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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 86-2 - Residential Health Care Facilities › Section 86-2.40 - Statewide prices for non-capital reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
The non-capital cost components of residential health
						care facility (facility) Medicaid rates for inpatient services for periods on
						and after January 1, 2012, shall be in accord with the following:
(a) "specialty facilities" means those
					 facilities or discrete units of facilities described in paragraph (c) of
					 subdivision 2-c of section 2808  of the Public Health Law. Such
					 facilities and such discrete units of facilities shall not be subject to the
					 provisions of this section, other than subdivisions (ac)(2) and (ad) of this
					 section, and the costs and statistical data reported by such facilities and
					 such discrete units of facilities shall not be included in the rate
					 computations otherwise made pursuant to this section, and the term "facilities"
					 as used in this section shall not be deemed to include such
					 facilities.
(b) The operating
					 component of rates shall be a price and shall consist of the sum of the direct,
					 indirect and non-comparable price components.
(c) For purposes of calculating the direct
					 and indirect price component of the rates, the following peer groups shall be
					 established:
(1) all facilities;
(2) free-standing facilities with certified
					 bed capacities of 300 beds or more and all hospital-based facilities as defined
					 in section
					 86-2.10(a)(13) 
					 of this Subpart ("HBF
Click to
					 view image
300 bed"); and
(3) all free-standing facilities with
					 certified bed capacities of less than 300 beds ("-300 bed").
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 86-2 - Residential Health Care Facilities › Section 86-2.41 - Sprinkler systems

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Subject to the availability of Federal financial participation, the capital
					 cost components of the rates of eligible residential health care facilities for
					 periods on and after the effective date of this regulation shall be adjusted in
					 accordance with the following:
(1) For the
					 purposes of this section, eligible facilities are those facilities which the
					 commissioner determines are financially distressed in terms of their being
					 unable to finance, at terms acceptable to the commissioner, the installation of
					 automatic sprinkler systems, in conformity with the provisions of Federal
					 regulations set forth in
					 42 CFR
					 483.70(a)(8). In making such
					 determinations of eligibility the commissioner shall consider information
					 obtained from a facility's cost report, other more recent financial information
					 to be provided by the facility, and such other information as may be required
					 by the commissioner, including, but not limited to:
(i) operating profits and losses;
(ii) eligibility for funding pursuant to
					 subdivision twenty-one of section 2808  of the Public Health Law;
(iii) unrestricted fund balances;
(iv) documentation demonstrating the
					 inability of the facility to obtain credit, at terms acceptable to the
					 commissioner, without the reimbursement treatment accorded pursuant to this
					 section;
(v) working
					 capital;
(vi) days of cash expense
					 on hand;
(vii) days of revenue in
					 accounts receivable;
(viii)
					 transfers and withdrawals;
(ix)
					 information related to the health and safety of a facility's
					 residents;
(x) other financial
					 information as may be required from the facility by the commissioner;
					 and
(xi) the filing of a notice
					 pursuant to subdivision 1-a of section 2802  of the Public Health Law, or the
					 receipt of required CON approvals, as appropriate.
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 86-2 - Residential Health Care Facilities › Section 86-2.42 - Residential health care facility quality pool

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the calendar year 2013 and
					 thereafter, the Commissioner shall establish a residential health care facility
					 quality pool for the purpose of making quality incentive payments to facilities
					 meeting the criteria set forth in this section. This program shall be referred
					 to as the Nursing Home Quality Pool (NHQP). The amount of the NHQP shall be $50
					 million or as determined by the Commissioner. The financial awards to
					 facilities shall be determined by their performances in the Nursing Home
					 Quality Initiative (NHQI). The measures on which facilities will be evaluated
					 in the NHQI are described below.
(1) The NHQI
					 shall contain measurement components comprised of quality measures, compliance
					 measures, efficiency measures, and satisfaction measures, if and when
					 satisfaction data becomes available. Each measure shall be awarded points based
					 on the facility's performance in the measure. The points from each measure
					 shall be summed to create an overall score. Nursing homes shall be categorized
					 into quintile placements based on the distribution of the overall
					 scores.
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 86-3 - Health Maintenance Organizations › Section 86-3.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart, health maintenance organization
						or HMOmeans any entity or entities providing a comprehensive prepaid health
						service plan(s) certified under article 44 of the Public Health Law. IX-C rate
						refers to individual hospital rates promulgated by IX-C hospital service plans
						pursuant to formulae certified by the Commissioner of Health. For the purposes
						of this Subpart, this shall currently mean the rate established for Blue Cross
						plans under Subpart 86-1, which constitute the only certified rates at this
						time. In the event that rates are certified by the commissioner for another
						IX-C plan in any area in which an HMO is situated, the IX-C rate shall mean the
						rate approved for the Blue Cross plan in that area.
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 86-3 - Health Maintenance Organizations › Section 86-3.2 - Applicability of subpart

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of this Subpart is to implement the
						legislative requirement that the Commissioner of Health approve rates to be
						paid by article 44 HMO's to hospitals for inpatient 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 86-3 - Health Maintenance Organizations › Section 86-3.4 - Administrative procedures

Current through Register Vol. 46, No. 28, July 10, 2024
Implementation of these regulations shall be based on the
						following:
(a) No written agreement
					 between hospital and HMO is required to initiate and continue this
					 reimbursement methodology.
(b) Upon
					 request by the HMO, a hospital shall furnish documentation of the certified
					 IX-C rate(s) in effect at the hospital, or other approved IX-C reimbursement if
					 per diem is not in use.
(c) Upon
					 receipt of inpatient statements itemizing charges and stating total IX-C
					 reimbursement due to the hospital, the HMO may reimburse the hospital directly.
					 The HMO shall pay such obligations within 30 days of receipt of the
					 statement(s), unless other arrangements are approved by the hospital.
(d) HMO's and hospitals shall mutually
					 furnish administrative and medical data as is customarily required when third
					 parties are involved in the process of hospital admission, discharge and
					 reimbursement.
(e) The HMO is
					 responsible for paying retroactive adjustments to IX-C Medicaid and Medicare
					 rates on the basis of the number of patient days of care utilized when the
					 reimbursement method is the 86-3 IX-C access rate.
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 86-3 - Health Maintenance Organizations › Section 86-3.6 to 86-3.7 - 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 86-4.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart:
(a) Facility shall mean all free-standing
					 ambulatory care facilities, diagnostic and/or treatment centers and clinics
					 that are subject to article 28 of the Public Health Law, provided that such
					 facility has been established by the Public Health Council and possesses a
					 valid operating certificate issued by the Commissioner of Health. Rates of
					 reimbursement for hospital-based facilities shall be governed by Subpart 86-1
					 of this Part.
(b) Free-standing
					 ambulatory care facility, diagnostic and/or treatment center and clinic shall
					 mean a medical facility with one or more organized health services not part of
					 an inpatient hospital facility or vocational rehabilitation center, which is
					 primarily engaged in providing services to out-of-hospital or ambulatory
					 patients by or under the supervision of a physician or dentist, for the
					 prevention, diagnosis or treatment of human disease, pain, injury, deformity or
					 physical condition.
(c)
					 Commissioner shall mean the New York State Commissioner of Health.
(d) Department shall mean the New York State
					 Department of Health.
(e) Bureau
					 shall mean the Bureau of Ambulatory Care Reimbursement in the
					 department.
(f) Article 43
					 corporation shall mean a corporation organized and operating pursuant to
					 article 43 of the Insurance 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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.2 - Facility rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Computation
					 of rates of payment for facility services by government agencies and article 43
					 corporations shall be governed by the provisions of this Subpart.
(b) Each article 43 corporation shall submit
					 a proposed reimbursement formula not inconsistent with the rules set forth in
					 this Subpart, for approval by the commissioner, no later than 90 days prior to
					 the effective date of rates of payment unless otherwise specified by the
					 commissioner. In order to facilitate the exchange of information necessary for
					 development of the reimbursement formula and rates, each article 43 corporation
					 may confer with any facility, group or association of facilities prior as well
					 as subsequent to submission of its proposed reimbursement formula and rates.
					 The commissioner may require a report of any such contacts, when it is
					 reasonably necessary to the discharge of his or her responsibilities under 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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.3 - Recording and reporting of financial and statistical data

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective for all fiscal years beginning
					 on or after January 1, 1975 treatment centers and/or diagnostic centers shall
					 use the accrual basis of accounting except where an alternate basis is mandated
					 by law. For fiscal years beginning on or after January 1, 1986 treatment
					 centers and/or diagnostic centers shall submit to the New York State Department
					 of Health a certified Ambulatory Health Care Facility-1 form (AHCF-1) no later
					 than April 30th of each year or a later due date if specified in the annual
					 report form transmittal.
(1) Investments,
					 other than donations, shall be reported on the balance sheet of the AHCF-1 at
					 cost. However, the notes to the financial statements shall describe the assets
					 and indicate the quoted market value and cost for each category of
					 investment.
(2) Fixed assets, other
					 than donations, shall be reported on the balance sheet of the AHCF-1 at
					 cost.
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 86-4.4 - Certification of reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All
					 financial and statistical reports shall be certified by an independent licensed
					 public accountant or an independent certified public accountant on forms
					 prescribed and provided by the department. A copy of the audited financial
					 statements shall accompany the financial and statistical reports. Where the
					 required financial and statistical report data are incorporated into the
					 audited financial statements of a larger entity, the independent licensed
					 public accountant or the independent certified public accountant shall provide
					 the information necessary to reconcile the cost report presentation to the
					 financial statements in detail. An accountant shall not be independent if:
(1) any family relationship, including a
					 relationship by marriage, exists between any accountant, member or employee of
					 the accounting firm and the owner, operator or administrator of the
					 facility;
(2) any business
					 relationship other than one related to accounting services exists between any
					 accountant, member or employee of the accounting firm and the owner, operator
					 or administrator of the facility;
(3) any accountant, member or employee of the
					 accounting firm is responsible for the books and records of the facility;
					 or
(4) any accountant, member or
					 employee of the accounting firm is a member of the board of directors, officer
					 or employee 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 86-4.5 - Correction and supplementation of reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the event that any information or data
					 which a facility has submitted to the department for use in establishing rates
					 is found by the facility to be incorrect or incomplete for any reason, the
					 facility shall submit corrected and complete information or data to the
					 department within 30 days of such finding and prior to certification of the
					 rate.
(b) If the financial and
					 statistical reports required by this Subpart are determined by the department
					 or its agent to be incomplete or incorrect, the facility shall provide
					 additional or corrected data within 30 days from the date of receipt of notice
					 of the determination. Should the facility fail to file the corrected or
					 additional data within that period or by a later date specified by the
					 commissioner, the provisions of subdivision (h) of section 86- 4.3 of this
					 Subpart shall apply.
(c) All
					 corrected or completed data or information must meet the certification
					 requirements of section
					 86-4.4 
					 of this Subpart.
(d) Specific
					 additional data related to the rate setting process may be required by the
					 commissioner. The commissioner shall supply each facility with a preliminary
					 listing of the data that will be required prior to the start of each rate
					 period. Such data shall be submitted by the facility within 30 days from the
					 date of receipt of a request for such information or by a later date specified
					 by the commissioner. Failure to submit the additional data shall result in the
					 application of the provisions of section
					 86-4.3(h),
					 unless the facility documents that the requested data does not exist or cannot
					 reasonably be produced.
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 86-4.6 - Audits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All fiscal and
					 statistical records and reports shall be subject to audit, which must commence
					 no later than six years from the date of filing or the date when due, whichever
					 is later. There shall be no limitation in situations involving possible fraud
					 or where the facility or its agent prevents the Department of Health or the
					 Department of Social Services from performing an audit. Notification by either
					 department to the facility of the department's intent to audit shall toll the
					 six-year period.
(b) All underlying
					 books, records and documentation which form the basis for fiscal and
					 statistical reports filed by the facility with the department, shall be kept
					 and maintained by the facility for not less than six years from the date of
					 filing or the date upon which the fiscal and statistical records were to be
					 filed, whichever date is later. Any rate of payment certified or approved by
					 the commissioner prior to audit shall represent a provisional rate until an
					 audit is performed and completed, at which time such rate or adjusted rate
					 shall represent the audit rate.
(c)
					 Rate revisions resulting from audits shall be retroactive to the audited rate
					 period or periods. Any resulting overpayments or underpayments shall be
					 corrected by retroactive adjustment of the provisional rate paid, based upon
					 the period audited.
(d) The
					 commissioner may promulgate rate revisions based upon audits completed by the
					 department or other State agencies. Unless otherwise indicated, such audits
					 shall not be considered final and shall not preclude conduct of a complete
					 audit by the Department of Health, Department of Social Services or their
					 agents.
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 86-4.7 - Title xviii (medicare) certification

Current through Register Vol. 46, No. 28, July 10, 2024
Any facility eligible for title XVIII (Medicare)
						certification providing services to patients insured under title XIX which is
						not, or ceases to be, a title XVIII provider of care shall have its current
						reimbursement rate reduced by 10 percent. This rate reduction may remain in
						effect until the first day of the month following certification of such a
						provider by the title XVIII program. Such rate reductions shall be in addition
						to any revision of rates based on audit exceptions.
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 86-4.8 - 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 86-4.9 - Units of service

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 unit of service used to establish rates of payment shall be the threshold
					 visit, except for dialysis, abortion, sterilization services and free-standing
					 ambulatory surgery, for which rates of payment shall be established for each
					 procedure. For methadone maintenance treatment services, the rate of payment
					 shall be established on a fixed weekly basis per recipient.
(b) A threshold visit, including all
					 part-time clinic visits, shall occur each time a patient crosses the threshold
					 of a facility to receive medical care without regard to the number of services
					 provided during that visit. Only one threshold visit per patient per day shall
					 be allowable for reimbursement purposes, except for transfusion services to
					 hemophiliacs, in which case each transfusion visit shall constitute an
					 allowable threshold visit.
(c) The
					 following shall not constitute threshold visits within the meaning of
					 subdivisions (a) and (b) of this section:
(1)
					 visits solely for the purpose of receiving ordered ambulatory
					 services;
(2) visits solely for the
					 purpose of receiving pharmacy services;
(3) visits solely for the purpose of
					 receiving nutrition services;
(4)
					 visits solely for the purpose of receiving respiratory therapy;
(5) visits solely for the purpose of
					 receiving recreation therapy;
(6)
					 visits solely for the purpose of receiving medical social services, except for
					 clinical social worker psychotherapy services as defined in subdivision (g) of
					 this section;
(7) visits solely for
					 the purpose of receiving group services, except for clinical group
					 psychotherapy services in accordance with the provisions of subdivision (h) of
					 this section;
(8) offsite services,
					 defined as medical services provided by a facility's clinic staff at locations
					 other than those operated by and under the licensure of the facility, or visits
					 related to the provision of such offsite services, except in accordance with
					 the provisions of subdivision (i) 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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.10 - Minimum utilization standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purpose of determining the number
					 of threshold visits to be used in the computation of basic rates, the
					 commissioner shall establish minimum utilization standards as provided in this
					 section. Such standards shall be based upon an assessment of visits per
					 full-time equivalent for health care personnel. A full-time equivalent (FTE)
					 shall be based upon a 35-40 hour week.
(b) For the comprehensive primary care
					 facilities, threshold visits shall be imputed at:
(1) 3,500 visits per year per FTE for the
					 services of physicians and physician specialists;
(2) 3,000 visits per year per FTE for the
					 services of dentists;
(3) 2,100
					 visits per year per FTE for the services of other health care providers, such
					 as physician's assistants, licensed midwives, nurse practitioners and dental
					 hygienists;
(4) 2,100 visits per
					 year per FTE for the services of therapists, such as speech, occupational and
					 physical therapists;
(5) 1,500
					 visits per year per FTE for the services of mental health counselors.
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 86-4.11 - Computation of basic rate for facilities other than licensed free-standing ambulatory surgery centers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Rates
					 of payment for facilities other than licensed free-standing ambulatory surgery
					 centers shall be established on a prospective basis and shall be computed on
					 the basis of allowable fiscal and statistical data submitted by the facility
					 for the fiscal year ended at least 15 months prior to the year for which rates
					 are being set. Unless otherwise specified in this Subpart, the computed rates
					 shall be all-inclusive, taking into consideration total allowable costs and
					 total billable patient visits or procedures.
(b) Rates will be determined by applying
					 ceiling limitations to allowable operating costs, applying the trend factor to
					 the result, adding reimbursable capital costs, and dividing the sum by the
					 total number of visits or procedures. In the case of proprietary facilities, a
					 return on investment shall be added to reimbursable costs.
(c) Certification by the commissioner of
					 reimbursement rates of payment by governmental agencies for the period April 1,
					 1993 through March 31, 1994 shall be extended six months, through September 30,
					 1994, by applying the applicable trend factors. Rates of payment shall then be
					 for the fiscal-year period October 1st through September 30th. Approval by the
					 commissioner of reimbursement rates for article 43 corporations shall be for
					 the periods specified in the reimbursement formula approved by the 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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.13 - Groupings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purpose
					 of establishing reimbursable operating costs, facilities shall be compared on
					 the basis of the following general criteria:
(1) similarity of services; and
(2) regional economic factors.
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 86-4.14 - Ceilings on payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Reimbursement rate ceilings for the administrative cost center, the patient
					 transportation cost center and for comparable patient care cost centers shall
					 be established for facilities. Comparable patient care cost centers shall
					 include, but not be limited to, the following:
(1) ancillary services cost center (clinical
					 laboratory, pharmacy and diagnostic radiology services);
(2) medical services cost center;
(3) dental services cost center;
					 and
(4) therapy services cost
					 centers.
For a facility which provides limited primary medical
						care services as defined in section
						86-4.13(b)(2) 
						of this Subpart, the administrative and patient care costs incurred by the
						facility to provide such limited primary medical care services shall be
						excluded from the costs used to determine the ceilings for the facility's peer
						group. Reimbursement specific to limited primary medical care services will be
						established for the facility. The ceilings on costs related to limited primary
						medical care services will be determined based on the cost experience of
						facilities which provide limited primary medical 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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.15 - Calculation of trend factor

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 commissioner shall establish trend factors to project increases in allowable
					 operating costs during the effective period of the reimbursement
					 rate.
(b) To determine trend
					 factors, the elements of facilities' costs shall be weighted based upon data
					 for salaries, employee health and welfare expense, nonpayroll administrative
					 and general expense, nonpayroll household and maintenance expense, and
					 nonpayroll professional care expense. Each weight shall be adjusted by one or
					 more price indices. Included among these indices are elements of the United
					 States Department of Labor consumer and producer price indices and special
					 indices developed by the commissioner for this purpose.
(c) The projected trend factors shall be
					 updated on an annual basis, based upon then current and available data. The
					 commissioner shall adjust subsequent trend factors based upon such
					 update.
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 86-4.16 - Revisions in certified rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The commissioner shall consider only those applications for prospective
					 revisions of certified or approved rates which are in writing and which address
					 one or more of the issues set forth in this section.
(b) Errors, whether mathematical or clerical,
					 made by the department or an article 43 corporation in the rate calculation
					 process or in the development of group ceilings, and errors, whether
					 mathematical or clerical or otherwise, in data submitted by a facility, when
					 the revised data submitted meet the same certification requirements as the
					 original data, may be the basis for an application for prospective revision of
					 a certified or approved rate. Such errors may include, but shall not be limited
					 to, the following areas related to the development of reimbursable costs:
(1) funding of depreciation, capital costs,
					 patient visits/procedures; and
(2)
					 nonallowable costs, such as revenue recoveries. Applications pursuant to this
					 subdivision must be submitted within 120 days of receipt of the applicable
					 title XIX or article 43 corporation program initial rate computation sheet. Any
					 modified rate certified or approved pursuant to this paragraph shall be
					 effective the first day of the rate period. If not commenced within 120 days of
					 receipt of the commissioner's initial rate computation sheet, a rate appeal
					 pursuant to this subdivision may be initiated at time of audit of the base-year
					 cost figures upon or prior to receipt of the notice of program reimbursement.
					 Such rate appeals shall be recognized only to the extent that they are based
					 upon mathematical or clerical errors in cost and/or statistical data originally
					 submitted by the facility, or revisions initiated by a third-party fiscal
					 intermediary or, in the case of a governmental facility, by the sponsor
					 government, or mathematical or clerical errors made by the Department of
					 Health. Such notice of appeal must be presented in writing prior to or at the
					 exit conference for such audits.
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 86-4.17 - Appeal process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
					 application by a facility for review of a certified or approved rate pursuant
					 to section
					 86-4.16 
					 of this Subpart shall be submitted to the bureau for staff review and shall set
					 forth the basis for the appeal and the issues of fact. Documentation shall
					 accompany the application, where appropriate, and the department may request
					 such additional documentation as is necessary for determination of the issues.
					 The affirmation or revision of the rate based upon such staff review shall be
					 final unless, within 30 days of its receipt, a hearing before a rate review
					 officer is requested by registered or certified mail. The request shall contain
					 a statement of the factual issues to be resolved. The facility may submit
					 memoranda on legal issues which it deems relevant to the appeal.
(b) Where the rate review officer determines
					 that there is no actual issue, the request for a hearing shall be denied and
					 the facility shall be notified of such determination. No administrative appeal
					 shall be available from this determination. Where the rate review officer
					 determines that there is a factual issue, a notice of hearing shall be issued
					 establishing the date, time and place of the hearing and setting forth the
					 factual issues as determined by such officer. The hearing shall be held in
					 conformity with the provisions of section 12-a  of the Public Health Law and the State
					 Administrative Procedure Act.
(c)
					 The recommendation of the rate review officer shall be submitted to the
					 Commissioner of Health for final approval or disapproval and recertification of
					 the rate where appropriate.
(d) In
					 reviewing appeals for revisions to certified or approved rates, the
					 commissioner may refuse to accept or consider an appeal from a facility:
(1) which is providing an unacceptable level
					 of care as determined after review by the State Hospital Review and Planning
					 Council;
(2) which is operated by
					 management determined by the department to be providing an acceptable level of
					 care in one of its facilities as determined after review by the State Hospital
					 Review and Planning Council;
(3)
					 where it has been determined by the commissioner that the operation is being
					 conducted by a person or persons not properly established in accordance with
					 the Public Health Law; or
(4) where
					 a fine or penalty has been imposed on the facility and such fine or penalty has
					 not been paid.
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 86-4.18 - 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 86-4.19 - Rates for facilities without adequate cost experience

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A facility shall be deemed to be without
					 adequate cost experience when fiscal and statistical data necessary for setting
					 a rate are unavailable through no fault of the operator or his or her agents,
					 and due to circumstances beyond his or her control, or in the instance of a
					 newly licensed facility or in the instance of a new service for which
					 certificate of need (CON) approval has been received as required by law. The
					 rates certified for a facility without adequate cost experience shall be
					 determined on the basis of:
(1) the rates
					 established for comparable services or facilities in the geographic
					 area;
(2) reasonable and complete
					 cost projections based on estimated costs and statistics contained in a
					 proposed annual budget for the new service or newly licensed facility, reviewed
					 for adequacy and reasonableness of the proposed operation, including but not
					 limited to utilization, as compared to standards established in section
					 86-4.10 
					 of this Subpart, staffing, and salaries;
(3) actual allowable expenditures and
					 statistics for prior or subsequent cost reporting periods; and/or
(4) existing ceilings.
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 86-4.20 - Capital cost reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
The capital cost of a facility for purposes of
						determining and certifying the capital cost component of a rate shall be
						determined and computed in accordance with the provisions of sections
						86-4.23
						through
						86-4.26 
						of this Subpart, and shall be certified and audited as actually having been
						expended. Capital costs shall not be trended or held to operating cost ceilings
						pursuant to sections
						86-4.15
						and
						86-4.14,
						respectively.
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 86-4.22 - Recoveries of expense

Current through Register Vol. 46, No. 28, July 10, 2024
Operating costs shall be reduced by the cost of services
						and activities which are not properly chargeable to patient care. In the event
						that the commissioner determines that it is not practical to establish the
						costs of such services and activities, the income derived from them may be
						substituted for their costs. The activities and services covered by this
						provision include, but are not limited to:
(a) drugs and supplies sold to other than
					 facility patients;
(b) telephone
					 and telegraph services for which a charge is made;
(c) discount on purchases;
(d) sale of scrap;
(e) employee cafeterias;
(f) vending machines;
(g) operation of parking facilities for
					 community convenience;
(h) lease of
					 office and other space to concessionaires; and
(i) sale of silver from X-ray
					 films.
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 86-4.23 - Depreciation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Allowable
					 depreciation shall be limited to those assets which are used for purposes of
					 providing or supporting direct patient care. Reported depreciation based on
					 historical cost is recognized as a proper element of cost. Useful lives for
					 assets purchased after 1991 shall be the higher of the reported useful life or
					 those useful lives from the Estimated Useful Lives of Depreciable Hospital
					 Assets, 1988 edition, American Hospital Association, consistent with title
					 XVIII provisions. Useful lives for assets purchased prior to 1991 shall be
					 determined by use of the 1983 edition. Copies of these publications are
					 available from the American Hospital Association, 840 North Lake Shore Drive,
					 Chicago, IL 60611, and copies are available for inspection and copying at the
					 offices of the Records Access Officer of the Department of Health, Corning
					 Tower Building, Empire State Plaza, Albany, NY 12237.
(b) In the computation of rates for voluntary
					 facilities, depreciation shall be included on a straight-line method on plant
					 and nonmovable equipment. Depreciation on movable equipment may be computed on
					 a straight-line method on accelerated under a double declining balance or
					 sum-of-the-years' digits method.
(1)
					 Voluntary facilities shall fund depreciation unless the commissioner
					 determines, upon application by the facility and after inviting written
					 comments from interested parties, that a waiver of the requirement for funding
					 is necessary and in the public interest. Funding shall mean the transfer of
					 monies to the funded accounts. Board-designated funds and the accrual of
					 liabilities to the funded depreciation accounts shall not be recognized as
					 funding of depreciation. Deposits to the funded depreciation accounts must
					 remain in such accounts for six months or more to be considered as valid
					 funding transactions unless expended for the purposes for which the account was
					 funded.
(2) Funding for plant and
					 fixed equipment shall 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.
(3) Depreciation on major
					 movable equipment shall be funded in the year revenue is received from the
					 reimbursement of each expense and in the amount included in reimbursement for
					 that year.
(4) Such funds may be
					 used only for capital expenditures with approval as required for the
					 amortization of capital indebtedness.
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 86-4.24 - Interest

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
					 facilities.
(b) To be considered an
					 allowable cost, interest must 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. The interest must be paid to a
					 lender not related through control, ownership, affiliation or personal
					 relationship to the borrower. 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 incomeshall 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.
					 Investment income shall reduce interest expense allowed for reimbursement as
					 follows:
(1) for all medical facilities,
					 investment income shall first be used to reduce operating interest expense for
					 that year;
(2) any remaining amount
					 of investment income, after application of paragraph (1) of this subdivision,
					 shall be used to reduce capital interest expense reimbursed that year for
					 medical facilities; and
(3) any
					 remaining amount of investment income after application of paragraph (2) of
					 this subdivision 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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.25 - Return on investment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
					 computing the allowable costs of a proprietary facility, there shall be
					 included an allowance for a reasonable return on the average equity capital
					 representing the owner's investment for the provisions of patient care. The
					 percentage to be used in computing the allowance shall be a rate determined
					 annually by the commissioner to be reasonably related to the then current money
					 market.
(b) Equity capital is the
					 net worth of the provider adjusted for those assets and liabilities which are
					 not related to the provision of patient care. Equity capital consists of the
					 provider's investment in plant, property and equipment, net of depreciation and
					 noncurrent debt related to the investment or deposited funds, and net working
					 capital for necessary and proper operation of patient care
					 activities.