included
					 in reimbursable costs had it retained legal title to the equipment, such as
					 interest, taxes, depreciation, insurance and maintenance costs.
(5) If a facility enters into a sale and
					 leaseback agreement with a nonrelated purchaser involving land, the incurred
					 rental costs associated with the land are not includable in allowable
					 costs.
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 86-4.27 - Compensation of operators and relatives of operators

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reasonable compensation for operators or
					 relatives of operators for required services actually performed shall be
					 considered an allowable cost. The amount to be allowed shall be equal to the
					 amount normally required to be paid for the same service provided by a
					 nonrelated employee, as determined by the commissioner. Compensation shall not
					 be included in the rate computation for any services which the operator or
					 relative of the operator is not authorized to perform under New York State law
					 and regulation.
(b) In determining
					 a reasonable level of compensation for operators or relatives of operators, the
					 commissioner may consider the quality of care provided to patients by the
					 facility during the year in question.
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 86-4.28 - Related organizations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 related organization shall be defined as any entity which controls the facility
					 or which the facility controls, either directly or indirectly, or an
					 organization or institution whose actions or policies the facility has the
					 power, directly or indirectly, to significantly influence or direct, or a
					 special purpose organization or where an association of material interest
					 exists in an entity which supplies goods and/or services to the facility, or
					 any entity which is controlled directly or indirectly by the immediate family
					 of the operator. Immediate family shall include each parent, child, spouse,
					 brother, sister, first cousin, aunt and uncle, whether such relationship arises
					 by reason of birth, marriage or adoption. A special purpose organization shall
					 be defined as an organization which is established to conduct certain of the
					 facility's patient-care-related or nonpatient-care related activities. The
					 special purpose organization shall be considered to be related if:
(1) the facility controls the special purpose
					 organization through contracts or other legal documents that allow direct
					 authority over the organization's activities, management and policies;
					 or
(2) the facility is, for all
					 practical purposes, the sole beneficiary of the special organization's
					 activities. The facility shall be considered the special purpose organization's
					 sole beneficiary if one or more of the three following circumstances exist:
(i) a special purpose organization has
					 solicited funds in the name of and with the expressed or implied approval of
					 the facility, and substantially all the funds solicited by the organization
					 were intended by the contributor or were otherwise required to be transferred
					 to the facility or used at its discretion of direction;
(ii) the facility has transferred some of its
					 resources to a special purpose organization, substantially all of whose
					 resources are held for the benefit of the facility; or
(iii) the facility has assigned certain of
					 its functions (such as the operation of a dormitory) to a special purpose
					 organization that is operating primarily for the benefit of the
					 facility.
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 86-4.29 to 86-4.30 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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 86-4.31 - Termination of service

Current through Register Vol. 46, No. 28, July 10, 2024
The bureau shall be notified within 30 days of the
						deletion of any previously offered service or if services are withheld from
						patients paid for by any government agency. Such notification shall include a
						statement indicating the date of the deletion or withholding of the service and
						the cost impact of such action on the facility. Rates shall be adjusted to
						reflect the deletion or withholding of a service. Should the facility fail to
						provide timely notice to the bureau and receive overpayments, penalties and
						rate reduction in the manner provided in sections
						86-4.3
						and
						86-4.6  of this
						Subpart shall apply.
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 86-4.32 to 86-4.33 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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 86-4.34 - Pilot reimbursement projects

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The commissioner may waive the
					 requirements of this Subpart to effect the development of additional knowledge
					 and experience in different types of reimbursement mechanisms, contingent upon
					 the approval of the United States Department of Health and Human Services where
					 necessary.
(b) Individual
					 facilities or groups of facilities shall enter into such ventures with the
					 understanding that the reimbursement received over the life of the projects
					 shall be as defined in the experiment contract.
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 86-4.36 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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 86-4.38 - Computation of basic rates of payment for services provided to medicaid patients by specialty clinics

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Notwithstanding other provisions of this Subpart or Subpart 86-1, rates of
					 reimbursement for specialty services, including but not limited to hemo and
					 peritonial dialysis and outpatient rehabilitative services, shall be calculated
					 in the manner described in section
					 86-4.37(a)
					 through (h)  of this Subpart. Rates of
					 reimbursement for methadone maintenance treatment services shall be calculated
					 in the manner described in section
					 86-4.39.
					 Rates of reimbursement for day health care services provided to patients with
					 acquired immune deficiency syndrome (AIDS) and other human immunodeficiency
					 virus (HIV) related illnesses by free-standing ambulatory care facilities shall
					 be calculated in the manner described in section
					 86-4.41 
					 of this Subpart. Such payment levels will be made available to providers who
					 document in writing and through site inspection or records review that they
					 are, in fact, organized and providing specialty services.
(b) The criteria for recognition as a
					 specialty service include but are not limited to: requirement for highly
					 specialized staff, equipment or facilities; whether the facility presently
					 provides the services to the population in need; whether the services may be
					 provided safely and effectively on an outpatient basis; and whether the
					 services are structured to address extensive and complex needs for patients
					 with chronic or infectious medical conditions.
(c) In addition to complying with the
					 requirements for recording and reporting financial and statistical data in
					 sections
					 86-4.3,
					 86-4.4
					 and
					 86-4.5 
					 of this Subpart, facilities shall complete surveys of patient characteristics,
					 treatment patterns, health care organization factors, costs associated with
					 patient care, and other factors as undertaken from time to time by the
					 commissioner.
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 86-4.39 - Computation of basic rates for methadone maintenance treatment services provided by free-standing ambulatory care facilities and hospital outpatient clinic services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
					 payments made pursuant to this section and pursuant to section 86- 1.11(h)(5)
					 of this Part, for methadone maintenance treatment services reimbursement shall
					 be based upon a fixed weekly payment per recipient.
(b) To be eligible to receive reimbursement
					 pursuant to this section, facilities must have an operating certificate issued
					 pursuant to Part 401 of this Title, and be certified to provide outpatient
					 methadone maintenance treatment services.
(c) The clinic services which shall be
					 provided to be eligible for reimbursement according to the price as established
					 by this section includes: urinalysis drug testing, dispensing of methadone,
					 medical supervision and arranging for appropriate laboratory tests for the
					 initial and annual physical examinations, preparation and monitoring of
					 treatment plans, maintenance of patient medical histories, prescribing
					 methadone dosage, counseling as prescribed in the patients' individual
					 treatment plan, and maintenance of records.
(d) The weekly price established pursuant to
					 this section shall be reimbursement for the following, as required by New York
					 State Office of Alcoholism and Substance Abuse Services in 10 NYCRR Part 1040:
(1) physician services, nursing services,
					 therapist services, technician services, nutrition services, health education
					 services, psychosocial services, care coordination services and other related
					 professional expenses directly incurred by the licensed facility;
(2) space occupancy and plant overhead
					 costs;
(3) all ancillary procedures
					 directly related to the provision of services with the exception of laboratory
					 and diagnostic tests other than urinalysis testing;
(4) all medical supplies and drugs directly
					 related to the provision of services; and
(5) administrative personnel, business
					 office, data processing recordkeeping, housekeeping, and other related facility
					 overhead expenses.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart:
(a) The term long-term home health care
					 program (LTHHCP)shall mean an organization defined in article 36 of the Public
					 Health Law possessing a valid operating certificate or valid certificate of
					 approval issued by the State Commissioner of Health to operate a
					 LTHHCP.
(b) The term AIDS Home Care
					 Program (AHCP) shall mean a LTHHCP possessing a valid operating certificate or
					 valid certificate of approval issued by the State Commissioner of Health to
					 operate an AHCP.
(c) The term
					 related organization shall be defined as any entity which the LTHHCP is control
					 of or is controlled by, either directly or indirectly, or where an association
					 of material interest exists in an entity which provides goods and/or services
					 to the LTHHCP, or any entity which is controlled directly or indirectly by the
					 immediate family of the operator. Immediate family shall include each parent,
					 child, spouse, brother, sister, first cousin, aunt and uncle, whether such
					 relationship arises by reason of birth, marriage or adoption.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.3 - Patient assessment

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Long-term home health care program participation. The direct costs for patient
					 assessments and reassessments to the LTHHCP shall be included in the
					 administrative costs of the LTHHCP and shall be included in the program's
					 conversion of its cost report to an hourly or visit cost basis. These costs
					 shall be limited to LTHHCP staff participation in the patient
					 assessment.
(b) The cost of
					 hospital/RHCF staff participating in patient assessment and discharge planning
					 is included in the Medicaid rate of the facility and may not be added to the
					 costs of the long-term home health care program.
(c) The cost of staff of the local social
					 services district may not be included in the cost of the patient
					 assessment.
(d) Physician
					 participation.
(1) If the patient is in a
					 hospital/RHCF and the physician is not on the staff of that facility,
					 reimbursement for the physician's initial assessment is included in his visit
					 fee in accordance with the Medicaid fee schedule.
(2) If the patient is in the community:
(i) and the assessment takes place in a
					 clinic, reimbursement for the initial assessment is included in the clinic rate
					 for medical or social care provided;
(ii) and the assessment takes place in the
					 home, reimbursement for the initial assessment is included in the physician's
					 home visit fee;
(iii) and the
					 assessment takes place in the nonfacility-related physician's office,
					 reimbursement for the initial assessment is included in the physician's office
					 visit fee.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.4 - Generally accepted accounting principles

Current through Register Vol. 46, No. 28, July 10, 2024
The completion of the financial and statistical report
						forms shall be in accordance with generally accepted accounting principles as
						applied to the LTHHCP, unless the reporting instructions authorize specific
						variation in such principles.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.5 - Accountant's certification

Current through Register Vol. 46, No. 28, July 10, 2024
The financial and statistical reports shall be certified
						by an independent licensed public accountant or an independent certified public
						accountant.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.6 - Certification by operator or officer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The financial and statistical reports
					 shall be certified by the operator of a proprietary medical facility, an
					 officer of a voluntary medical facility or the public official responsible for
					 the operation of a public medical facility.
(b) The form of the certification required in
					 subdivision (a) of this section shall be as prescribed in the annual fiscal and
					 statistical report forms provided by the State Commissioner of
					 Health.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.8 - Patient visits/hourly rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A patient visit or an hourly rate are the
					 units of measure by which an LTHHCP may bill for services provided.
(b) Nursing, therapeutic and related services
					 will be billed per visit.
(c) Home
					 health aides, personal care aides, homemaker and housekeeper services will be
					 billed on an hourly basis.
(d) The
					 hourly/visit rate will include an amount for the indirect costs of the LTHHCP
					 as defined in section
					 86-5.17  of this
					 Subpart.
(e) No provider of an
					 LTHHCP shall establish charges for such program in excess of the higher of
					 those rates established pursuant to section 3614  of the Public Health Law and rules and
					 regulations adopted pursuant to section 3612  of the Public Health Law (Medicaid) or
					 subchapter XVIII of the Federal Social Security Act (Medicare).
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 86-5 - Long-term Home Health Care Programs › Section 86-5.10 - Computation of average monthly nursing home rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Computation of average monthly nursing
					 home service (SNF) or health related services in an intermediate care facility
					 (HRF) rates used to establish patient eligibility caps pursuant to section
					 86-5.9 
					 of this Subpart shall be based on average Medicaid rates for each social
					 services district for SNF or HRF levels of care weighted by patient
					 days.
(b) Average monthly rates
					 calculated pursuant to subdivision (a) of this section shall be based on
					 skilled nursing facility or health-related facility rates in effect on January
					 1, 1992 trended forward to the rate year by the trend factor for the facilities
					 in each social service district. Such trend factors shall be established
					 pursuant to section
					 86-2.12 
					 of this Title. The average monthly rates established pursuant to subdivision
					 (a) of this section will be adjusted annually utilizing the latest January 1,
					 1992 rate available, including any rate adjustments made prior to the
					 calculation of the patient eligibility caps for the following year. No other
					 adjustments will be made to the average monthly rates established pursuant to
					 subdivision (a) of this section.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.11 - Computation of individual hourly or per-visit service rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Individual service rates, except for
					 rates established pursuant to section 861.46(b) of this Subpart, shall be
					 computed on the basis of allowable fiscal and statistical data submitted by the
					 LTHHCP. The computed rates shall be all-inclusive rates, taking into
					 consideration total allowable costs.
(b) To the allowable basic rate based on
					 actual LTHHCP cost, there shall be added a factor to adjust allowable costs
					 during the effective period of the cost-based reimbursement rate. Such
					 adjustments shall not be made to rates based on budgeted costs. This adjustment
					 shall be determined as follows:
(1) The
					 elements of a long-term home health care program's cost shall be weighted based
					 upon data for the following categories:
(i)
					 salaries;
(ii) employee health and
					 welfare expense;
(iii) nonpayroll
					 administrative and general expense;
(iv) nonpayroll housekeeping and maintenance
					 expense; and
(v) nonpayroll
					 professional care expense.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.12 - Cost guidelines for reimbursement purposes

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purpose of promulgating
					 cost-based rates or rates based on budget, the department shall establish
					 regional guidelines to be applied to the rate for each service to be provided.
					 The cost guidelines shall be computed on a regional basis and based on the most
					 recent annual cost data available to the department. For this purpose, LTHHCPs
					 shall be grouped on the following basis:
(1)
					 Downstate: Putnam, Rockland, Westchester, Nassau, Suffolk, Kings, New York,
					 Richmond, Queens and Bronx Counties.
(2) Upstate: All other New York State
					 counties.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.13 - Adjustments to provisional rates based on errors

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Errors resulting from submission of
					 fiscal and statistical information by a LTHHCP may be corrected if brought to
					 the attention of the State Commissioner of Health within 120 days of receipt of
					 the commissioner's initial rate computation sheets. Errors on the part of the
					 State Department of Health resulting from the rate computation process may be
					 corrected if brought to the attention of the commissioner within 120 days of
					 receipt of the commissioner's initial rate computation sheet. Subsequent errors
					 on the part of the State Department of Health resulting from the revision of a
					 rate may be corrected if brought to the attention of the commissioner within 30
					 days of receipt of the commissioner's revised rate computation sheet. In no
					 event, however, shall a facility have less than 120 days from receipt of the
					 initial rate computation sheets to bring errors to the attention of the
					 commissioner.
(b) Rate appeals
					 pursuant to this section, if not commenced within 120 days of receipt of the
					 commissioner's initial rate computation sheet, may be initiated at time of
					 audit. Such rate appeals shall be recognized only to the extent that they are
					 based upon errors in the cost and/or statistical data submitted by the LTHHCP
					 or, in the case of a governmental facility, by the sponsor government, or
					 errors made by the Department of Health.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.14 - Revisions in certified rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The State Commissioner of Health may consider only those applications for
					 revisions of certified rates which are based on:
(1) six-month cost reports filed pursuant to
					 subdivision (e) of section
					 86-5.2 
					 of this Subpart. Such rate shall become effective on the first day of the
					 six-month period referred to in section
					 86-5.2(f) 
					 of this Subpart;
(2) errors made by
					 the department in the rate calculation process and errors in data submitted by
					 a medical facility which have been brought to the attention of the commissioner
					 within the time limits prescribed in section
					 86-5.13 
					 of this Subpart;
(3) significant
					 increases in the overall operating costs of the LTHHCP resulting from the
					 implementation of additional programs, staff or services specifically mandated
					 for the program by the commissioner;
(4) requests for waivers of any provisions of
					 this Subpart for which waivers may be granted by the commissioner as prescribed
					 in specific sections; and
(5)
					 changes in the method of providing services which result in a lower overall
					 cost for the services provided.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.15 - Rates for lthhcp without adequate cost experience

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This subdivision shall apply where the
					 fiscal and statistical data of the facility are unavailable through no fault of
					 the provider or its agents, and due to circumstances beyond its control, or
					 where there is a new facility without adequate cost experience as set forth in
					 section
					 86-5.2 
					 of this Subpart.
(b) The rates
					 certified for such LTHHCP's as set forth in subdivision (a) of this section
					 shall be determined on the basis of generally applicable factors, including but
					 not limited to the following:
(1) cost
					 guidelines as defined in section
					 86-5.12 
					 of this Subpart and
(2) allowable
					 costs as defined in section
					 86-5.17  of this
					 Subpart.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.16 - Less expensive alternatives

Current through Register Vol. 46, No. 28, July 10, 2024
Reimbursement for the cost of providing services may be
						the lesser of the actual costs incurred or those costs which could reasonably
						be anticipated if such services had been provided by operation of joint central
						services or use of facilities or services which could have served effective
						alternatives or substitutes for the whole or any part of such
						services.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.18 - Recoveries of expense

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Operating costs shall be reduced by the costs of services and activities which
					 are not properly chargeable to patient care. In the event that the Commissioner
					 of Health determines that it is not practical to establish the costs of such
					 services and activities, the income derived therefrom may be substituted for
					 costs of these services and activities. Examples of activities and services
					 covered by this provision include, but are not limited to, the following:
(1) discount on purchases;
(2) tuitions and other payments for
					 educational service, and other services not directly related to LTHHCP
					 services; and
(3) lease of office
					 and other space to concessionaires providing services not related to LTHHCP
					 service.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.19 - Depreciation for voluntary and public lthhcp

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reported depreciation based on approved
					 historical cost of buildings, fixed equipment and capital improvements made
					 thereto is recognized as a proper element of cost for voluntary and public
					 LTHHCPs. Useful lives shall be the higher of the reported useful life or those
					 useful lives from Estimated Useful Lives of Depreciable Hospital Assets, 1983
					 edition. Copies of this publication are available from the American Hospital
					 Association, 840 North Lake Shore Drive, Chicago, IL 60611, and a copy is
					 available for inspection and copying at the offices of the records access
					 officer of the Department of Health, Corning Tower, Empire State Plaza, Albany,
					 NY 12237.
(b) In the computation of
					 the rates effective for voluntary LTHHCPs, depreciation shall be included on a
					 straight-line method on plant and nonmovable equipment. Depreciation shall be
					 funded unless the Commissioner of Health shall have determined, upon
					 application by the LTHHCP, and after inviting written comments from interested
					 parties, that the requested waiver of the requirements for funding is a matter
					 of public interest and necessity. In instances where funding is required, such
					 fund may be used only for capital expenditures with approval as required or for
					 the amortization of capital indebtedness. Funding for plant and fixed
					 equipmentshall mean that the transfer of monies to the funded accounts shall
					 occur by the end of the fiscal period in which the depreciation is recorded.
					 Board-designated funds and the accrual of liabilities to the funded
					 depreciation accounts (due to/from accounts) shall not be recognized as funding
					 of depreciation. Deposits to the funded depreciation accounts must remain in
					 such accounts to be considered as valid funding transactions unless expended
					 for the purpose for which it was funded.
(c) In the computation of rates for public
					 LTHHCPs, depreciation is to be included on a straight-line method on plant and
					 nonmovable equipment.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.20 - Interest for all lthhcps

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Necessary interest on both current and capital indebtedness is an allowable
					 cost for all LTHHCPs.
(b) To be
					 considered as an allowable cost, interest shall be incurred to satisfy a
					 financial need, and at a rate not in excess of what a prudent borrower would
					 have had to pay in the money market at the time the loan was made. Also, the
					 interest shall be paid to a lender not related through control, ownership,
					 affiliation or personal relationship to the borrower except in instances where
					 the prior approval of the Commissioner of Health has been obtained. Financial
					 need for capital indebtedness relating to a specific project shall exist when
					 all available restricted funds designated for capital acquisition of that type
					 have been considered for equity purposes.
(c) Interest expense shall be reduced by
					 investment income, with the exception of income from funded depreciation,
					 qualified pension funds, trusteed malpractice insurance funds or in instances
					 where income from gifts or grants is restricted by donors. Interest on funds
					 borrowed from a donor-restricted fund or funded depreciation is an allowable
					 expense. Investment income shall be defined as the aggregate net amount
					 realized from dividends, interest, rental income, interest earned on temporary
					 investment of withholding taxes, as well as all gains and losses. If the
					 aggregate net amount realized is a loss, the loss is not allowable. Rate year
					 investment income shall reduce rate year interest expense allowed for
					 reimbursement as follows:
(1) for all
					 LTHHCPs, investment income shall first be used to reduce operating interest
					 expense for that year; and
(2) any
					 remaining amount of investment income, after application of (1), shall be used
					 to reduce capital interest expense reimbursed that year for LTHHCP's;
					 and
(3) any remaining amount of
					 investment income after application of (2) shall not be considered in the
					 determination of allowable costs.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.21 - Capital cost reimbursement for propietary lthhcps

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reimbursement for capital costs shall be
					 allowable in determining rates for proprietary LTHHCPs. These costs shall be
					 included as such costs are allocated from a related organization to the extent
					 that:
(1) those costs are reasonably related
					 to the efficient production of long-term home health care services;
					 and
(2) the bases of allocation of
					 such costs are consistent with regulations applicable to the cost reporting of
					 the related organization.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.22 - Return of investment for proprietary lthhcps

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In computing the allowable costs of a
					 proprietary LTHHCP, there shall be included a reasonable return on average
					 equity capital. The percentage to be used in computing this allowance shall be
					 a rate determined annually by the commissioner as reasonably related to the
					 then current money market.
(b) The
					 average equity capital associated with the LTHHCP shall be that amount that is
					 allocated from a related organization to the extent that the bases of
					 allocation of average equity capital to the LTHHCP are consistent with
					 regulations applicable to cost reporting of the related organization.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.23 - Movable equipment

Current through Register Vol. 46, No. 28, July 10, 2024
Necessary and reasonable expenses related to movable
						equipment (depreciation computed on a straight-line method or accelerated under
						a double declining balance on sum-of-the-years-digits method, interest on
						indebtedness, lease, etc. pursuant to sections
						86-5.17,
						86-5.19,
						86-5.20
						and
						86-5.22 
						of this Subpart) are considered to be allowable costs for
						LTHHCPs.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.24 - Research

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All research
					 costs shall be excluded from allowable costs in computing reimbursement
					 rates.
(b) Research includes those
					 studies and projects which have as their purpose the enlargement of general
					 knowledge and understanding, are experimental in nature and hold no prospect of
					 immediate benefit to the program or its patients.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.25 - Education activities

Current through Register Vol. 46, No. 28, July 10, 2024
The costs of educational activities, less tuition and
						supporting grants, shall be included in the calculation of the basic rates,
						provided such activities are directly related to patient care
						services.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.26 - Termination of services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 Division of Health Care Financing in the Department of Health shall be notified
					 immediately of the deletion of any previously offered service or of the
					 withholding of services from patients paid for by government agencies. Such
					 notification shall include a statement indicating the date of the deletion or
					 withholding of such service and the cost impact on the LTHHCP of such action.
					 Any overpayments by reason of such deletion of previously offered service shall
					 be subject to such penalties as the Commissioner of Health may impose in the
					 amount of up to 25 percent of the overpayment for negligent incorrect
					 completion or negligent failure to file such notification, and up to 100
					 percent of the overpayment for willful incorrect completion or negligent
					 failure to file such notification. The penalties assessed under this section
					 are separate from, and shall not be construed to be in mitigation of damages
					 which may be recovered pursuant to section 145-b  of the Social Services
					 Law.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.27 - Aids home care programs

Current through Register Vol. 46, No. 28, July 10, 2024
Payment for services provided by LTHHCPs certified as
						AHCPs shall be at rates established pursuant to this Subpart provided, however,
						that nursing services provided by any LTHHCP to patients diagnosed with
						Acquired Immune Deficiency Syndrome (AIDS) as defined by ICD-9 codes 042, 043
						and 044 shall be reimbursed pursuant to section
						86-1.46(b) 
						of this Part.
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 86-5 - Long-term Home Health Care Programs › Section 86-5.28 - Related organizations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 related organization shall be defined as any entity which the LTHHCP is in
					 control of or is controlled by, either directly or indirectly, or an
					 organization, or institution whose actions or policies the LTHHCP has the
					 power, directly or indirectly, to significantly influence or direct the actions
					 or policies of an organization or institution or a special purpose organization
					 or where an association of material interest exists in an entity which supplies
					 goods and/or services to the LTHHCP, or any entity which is controlled directly
					 or indirectly by the immediate family of the operator. Immediate family shall
					 include each parent, child, spouse, brother, sister, first cousin, aunt and
					 uncle, whether such relationship arises by reason of birth, marriage or
					 adoption. A special purpose organization shall be defined as an organization
					 which is established to conduct certain of the provider's patient-care-related
					 or non-patient-care-related activities. The special purpose organization is
					 considered to be related if:
(1) the LTHHCP
					 controls the special purpose organization through contracts or other legal
					 documents that allow direct authority over the organization's activities,
					 management and policies; or
(2) the
					 LTHHCP is, for all practical purposes, the sole beneficiary of the special
					 organization's activities. The LTHHCP shall be considered the special purpose
					 organization's sole beneficiary if one or more of the three following
					 circumstances exist:
(i) a special purpose
					 organization has solicited funds in the name of and with the expressed or
					 implied approval of the LTHHCP, and substantially all the funds solicited by
					 the organization were intended by the contributor' or were otherwise required
					 to be transferred to the provider or used at its discretion or
					 direction;
(ii) the LTHHCP has
					 transferred some of its resources to a special purpose organization,
					 substantially all of whose resources are held for the benefit of the provider;
					 or
(iii) the LTHHCP has assigned
					 certain of its functions (such as the operation of a dormitory) to a special
					 purpose organization that is operating primarily for the benefit of the
					 LTHHCP.
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 86-6 - Hospices › Section 86-6.2 - Hospice rates of reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Pursuant to
					 42 USC
					 1396 a(a) (13)(D), rates of reimbursement for
					 hospice shall be in amounts no lower than the amounts used under part A of
					 title XVIII of the Social Security Act. Hospices may be eligible for
					 supplemental rates of payment under the supplemental financial assistance
					 program in accordance with the provisions set forth in section
					 86-6.6 
					 of this Subpart.
(1) The hospice payment
					 rates are established to reimburse each of the following four specific
					 categories of hospice care:
(i) routine home
					 care;
(ii) continuous home
					 care;
(iii) inpatient respite care;
					 and
(iv) general inpatient
					 care.
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 86-6 - Hospices › Section 86-6.3 - Reimbursement for attending and consulting physician services

Current through Register Vol. 46, No. 28, July 10, 2024
Reimbursement for attending and consulting physician
						services rendered to hospice patients shall be in accordance with the Medicaid
						fee schedule set forth in this title, as amended pursuant to chapter 904 of the
						Laws of 1984. The current fee schedule is set forth in section 7.0 of the
						Medicaid Management Information System Provider Manual, Physicians (Revised
						January 1985). Copies of this schedule may be obtained from the Bureau of
						Program, Policy and Operations of the Division of Medical Assistance of the New
						York State Department of Social Services, 40 North Pearl Street, Albany, NY
						12243. The current physicians fee schedule is available for inspection and
						copying at the Department of Health Records Access Office, 10th Floor, Corning
						Tower Building, Nelson A. Rockefeller Empire State Plaza, Albany, NY
						12237.