reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-12 - Liability for Services › Section 635-12.11 - Effect on liability and entitlements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This section applies to all services,
				  whether or not they are preexisting services.
(b) Nothing in this Subpart shall be
				  construed as a release of any liability for services, whether they were
				  delivered before, on or after the payment start date.
(c) Any reduction or waiver of a fee shall
				  not constitute nor be construed as a release of the individual or any liable
				  party from liability for payment of the full fee.
(d) Nothing in this Subpart shall be deemed
				  to create any entitlement to services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-12 - Liability for Services › Section 635-12.12 - Limited exception for supported employment services and respite services

Current through Register Vol. 46, No. 28, July 10, 2024
Prior to July 1, 2015, the limited exception provisions in
					 this section were applicable to individuals applying for supported employment
					 services who met specified criteria. The limited exception is no longer
					 permitted for individuals enrolling in supported employment services on and
					 after July 1, 2015.
(a) The provisions
				  of sections
				  635-12.2 
				  --635-12.10 of this Subpart are not applicable in the circumstances in either
				  paragraph (1) or paragraph (2) of this subdivision:
(1) Supported employment services. The
				  individual is enrolled in supported employment services and all of the
				  following conditions are met:
(i) either:
(a) the individual was enrolled in supported
				  employment services prior to July 1, 2015, and was continuously enrolled in
				  supported employment services with the same provider on and after July 1, 2015;
				  or
(b) the individual was enrolled
				  in supported employment services prior to July 1, 2015, and on or after July 1,
				  2015 the provider downsized or eliminated the provision of supported employment
				  services, causing the individual to dis-enroll in that provider's supported
				  employment services and re-enroll in supported employment services from the
				  same or a different provider.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-13 - Independent Practitioner Services for Individuals With Developmental Disabilities › Section 635-13.1 - Applicability and service definition

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart is applicable to independent
				  practitioner services for individuals with developmental disabilities (IPSIDD)
				  provided to individuals who meet the eligibility criteria specified in this
				  Subpart.
(b) IPSIDD is a Medicaid
				  State plan service that consists of clinical services identified in subdivision
				  (c) of this section provided on and after April 1, 2016.
(c) IPSIDD services include the following
				  clinical services that are not delivered as part of an individual's residential
				  and/or day habilitation service:
(1)
				  occupational therapy;
(2) physical
				  therapy;
(3) speech and language
				  pathology;
(4)
				  psychology;
(5) social
				  work.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-13 - Independent Practitioner Services for Individuals With Developmental Disabilities › Section 635-13.2 - Eligibility criteria

Current through Register Vol. 46, No. 28, July 10, 2024
To receive IPSIDD, the individual must:
(a) be determined by OPWDD to have a
				  developmental disability as defined in section 1.03 (22)  of the Mental
				  Hygiene Law; and
(b) not be
				  enrolled at a facility or program that includes provision of the services
				  identified in section
				  635-13.1(c) 
				  of this Subpart as part of its service model and reimbursement rates
				  (
e.g.,
developmental center, special residential unit,
				  specialty hospital, intermediate care facility for individuals with
				  intellectual disabilities (ICF/IID), day treatment facility, skilled nursing
				  facility, rehabilitation hospital, adult day healthcare facility, PACE
				  center).
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-13 - Independent Practitioner Services for Individuals With Developmental Disabilities › Section 635-13.3 - Qualifications for providing and billing for IPSIDD

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To provide and bill for IPSIDD the
				  independent practitioner must be a clinician licensed in New York State:
(1) whose name and credentials have been
				  submitted to, and verified by, OPWDD; and
(2) who has had specialized training and two
				  years of experience treating individuals with developmental
				  disabilities.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-13 - Independent Practitioner Services for Individuals With Developmental Disabilities › Section 635-13.4 - General provisions on service delivery

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Independent practitioner services for
				  individuals with developmental disabilities (IPSIDD) may be delivered in the
				  following locations:
(1) individualized
				  residential alternatives (IRAs), community residences (CRs) or family care
				  homes certified by OPWDD, or private residences;
(2) certified day habilitation,
				  pre-vocational, and day training facilities;
(3) community settings as deemed appropriate
				  by the clinician, including community settings where OPWDD services may occur;
				  or
(4) clinicians' private
				  offices.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(1) These
				  regulations apply to all providers certified by the New York Office for People
				  With Developmental Disabilities (OPWDD), pursuant to section 16.03 (a)(5)  of the Mental
				  Hygiene Law, to provide Crisis Services for Individuals with Intellectual
				  and/or Developmental Disabilities.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.2 - Qualifications for Providers of CSIDD

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In order to provide CSIDD services, the
				  provider must:
(1) be certified by OPWDD,
				  pursuant to section 16.03 (a)(5)  of the Mental
				  Hygiene Law, to provide CSIDD;
(2)
				  be OPWDD or a not-for-profit agency approved by OPWDD;
(3) enroll in the New York State Medicaid
				  program;
(4) have sufficient
				  professional staff to operate in their region; and
(5) coordinate a network of providers to
				  ensure coordination of services for CSIDD recipients.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.3 - Eligibility Requirements for Individuals to be Enrolled in CSIDD

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Eligibility for
				  CSIDD must be determined by the Developmental Disabilities Regional Offices
				  (DDRO) prior to the provision of services.
(b) Individuals may be eligible for
				  enrollment in CSIDD, if they:
(1) are
				  enrolled in Medicaid;
(2) are six
				  (6) years of age or older; and
(3)
				  meet the Medical Necessity Criteria, which includes having:
(i) established eligibility for OPWDD
				  services; and
(ii) significant
				  behavioral and/or mental health needs.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.4 - Service Description

Current through Register Vol. 46, No. 28, July 10, 2024
(a) CSIDD is
				  a short-term rehabilitative service targeted for individuals with intellectual
				  and/or developmental disabilities (I/DD) who have significant behavioral or
				  mental health needs. Services are delivered by multi-disciplinary teams that
				  provide personalized, intensive, time-limited services to individuals meeting
				  the CSIDD eligibility criteria.
(b)
				  CSIDD services must not replace or duplicate services in the community already
				  available to the individual.
(c)
				  While the individual is enrolled in CSIDD, the individual's system of support,
				  including their involved family members/caregivers, must be permitted to be
				  active participants in the process including the provision of any applicable
				  informed consent, ongoing person-centered planning, discussion, and
				  participation in the delivery of CSIDD.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.5 - Elements of CSIDD

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Allowable Services
(1) CSIDD
				  includes, but is not limited to:
(i) crisis
				  response and/or 24-hour emergency support;
(ii) conducting relevant/ongoing
				  assessments
(iii) communicating and
				  exchanging relevant information with other professionals or service providers
				  about the individual;
(iv)
				  communicating with the individual, their family/caregivers, or others through
				  written reports, telephone contacts, electronic contacts or face-to-face
				  encounters;
(v) planned and/or
				  emergency in-home clinical support;
(vi) training of the primary caregiver(s)
				  and/or support system who provide natural supports and services to the
				  individual on how to use behavioral supports, interventions, and strategies
				  specified in the CSIDD treatment plan; and
(vii) monitoring the implementation of the
				  CSIDD treatment plan through:
(a) observing
				  the individual, family, and/or staff as they utilize supports, interventions,
				  and strategies;
(b) following up
				  with the support system on the effectiveness of the supports, interventions,
				  and strategies; and
(c) transition
				  and/or discharge planning with the individual's caregiver(s) and/or support
				  system.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.6 - Interdisciplinary Treatment Team

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				  CSIDD interdisciplinary treatment team members must include an array of
				  clinical behavioral health disciplines appropriate for providing
				  multidisciplinary assessment and treatment.
(b) CSIDD delivered by Clinical Team Leaders,
				  Clinical Team Coordinators, and other professional clinical staff must be done
				  under the supervision of the Clinical Director, Medical Director, or
				  consultant.
(c) The CSIDD
				  interdisciplinary treatment team must include, but is not limited to:
(1) A Clinical Director or Medical
				  Director;
(2) Clinical Team
				  Leaders; and
(3) Clinical Team
				  Coordinators.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-16 - Crisis Services for Individuals With Intellectual And/or Developmental Disabilities (CSIDD) › Section 635-16.7 - Level of CSIDD Clinical Team Involvement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Level of Involvement and Intensity: As
				  individuals gain clinical stability, the level of involvement from the clinical
				  team should be reduced as appropriate, but not to exceed the level of intensity
				  most recently determined by the DDRO. The levels of involvement and intensity
				  include:
(1)
Stable
: The
				  individual is clinically stable and only needs periodic clinical team outreach
				  and plan review. Stabilization intervention and monitoring is provided at least
				  quarterly.
(2)
Mild
:
				  The individual is showing clear improvements in level of clinical stability and
				  has Stabilization intervention and monitoring is provided once a
				  month.
(3)
Moderate
:
				  The individual is not yet stable and has clinical needs requiring multiple
				  monitoring contacts per month with active Stabilization interventions and
				  reassessment of the plan, consultations, system engagement and linkages to
				  other resources and or supports/services. Stabilization intervention and
				  monitoring are provided multiple times per month.
(4)
Intensive
: The individual
				  has acute clinical needs requiring active crisis planning and system engagement
				  with contact weekly or more often. Stabilization intervention and monitoring
				  are provided weekly or more often.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-1 - Person-Centered Planning › Section 636-1.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
				  applies to:
(1) Medicaid Home and Community
				  Based Services (HCBS) that are operated, certified, funded, or subject to
				  oversight by OPWDD; and
(2) Care
				  Management, by whatever name known, that is subject to oversight by OPWDD and
				  provided to individuals who receive HCBS that are operated, certified, funded,
				  or subject to oversight by OPWDD.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-1 - Person-Centered Planning › Section 636-1.2 - Person-centered planning process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
				  person-centered planning process is a process in which, to the maximum extent
				  possible, an individual directs the planning of his or her services and makes
				  informed choices about the services and supports that he or she receives. The
				  planning process guides the delivery of services and supports to an individual
				  in a way that leads to outcomes or results in areas of the individual's life
				  that are most important to him or her (
e.g.
, health,
				  relationships, work, and home).
(1) The
				  person-centered planning process involves parties chosen by the individual,
				  often known as the individual's circle of support. The parties chosen by the
				  individual participate in the process as needed, and as defined by the
				  individual, except to the extent that decision-making authority is conferred on
				  another by State law.
(2) The
				  parties chosen by the individual assist the individual in decision-making by,
				  among other things, explaining issues to be decided, answering the individual's
				  questions, encouraging the individual to actively participate in
				  decision-making and, where necessary, assisting the individual to communicate
				  his or her preferences.
(3) The
				  person-centered planning process requires that:
(i) supports and services are based on the
				  individual's interests, preferences, strengths, capacities, and
				  needs;
(ii) supports and services
				  are designed to empower the individual by fostering skills to achieve desired
				  personal relationships, community participation, dignity, and respect;
				  and
(iii) the individual is
				  satisfied with activities, supports, and services.
(4) Person-centered planning is a
				  collaborative and recurring process between the individual and the service
				  provider. The planning process is used at the time of initial plan development
				  and during reviews of the plan.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-1 - Person-Centered Planning › Section 636-1.3 - Person-centered service plan

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				  person-centered service plan is created using the planning process described in
				  section
				  636-1.2 
				  of this subpart. The person-centered service plan may also be known as the
				  individualized service plan (ISP, see definition in section
				  635-99.1  of
				  this Title) or Life Plan.
(b) The
				  individual's Care Manager must develop a person-centered service plan with the
				  individual. The plan must include and document the following:
(1) the individual's goals and desired
				  outcomes;
(2) the individual's
				  strengths and preferences;
(3) the
				  individual's clinical and support needs as identified through an assessment of
				  functional and health-related needs;
(4) the necessary and appropriate services
				  and supports (paid and unpaid) that are based on the individual's preferences
				  and needs (as identified through an assessment of functional and health-related
				  needs) and that will assist the individual to achieve his or her identified
				  goals;
(5) the services that the
				  individual elects to self-direct;
(6) the providers of those services and
				  supports specified in paragraph (4) and (5) of this subdivision;
(7) if an individual resides in a certified
				  residential setting, document that the residence was chosen by the individual,
				  and document the alternative residential settings considered by the individual,
				  including alternative residential settings that are available to individuals
				  without disabilities (Note: The setting chosen by the individual is integrated
				  in, and supports full access of individuals receiving services to the broader
				  community, including opportunities to seek employment and work in competitive
				  integrated settings, engage in community life, control personal resources, and
				  receive services in the community with the same degree of access as the broader
				  community . The individual may choose service and support options that are
				  available to individuals without disabilities for his or her residence and
				  other areas of his or her life);
(8) the risk factors and measures in place to
				  minimize risk, including individual specific back-up plans and strategies when
				  needed; and
(9) the individual
				  and/or entity responsible for monitoring the plan.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-1 - Person-Centered Planning › Section 636-1.5 - Notice of the person-centered planning process and plan

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The service coordinator must give notice
				  of the individual's right to a person-centered planning process in accordance
				  with section 636-1.2  of this Subpart and to a person-centered plan in
				  accordance with section 636-1.3  of this Subpart, and of the right to object to
				  services pursuant to section
				  633.12 
				  of this Title, to the individual and the person upon whom decision-making
				  authority is conferred by State law (see section 636-1.2[a][1]  of this
				  Subpart), if any, in the following manner:
(1) for individuals who do not have an ISP in
				  place on November 1, 2015, the service coordinator must give written notice
				  prior to the initiation of the person-centered planning process and development
				  of the plan; or
(2) for individuals
				  who have an ISP in place on November 1, 2015, the service coordinator must give
				  written notice at the time of the individual's next ISP review.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-1 - Person-Centered Planning › Section 636-1.6 - Assessment of Functional and Health-Related Needs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) OPWDD or its designee will use an OPWDD
				  approved assessment to conduct an initial assessment and/or re-assessment of
				  functional and health-related needs for each individual applying for or
				  receiving services approved, authorized, funded or certified by
				  OPWDD.
(b) OPWDD will use the
				  results of the assessments described in subdivision (a) of this section, in
				  conjunction with additional information supporting an individual's medical,
				  behavioral, habilitative and/or functional needs, to inform service
				  authorization decisions.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-2 - Home and Community Based Services and Settings Requirements › Section 636-2.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
				  applies to the following services and settings:
(1) Medicaid Home and Community Based
				  Services (HCBS) that are operated, certified, funded, authorized, approved, or
				  subject to oversight by OPWDD and/or its authorized provider(s), except those
				  services identified in subdivision 636-2.1(b); and
(2) Settings where HCBS are delivered, except
				  those settings identified in subdivision 636-2.1(b).
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-2 - Home and Community Based Services and Settings Requirements › Section 636-2.2 - Background and Intent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) It is the
				  intent of this Subpart to require Medicaid Home and Community Based Services
				  (HCBS) that are operated, certified, funded, authorized, approved, or subject
				  to oversight by OPWDD, and/or an OPWDD authorized provider, to be delivered in
				  integrated settings that do not isolate individuals receiving Medicaid HCBS
				  from the broader community of people not receiving Medicaid HCBS.
(b) HCBS supports and services must encourage
				  individuals to take part in the broader community in a way that is meaningful
				  to the individual, in accordance with:
(1) a
				  person-centered service plan developed, implemented, and reviewed in compliance
				  with Subpart 636-1 of this Part;
(2) applicable HCBS requirements in Subpart
				  635-10 of this Title; and
(3)
				  sections 636-2.3, 636-2.4, and 636-2.5  of this Subpart.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-2 - Home and Community Based Services and Settings Requirements › Section 636-2.3 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Broader
				  community. Community settings that are used by the general public, where
				  individuals have opportunities to interact with people who do not have
				  disabilities, do not receive Medicaid HCBS, and are not paid to provide
				  services to individuals.
(b)
				  Heightened scrutiny. Review of a setting presumed to be isolating and/or having
				  institutional qualities because it is:
(1)
				  located in a building that is also a publicly or privately-operated facility
				  that provides inpatient institutional treatment;
(2) in a building on the grounds of, or
				  immediately adjacent to, a public institution; or
(3) any other setting that has the effect of
				  isolating individuals receiving Medicaid HCBS from the broader
				  community.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-2 - Home and Community Based Services and Settings Requirements › Section 636-2.4 - General Provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any
				  setting where Medicaid HCBS are delivered must have all the following qualities
				  and meet all the following conditions based on the needs and goals of the
				  individual receiving HCBS as identified in his/her person-centered service
				  plan:
(1) The setting must be integrated and
				  support full access of individuals receiving HCBS to the broader community. It
				  must support opportunities to seek employment and work in competitive
				  integrated settings, engage in community life, control personal resources, and
				  receive services in the community with the same degree of access as the broader
				  community.
(2) The setting must be
				  selected by the individual from among setting options, including non-disability
				  specific settings, and an option for a private home or private bedroom in a
				  residential setting, where applicable. The setting options must be identified
				  and documented in the person-centered service plan or other planning/service
				  related documents and must be based on the individual's needs, preferences and,
				  for residential settings, resources available for room and board.
(3) The setting must ensure the individual's
				  rights of privacy, dignity, and respect, and freedom from coercion and
				  restraint.
(4) The setting must
				  optimize, and not regiment, individual initiative, autonomy, and independence
				  in making life choices including, but not limited to, the individual's
				  decisions regarding daily activities, physical environment, and with whom to
				  interact.
(5) The setting must
				  facilitate individual choice regarding services and supports and who provides
				  them.
(6) The individual must have
				  freedom and support to control his or her own schedules and activities,
				  consistent with the same or similar settings for the broader
				  community.
(7) The individual must
				  have access to food at any time, consistent with the same or similar settings
				  for the broader community.
(8) The
				  individual must be able to have visitors of his or her choosing at any time,
				  consistent with the same or similar settings for the broader
				  community.
(9) The setting must be
				  physically accessible to the individual.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-2 - Home and Community Based Services and Settings Requirements › Section 636-2.5 - Heightened Scrutiny

Current through Register Vol. 46, No. 28, July 10, 2024
A Medicaid HCBS setting subject to heightened scrutiny, as
					 defined in subdivision 636-2.3(c)  of this Subpart, will be reviewed in the form
					 and format specified by CMS, DOH, and/or OPWDD.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
				  applies to all providers of residential facilities certified or operated by the
				  Office for People With Developmental Disabilities (OPWDD) (referred to herein
				  as "Residential Provider Agencies").
(b) This Subpart also applies to providers of
				  OPWDD care management services, such as Comprehensive Health Home Care
				  Management and Basic HCBS Plan Support.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.2 - Background and Intent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
				  contains requirements and processes for the provision of residential services
				  to individuals with intellectual and developmental disabilities in residential
				  facilities certified or operated by OPWDD (collectively "residential
				  facilities").
(b) The most
				  integrated and least restrictive housing options must be explored for all
				  individuals seeking services in residential facilities.
(c) Providers of care management services and
				  Residential Provider Agencies must partner with OPWDD to facilitate the
				  provision of residential services to individuals with intellectual and
				  developmental disabilities, when appropriate.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.3 - Statutory Authority

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Sections
				  13.01,
				  13.07, and
				  13.17 of the New York State Mental
				  Hygiene Law authorize the commissioner of OPWDD to develop an effective,
				  integrated, comprehensive system for the delivery of services to individuals
				  with developmental disabilities.
(b) Section
				  13.09 of the New York State Mental
				  Hygiene Law grants the commissioner of OPWDD the authority to promulgate rules
				  and regulations necessary and proper to implement any matter under their
				  jurisdiction.
(c) Sections
				  16.00 and
				  16.01 of the New York State Mental
				  Hygiene Law enable the commissioner of OPWDD to regulate and assure the
				  consistently high quality of services provided within the State to individuals
				  with developmental disabilities.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.4 - Responsibilities of Residential Provider Agencies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Residential
				  Provider Agencies must:
(1) notify OPWDD of
				  any vacancies in residential facilities;
(2) timely review residential
				  referrals;
(3) prioritize
				  individuals for services in residential facilities who have been designated as
				  having a higher need for such services;
(4) screen individuals referred for services
				  in residential facilities to assess the appropriateness of the service needs of
				  individuals referred for all available vacancies;
(5) submit screening reports to OPWDD
				  following review of residential referrals and assessments; and
(6) adhere to all community placement and due
				  process procedures in this Part for both internal and external moves (see e.g.,
				  section 633.12  of this
				  Part).
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.5 - Responsibilities of Providers of Care Management Services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Prior to
				  referring an individual for services in a residential facility, Care Managers
				  must:
(1) ensure the individual has
				  established OPWDD eligibility;
(2)
				  ensure the individual has requested services in a residential facility;
				  and
(3) have fully explored with
				  the individual and their guardian, family, or advocate, as applicable, the
				  possibility of remaining in their current residence or other community living
				  arrangement with additional supports and services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.6 - Levels of Need for Certified Residential Services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) OPWDD will
				  assess and determine whether an individual requires services in a residential
				  facility and the individual's level of need.
(b) Levels of need for services in
				  residential facilities are designated by OPWDD to determine the prioritization
				  of individuals for available opportunities in residential facilities.
(c) Levels of need are determined by OPWDD
				  and are based on factors including, but not limited to, level of care required
				  due to an individual's developmental or intellectual disability, availability
				  and adequacy of an individual's natural supports, and risk of harm associated
				  with an individual's current situation.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.7 - Residential Referral Process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Residential
				  Provider Agencies must attempt to fill any current or anticipated vacancies
				  with individuals designated by OPWDD as having the highest level of need prior
				  to considering other individuals for available residential services.
(b) Residential Provider Agencies may only
				  consider individuals designated as having lower levels of need upon receipt of
				  prior approval from OPWDD.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 636 - Services And Supports For Individuals With Developmental Disabilities › Subpart 636-3 - Certified Residential Opportunities › Section 636-3.8 - Internal Moves

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Internal
				  moves are those that move an individual currently residing in a residential
				  facility to another residential facility operated by the same Residential
				  Provider Agency.
(1) OPWDD must be notified
				  prior to any internal move.
(2)
				  OPWDD approval is required prior to any internal move that will result in the
				  relocation of an individual outside of their current district.
(3) Ifan internal move will change the
				  location of a vacancy that was previously announced, OPWDD must be notified of
				  the new vacancy location.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.1 - Rate Setting For Non-State Providers

Current through Register Vol. 46, No. 28, July 10, 2024
Rates of reimbursement for residential habilitation
					 services provided in community residences, including IRAs, and for day
					 habilitation services, other than those provided by OPWDD, shall be determined
					 in accordance with Title 10 NYCRR 86-10.The rates of payment made for services
					 rendered to title XIX recipients established in accordance with the methodology
					 contained in this Title10 NYCRR Part 86-10 shall be contingent upon Federal
					 financial participation (FFP) and approval.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.2

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.3

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.4

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.5 - Trend Factor

Current through Register Vol. 46, No. 28, July 10, 2024
For years in which DOH does not update the base year,
					 subject to the approval of the Director of the Budget, DOH may use a compounded
					 trend factor to bring base year costs forward to the appropriate rate period.
					 The trend factor shall be taken from applicable years from consumer and
					 producer price indices, including, but not limited to the Medical Care Services
					 Index; U.S. city average, by expenditure category and commodity and service
					 group for the period April to April of each year.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.6 - Transition periods and reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Transition to new methodology. The
				  reimbursement methodology described in this subpart will be phased-in over a
				  three-year period, with a year for purposes of the transition period meaning a
				  twelve month period from July 1st to the following June 30th, and with full
				  implementation in the beginning of the fourth year. During this transition
				  period, the base operating rate will transition to the target rate as
				  determined by the reimbursement methodology described in this subpart,
				  according to the phase-in schedule immediately below. The base operating rate
				  will remain fixed and the target rate, as determined by the reimbursement
				  methodology in this subpart, will be updated to reflect rebasing of cost data,
				  trend factors and other appropriate adjustments.
Phase-in Percentage
Transition Year
Base operating rate
Target Rate
Year One (July 1, 2014 - June 30, 2015)
75%
25%
Year Two (July 1, 2015 - June 30, 2016)
50%
50%
Year Three (July 1, 2016 -June 30, 2017)
25%
75%
Year Four (July 1, 2017 - June 30, 2018)
0%
100%
(b) Transition from monthly to daily units of
				  service. Reimbursement for residential habilitation provided in supervised
				  community residences shall be according to a daily unit of service. From the
				  period beginning July 1, 2014 through June 30, 2015, providers that receive
				  reimbursement of residential habilitation in supervised community residences
				  pursuant to this Subpart shall determine and report to DOH retainer days,
				  therapeutic leave days and vacant bed days.
(1) Retainer days shall mean days during
				  which an individual is on medical leave from the community residence, or
				  associated days when any other institutional or in-patient Medicaid payment is
				  made for providing services to the individual.
(i) Retainer days shall be reimbursed at zero
				  dollars.
(ii) At the mid-point and
				  again at the conclusion of the period ending June 30, 2015, DOH will reconcile
				  the services recorded under the retainer days in order to determine the amount
				  of reimbursement owed to the provider. Providers shall be paid for retainer
				  days at the level described in subdivision (a) of this section.
(iii) Providers shall not be paid for more
				  than fourteen retainer days per annual period for any one individual.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 641 - Rate Setting For Non-state Providers › Subpart 641-1 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs), and for Non-State Providers of Day Habilitation › Section 641-1.7 - Rate corrections

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Arithmetic or calculation errors will be adjusted accordingly in instances that
				  would result in a change of $5,000 or more in a provider's annual reimbursement
				  for either residential habilitation services provided in community residences
				  or day habilitation services.
(b)
				  In order to request a rate correction in accordance with subdivision (a) of
				  this section, the provider must send to Department of Health its request by
				  certified mail, return receipt requested, within 90 days of the provider
				  receiving the rate computation or within 90 days of the first day of the rate
				  period in question, whichever is later.