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 86-10 - Rates for Non-state Providers of Residential Habilitation in Community Residences, Including Individualized Residential, Including Individualizad Residential Alternatives (iras) and for Non-state Providers of Day Habilitation › Section 86-10.6 - 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 12 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 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 the
						department 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. For the
					 period beginning July 1, 2014 through June 30, 2015, retainer days shall be
					 reimbursed at zero dollars.
(2)
Therapeutic leave days
shall mean days during which an
					 individual is away from the community residence and is not receiving services
					 from residential habilitation staff, and the absence is for the purpose of
					 visiting with family or friends, or a vacation. Therapeutic leave days shall be
					 reimbursed at the level described in subdivision (a) of this section.
(3)
Vacant bed days
shall
					 mean days for which the provider is unable to bill due to a resident moving
					 from one residential site to another, or due to a resident passing away.
At the midpoint of the initial period and again at the
						conclusion of the period ending June 30, 2015, the department 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. Providers shall
						not be paid for more than 14 retainer days per annual period for any one
						individual. Providers will be paid for vacant bed days at 75 percent of the
						level described in subdivision (a) of this section, up to a maximum of 90 days
						per bed.