reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-6 - Hospices › Section 86-6.4 - Reporting requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each
					 hospice provider shall complete and file with the New York State Department of
					 Health and/or its agent, financial and statistical reports as deemed necessary
					 by the Commissioner of Health on forms supplied by the department. In instances
					 where the hospice is a component part of a larger organization, the cost and
					 statistics related to the operation of the hospice shall be separately
					 maintained from the operator's other activities.
(b) Completion of such financial and
					 statistical reporting forms shall be in accordance with generally accepted
					 accounting principles as applied to the hospice, unless the reporting
					 instructions authorize specific variation in such principles.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-6 - Hospices › Section 86-6.5 - Trend factor

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 commissioner shall establish trend factors to project annual increases in the
					 costs of hospice services. Each payment rate for the categories of hospice
					 care, as established pursuant to the provisions of section
					 86-6.2 
					 of this Subpart, shall be trended each year by the trend factors developed in
					 accordance with the provisions of this section.
(b) The elements of certified home health
					 agencies' costs shall be weighted based upon data for the categories listed
					 below in developing the trend factor that will be applied to the routine and
					 continuous home care rates. The elements of general hospitals' costs shall be
					 weighted based upon data for the categories listed below in developing the
					 trend factor that will be applied to the inpatient and respite care rates:
(1) salaries;
(2) employee health and welfare
					 expense;
(3) nonpayroll
					 administrative and general expense;
(4) nonpayroll household and maintenance
					 expense;
(5) nonpayroll
					 professional care expense.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-6 - Hospices › Section 86-6.6 - Supplemental financial assistance program

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The supplemental financial assistance
					 program provides enhanced payments to patients with special needs as defined in
					 section
					 86-6.1(k) 
					 of this Subpart using payment rates established pursuant to section
					 86-6.2(g) 
					 of this Subpart.
(b) To receive the
					 enhanced Medicaid payment rates as set forth in section 86- 6.2(g) of this
					 Subpart, a hospice must:
(1) meet all
					 certification requirements pursuant to article 40 of the Public Health
					 Law;
(2) continue efforts to obtain
					 financial support from public and community funding sources;
(3) make a reasonable effort to collect
					 payments for services from third party insurance payers, governmental payers
					 and self paying patients;
(4)
					 establish a reasonable relationship between costs and charges, or establish
					 charges at approximate costs; and
(5) with respect to the enhanced payment
					 rates for escort services, provide the commissioner with an acceptable written
					 plan explaining how escort services will be used by each agency which may be
					 billing the routine home care rates with escort.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-6 - Hospices › Section 86-6.7 - Hospice reimbursement for room and board provided to patients residing in a nursing facility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Daily
					 payment will be made to a hospice for Medicaid eligible patients who have
					 elected the hospice benefit and reside in a nursing facility (see
					 42 USC
					 1396 a [a][13][D]). Payment shall be made for
					 a hospice patient to take into account the room and board furnished by the
					 nursing facility and will be in an amount equal to 95 percent of the facility
					 rate that would have been paid by the State to the facility in accordance with
					 the applicable provisions of Subpart 86-2 of this Part, if the patient had not
					 elected to receive hospice care. A hospice cannot bill for this additional
					 amount on a day in which the patient who has elected hospice care is receiving
					 either general inpatient or inpatient respite care. Patients covered under
					 provisions set forth in this section must be patients who would be eligible
					 under Medicaid for nursing facility services if he/she had not elected to
					 receive hospice care.
(b) To be
					 eligible to receive Medicaid payment as set forth in subdivision (a) of this
					 section, a hospice must have a written agreement with a nursing facility under
					 which the hospice takes full responsibility for the professional management of
					 the patient' s hospice care, and the nursing facility agrees to provide room
					 and board to the patient, collect any patient payment contributions, and
					 maintain an accounting of the patient's financial contribution.
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 86-7 - Assisted Living Program › Section 86-7.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart, the following words shall have
						the following meanings:
(a) Assisted
					 living program shall mean an entity as defined in paragraph (a) of subdivision
					 (1) of section 461-1 of the Social Services Law.
(b) Services shall mean all services for
					 which full payment to an assisted living program is included in the rate of
					 payment which shall consist of the following: nursing services, personal care
					 services, home health aide services, physical therapy, occupational therapy,
					 speech therapy, medical supplies and equipment not requiring prior approval,
					 personal emergency response services and adult day health care in a program
					 approved by the commissioner and which the assisted living program shall
					 provide directly, or arrange for the provision of, through contract(s) with a
					 social services district, a long term home health care program or a certified
					 home health agency, or other qualified providers.
(c) Patient classification groups shall mean
					 patient categories contained in the classification system, Resources
					 Utilization Groups-II (RUG-II), which identifies the relative resource
					 consumption required by different types of residential health care facility
					 (RHCF) patients as specified in Appendix 13- A, infra.
(d) Regions shall mean the 16 regions within
					 the State into which residential health care facilities are grouped, by county,
					 as identified in Appendix 13-A, infra.
(e) Rate of payment shall mean the capitated
					 per diem rate of reimbursement established pursuant to this Subpart for
					 governmental agencies for services provided directly by an assisted living
					 program or provided through contract(s) with eligible providers.
(f) Per diem shall mean the unit of measure
					 denoting services rendered to one patient between the census taking hour on two
					 successive days. In computing per diems, the day of admission shall be counted
					 but not the day of discharge. When a patient is admitted and discharged on the
					 same day, this period shall be counted as one per diem.
(g) Roll factor shall mean the cumulative
					 result of multiplying one year's trend (inflation) factor times one or more
					 other year's trend factor which is used to inflate costs from a base period to
					 a rate period.
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 86-7 - Assisted Living Program › Section 86-7.2 - Computation of the rate of payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For each region, a rate of payment shall
					 be established for each of the 16 patient classification groups. The rate of
					 payment shall be established for the calendar year 1992. For each subsequent
					 calendar year, the 1992 rate of payment shall be increased by a roll factor as
					 determined pursuant to section
					 86-7.3 
					 of this Subpart.
(b)
(1) For purposes of this Subpart, the rate of
					 payment shall be related to an average residential health care facility rate
					 consisting of two components:
(i) direct
					 component; and
(ii) other than
					 direct component.
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 86-7 - Assisted Living Program › Section 86-7.3 - Adjustments to rate of payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 For the calendar year 1992, for each region, the direct component as identified
					 in section
					 86-7.2(b)(2) 
					 of this Subpart and the mean indirect price per day divided by the regional
					 indirect input price adjustment factor for the patient classification group as
					 identified in section
					 86-7.2(b)(3) 
					 of this Subpart shall be trended to 1992 by a roll factor to project allowable
					 cost increases for the rate period. The trend factors used in the calculation
					 of the roll factor shall be determined in a manner consistent with the
					 methodology set forth in section
					 86-2.12 
					 of this Part. A weighted average roll factor shall be calculated for each
					 region. Relative weights shall be assigned to each trend factor group within
					 the region and shall be based upon the aggregate operating portion of RHCF
					 rates as defined in section
					 86-2.10(a)(7) 
					 of this Part using the initial July 1, 1992 RHCF rate certified by the
					 commissioner pursuant to section 2807 (3)  of the Public
					 Health Law times the 1990 RHCF's patient days. The weighted average roll factor
					 for each region shall be calculated by multiplying the weights for each trend
					 factor group within each region times the respective July 1, 1992 roll factors
					 determined pursuant to section
					 86-2.12 
					 of this Part excluding prospective adjustments made pursuant to section 86-
					 2.12(f).
(b) For calendar years
					 beginning January 1, 1993 and on January 1st of each subsequent year, the 1992
					 rate of payment as identified in section
					 86-7.2(c) 
					 of this Subpart shall be increased by a roll factor to project allowable cost
					 increases for the rate period. The trend factor(s) used in the calculation of
					 the roll factor shall be determined in a manner consistent with the methodology
					 set forth in section
					 86-2.12 
					 of this Part. A weighted average roll factor shall be calculated for each
					 region. The weighted average roll factor for the rate period shall be computed
					 utilizing the weights developed from the computation in subdivision (a) of this
					 section adjusted to reflect any changes in trend factor groups made pursuant to
					 section
					 86-2.12 
					 of this Part. The regional weighted average roll factor for the rate period
					 shall also include the prospective annual adjustments to the RHCF trend factors
					 made pursuant to section
					 86-2.12(f).
(c) The rate of payment shall not exceed
					 customary charges to the general public.
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 86-7 - Assisted Living Program › Section 86-7.4 - Federal financial participation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart shall be effective if, and
					 as long as, Federal financial participation is available for medical assistance
					 expenditures made pursuant to 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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.1 - Scope

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
					 shall govern Medicaid rates of payments for ambulatory care services provided
					 in the following categories of facilities for the following periods:
(1) outpatient services provided by general
					 hospitals on and after December 1, 2008;
(2) emergency department services provided by
					 general hospitals on and after January 1, 2009;
(3) ambulatory surgery services provided by
					 general hospitals on and after December 1, 2008;
(4) ambulatory services provided by
					 diagnostic and treatment centers on and after September 1, 2009;
(5) ambulatory surgery services provided by
					 free-standing ambulatory surgery centers on and after September 1, 2009;
					 and
(6) hospital-based mental
					 hygiene services on and after July 1, 2010, including:
(i) mental retardation clinics;
(ii) mental health clinics;
(iii) alcoholism and drug abuse clinics and
					 outpatient rehabilitation; and
(iv)
					 methadone clinics.
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.3 - Recordkeeping, reports and audits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General hospitals whose rates of payments
					 are governed by this Subpart shall:
(1)
					 continue to maintain financial and statistical data and records in accordance
					 with otherwise applicable statutes and regulations, including, but not limited
					 to, regulations as set forth in Subpart 86-1 of this Part;
(2) continue to submit to the department all
					 cost reports and other information in accordance with otherwise applicable
					 statutes and regulations, including, but not limited to, regulations as set
					 forth in Subpart 86-1 of this Part;
(3) continue to have all books and records
					 subject to audit in accordance with otherwise applicable statutes and
					 regulations, including, but not limited to, regulations as set forth in Subpart
					 86-1 of this Part.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.4 - Capital cost reimbursement and rate add-ons

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A capital cost component shall be added
					 to Medicaid payments made pursuant to this Subpart and computed in accordance
					 with the following:
(1) the computation of
					 the capital cost component for payments for general hospital outpatient and
					 emergency services shall remain subject to otherwise applicable statutory
					 provisions as set forth in subparagraphs (i) and (ii) of paragraph (g) of
					 subdivision 2 of section 2807  of the Public Health Law;
(2) the computation of the capital cost
					 component for payments for diagnostic and treatment center services shall
					 remain subject to otherwise applicable statutory provisions as set forth in
					 paragraph (b) of subdivision 2 of section 2807  of the Public Health Law;
(3) the computation of the capital cost
					 component for payments for ambulatory surgery services provided by
					 hospital-based and free-standing ambulatory surgery centers shall be the result
					 of dividing the total amount of capital cost reimbursement paid to such
					 facilities pursuant to section
					 86-4.40 
					 of this Part for the 2005 calendar year for the upstate region and for the
					 downstate region and then dividing each such regional total amount by the total
					 number of claims paid pursuant to section
					 86-4.40 
					 of this Part within each such region for the 2005 calendar year.
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.5 - Administrative rate appeals

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Administrative rate appeals of rates of payment issued pursuant to this Subpart
					 must be submitted to the department in writing within 120 days of the date such
					 rates are published by the department to the facility. Such rate appeals must
					 set forth in detail the basis for such appeal and be accompanied by any
					 relevant documentation. thereafter the department shall respond to such rate
					 appeals in writing and shall either affirm the original rates, revise such
					 rates or request additional information. A failure to respond to the
					 department's request for additional information within 30 days shall be deemed
					 to constitute the withdrawal, with prejudice, of the facility's rate appeal,
					 provided, however, that the department may extend that time period upon a
					 request by the facility and for good cause shown. Upon its receipt of the
					 requested additional information the department shall issue a written
					 determination of such rate appeal.
(b) The department's written determination of
					 a facility's rate appeal shall be deemed final unless the facility submits a
					 written request for further consideration of the rate appeal within 30 days of
					 the date the department issued such written determination, provided, however,
					 that if such written determination advises the facility that its rate appeal is
					 being denied on the ground that the appeal constitutes a challenge to the
					 rate-setting methodology set forth in this subpart such denial shall be deemed
					 to be the department's final administrative determination with regard to such
					 appeal and there shall be no further administrative review available. the
					 department shall otherwise respond in writing to the facility's request for
					 further consideration and either affirm or revise its original rate appeal
					 determination and this response by the department shall be deemed its final
					 administrative determination with regard to such rate appeal.
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.6 - Rates for new facilities during the transition period

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General hospital outpatient clinics which
					 commence operation after December 31, 2007 and prior to January 1, 2012, and
					 for which rates computed pursuant to Public Health Law section 2807(2) are not
					 available shall have the capital cost component of their rates based on a
					 budget as submitted by the facility and as approved by the department and shall
					 have the operating component of their rates computed in accordance with the
					 following:
(1) for the period December 1,
					 2008 through November 30, 2009, 75 percent of such rates shall reflect the
					 historical 2007 average payment per visit as calculated by the department, and
					 25 percent of such rates shall reflect APG rates as computed in accordance with
					 this Subpart;
(2) for the period
					 December 1, 2009 through December 31, 2010, 50 percent of such rates shall
					 reflect the historical 2007 average payment per visit as calculated by the
					 department, and 50 percent of such rates shall reflect APG rates as computed in
					 accordance with this Subpart;
(3)
					 for the period January 1, 2011 through December 31, 2011, 25 percent of such
					 rates shall reflect the historical 2007 average payment per visit as calculated
					 by the department, and 75 percent of such rates shall reflect APG rates as
					 computed in accordance with this Subpart;
(4) for periods on and after January 1, 2012,
					 100 percent of such rates shall reflect APG rates as computed in accordance
					 with this Subpart;
(5) for the
					 purposes of this subdivision, the historical 2007 regional average payment per
					 visit shall mean the result of dividing the total facility specific Medicaid
					 reimbursement paid for general hospital outpatient clinic claims paid in the
					 2007 calendar year in the applicable upstate or downstate region for all rate
					 codes reflected in the APG rate-setting methodology except those specifically
					 excluded pursuant to section
					 86-8.10 
					 of this Subpart, divided by the total visits on claims paid under such rate
					 codes.
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.7 - Section 86-8.7 apgs and relative weights

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The table of APG weights, procedure based
					 weights and units, and APG fee schedule fees and units for each effective
					 period are published on the New York State Department of Health website at:
					 http://www.health.state.ny.us/health_
					 care/medicaid/rates/apg/docs/apg_payment_components.xls
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.8 - Base rates

Current through Register Vol. 46, No. 28, July 10, 2024
Base rates shall be developed by the department for each
						category of providers set forth in section
						86-8.1(a) 
						of this Subpart, in accordance with the following:
(a) Separate base rates for each category of
					 provider shall be established based on the location of such providers in the
					 upstate region or the downstate region and such base rates shall reflect
					 differing regional cost factors as determined by the department.
(b) Additional discrete base rates may be
					 developed by the department for such peer groups as may be established by
					 regulation in this Subpart. Such base rates shall include a MR/DD/TBI peer
					 group for hospital clinics for periods commencing on and after July 1, 2010 and
					 a MR/DD/TBI peer group for free-standing clinics which may be established for
					 rate periods commencing on or after January 1, 2011.
(c) Such base rates shall be established
					 based on estimated historical per visit payment amounts, as adjusted to reflect
					 the level of State appropriations made available for such purposes. Such
					 adjustments shall be calculated on a per visit basis, utilizing the same
					 historical visit volume used to calculate the estimated per visit payment
					 amounts.
(d) Such base rates shall
					 be peer group specific and shall reflect the estimated case mix index for each
					 peer group and any projected changes in provider coding patterns for each peer
					 group.
(e) Such base rates may be
					 periodically adjusted to reflect changes in provider coding patterns and case
					 mix.
(f) For hospital clinics
					 operating under a Mental Hygiene Law license and instituting utilization of the
					 APG reimbursement methodology, the applicable blend rate calculation shall be
					 determined on a licensure-specific and provider-specific basis and shall be
					 based on the most recent 12-month period for which accurate and complete
					 billing information exists, as determined by the commissioner of the Mental
					 Hygiene Law agency having jurisdiction over that class of provider. Such
					 clinics shall have the blend rate otherwise computed and applied on the same
					 schedule as applies to Public Health Law article 28 - licensed hospital clinics
					 pursuant to paragraph (a) of subdivision 2-a of section 2807  of the Public Health 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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.9 - Diagnostic coding and rate computation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Facilities shall assign ICD-9 diagnostic
					 codes and HCPCS/CPT procedure codes to each claim as appropriate and shall
					 submit such information to the department or the department's designee in
					 accordance with written billing and reporting instructions issued by the
					 department. the department shall utilize such claim coding information to
					 assign each the applicable APG or APGs for each patient visit identified on the
					 claim, utilizing the APG software system to determine the significant procedure
					 APG or the medical visit APG, the applicable ancillary services APGs and the
					 final APG weight applicable to each such visit. the APG software system shall
					 incorporate methodologies for consolidation, packaging and discounting to be
					 reflected in the final APG weight to be assigned to each visit on the
					 claim.
(b) The operating component
					 of the payment rate for each patient shall be computed by multiplying the final
					 APG weight for each visit, as computed in accordance with subdivision (a) of
					 this section, by the applicable base rate, as determined in accordance with
					 section
					 86-8.7 
					 of this Subpart. A capital component shall then been added to each such payment
					 rate in accordance with the provisions of section
					 86-8.4 
					 of this Subpart.
(c) Drugs
					 purchased under the 340B drug benefit program and billed under the APG
					 reimbursement methodology shall be reimbursed at a reduced rate comparable to
					 the reduced cost of drugs purchased through the 340B drug benefit
					 program.
(d) In cases where the
					 only reimbursable APGs for a visit are one or more of the following APGs, there
					 shall be no reimbursement for capital costs included in the payment for that
					 visit.
94 CARDIAC REHABILITATION
274 PHYSICAL THERAPY, GROUP
275 SPEECH THERAPY AND EVALUATION, GROUP
322 MEDICATION ADMINISTRATION AND OBSERVATION
414 LEVEL I IMMUNIZATION AND ALLERGY IMMUNOTHERAPY
415 LEVEL II IMMUNIZATION
416 LEVEL III IMMUNIZATION
428 PATIENT EDUCATION, INDIVIDUAL
429 PATIENT EDUCATION, GROUP
451 SMOKING CESSATION TREATMENT
(e) The following APGs shall be designated as
					 "no blend APGs" and shall have their payments calculated solely under the APG
					 reimbursement methodology.
94 Cardiac Rehabilitation
310 Developmental & Neuropsychological Testing
312 Full Day Partial Hospitalization for Mental
						Illness
321 Crisis Intervention
414 Level I Immunization and Allergy Immunotherapy
415 Level II Immunization
416 Level III Immunization
426 Medication Management
428 Patient Education, Individual
429 Patient Education, Group
448 After Hours Services
451 Smoking Cessation Treatment
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.11 - System updating and incorporation by reference

Current through Register Vol. 46, No. 28, July 10, 2024
(a) the following elements of the APG
					 rate-setting system shall be updated no less frequently than annually:
(1) the listing of reimbursable APGs subject
					 to this Subpart and the relative weight assigned to each such APG;
(2) the base rates;
(3) the applicable ICD-9 codes utilized in
					 the APG software system;
(4) the
					 applicable CPT-4/HCPCS codes utilized in the APG software system;
(5) the APG software system
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.12 - Payments for extended hours of operation

Current through Register Vol. 46, No. 28, July 10, 2024
for visits occurring on and after January 1, 2009, by
						hospital outpatient clinics and diagnostic and treatment centers otherwise
						subject to this Subpart, which are scheduled and occur on evenings, weekends
						and holidays as defined by the department, a supplemental APG payment amount,
						as determined in accordance with section
						86-8.7 
						of this Subpart, shall be added on to the otherwise applicable payment amount
						for each such visit.
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.13 - Out-of-state providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Rates
					 for services specified in section
					 86-8.1(a) 
					 of this Subpart provided in outpatient facilities located outside New York
					 state shall be as follows:
(1) rates in effect
					 for similar services for providers located in the downstate region of New York
					 State shall apply with regard to services provided by out-of-state providers
					 located in the New Jersey Counties of Sussex, Passaic, Bergen, Hudson, Essex,
					 Union, Middlesex and Monmouth, in the Pennsylvania County of Pike, and in the
					 Connecticut Counties of Fairfield and Litchfield; and
(2) rates in effect for similar services for
					 providers located in the upstate region of New York State shall apply with
					 regard to all other out-of-state providers.
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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.14 - Non-apg payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Psychotherapy services by clinical social workers. To the extent authorized
					 pursuant to section 2807 (2-a)  of the Public
					 Health Law, payments for individual psychotherapy services provided by clinical
					 social workers, as defined by section
					 86-4.9  of this
					 Subpart, shall be established at $40.64 for encounters lasting between 20 and
					 30 minutes and at $62.33 for encounters lasting between 45 and 50 minutes and
					 at $69.93 for family therapy encounters lasting between 45 and 50
					 minutes.
(b) Wheelchair evaluation
					 services. Payments for comprehensive wheelchair evaluations, which shall
					 include assessments, fittings and training consisting of at least two hours of
					 direct patient care services, shall be established at $302.
(c) Eyeglasses dispensing. Payments for
					 dispensing eyeglasses shall be established at $89.77, plus capital, when such
					 service includes the cost of providing the eyeglasses and at $38.05, plus
					 capital, when such service does not include the cost of providing the
					 eyeglasses. the capital add-on per visit for each provider shall be the
					 provider's capital add-on per visit as otherwise calculated pursuant to
					 applicable provisions of section 2807 (2)  of the Public
					 Health 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 86-8 - Outpatient Services: Ambulatory Patient Group › Section 86-8.15 - Closures, mergers, acquisitions, consolidations, restructurings and inpatient bed de-certifications

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The commissioner may grant approval of a
					 temporary adjustment to the non-capital components of rates calculated pursuant
					 to this Subpart for eligible ambulatory care facilities licensed under article
					 28 of the Public Health Law (PHL).
(b) Eligible facilities shall include:
(1) facilities undergoing closure;
(2) facilities impacted by the closure of
					 other health care facilities;
(3)
					 facilities subject to mergers, acquisitions, consolidations or
					 restructuring;
(4) facilities
					 impacted by the merger, acquisition, consolidation or restructuring of other
					 health care facilities; or
(5)
					 outpatient facilities of general hospitals which have entered into an agreement
					 with the department to permanently decertify a specified number of staffed
					 hospital inpatient beds, as reported to the department.
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 86-9 - Limited Home Care Services Agencies › Section 86-9.1 - Services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reimbursement
					 is available under this Subpart only for the following services provided
					 directly by limited home care services agencies, licensed by the department
					 pursuant to section 3605  of the Public Health Law, to eligible
					 individuals who are residents of adult homes or enriched housing programs
					 certified in accordance with article seven of the Social Services Law:
(1) Level II personal care services, as
					 defined in 18 NYCRR section 505.14(a)(6)(ii), including related nursing
					 supervision, authorized and provided in accordance with rules and regulations
					 of the department, but not including Level I personal care services as defined
					 in 18 NYCRR section 505.14(a)(6)(i); and
(2) the administration of subcutaneous and/or
					 intramuscular injections and application of sterile dressings by a registered
					 professional nurse, including associated nursing tasks. Reimbursement is
					 available under this Subpart only for services provided by limited home care
					 services agencies which are not services that must be provided to residents of
					 adult homes or enriched housing programs pursuant to article seven of the
					 Social Services Law and rules and regulations of the department.
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 86-9 - Limited Home Care Services Agencies › Section 86-9.2 - Computation of the rates of payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For purposes of this Subpart, rates of
					 payment for Level II personal care services shall be calculated for two
					 regions: a downstate region to consist of Bronx, Kings, New York, Queens and
					 Richmond Counties and an upstate region to consist of all other counties in New
					 York State. For purposes of this Subpart, rates of payment for registered
					 professional nurse services shall be calculated for two regions: a downstate
					 region to consist of Rockland, Westchester, Nassau, Suffolk, Bronx, Kings, New
					 York, Queens and Richmond Counties and an upstate region to consist of all
					 other counties in New York State.
(b) For each region, the unit of measure for
					 which a limited home care services agency may bill for services rendered is a
					 quarter hour.
(c) For purposes of
					 this Subpart, the rate of payment for Level II personal care services for the
					 downstate region shall be the weighted average January 1, 1997 Level II
					 personal care rate for the downstate region. For purposes of this Subpart, the
					 rate of payment for Level II personal care services for the upstate region
					 shall be the weighted average January 1, 1997 Level II personal care rate for
					 the upstate region for direct care and training, capital, and criminal checks,
					 plus no more than 15 percent of such rate for administrative
					 expenses.
(d) For purposes of this
					 Subpart, the rate of payment for registered professional nurse services for the
					 downstate region for the administration of subcutaneous and/or intramuscular
					 injections and application of sterile dressings shall be the average January 1,
					 1997 fee established for nursing services rendered by a registered professional
					 nurse on a private practitioner basis for the downstate region. For purposes of
					 this Subpart, the rate of payment for registered professional nurse services
					 for the upstate region for the administration of subcutaneous and/or
					 intramuscular injections and application of sterile dressings shall be the
					 average January 1, 1997 fee established for nursing services rendered by a
					 registered professional nurse on a private practitioner basis for the upstate
					 region.
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 86-10.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
On and after November 1, 2014, rates of reimbursement for
						residential habilitation services provided in community residences, including
						IRAs, and for day habilitation services, other than those provided by the
						Office for People with Developmental Disabilities, shall be determined in
						accordance with 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 86-10 - 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 86-10.3 - Rates for residential habilitation services and for day habilitation services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) There
					 shall be one provider-wide rate for each provider of residential habilitation
					 service and one provider-wide rate for each provider of day habilitation
					 services, except that rates for residential habilitation or day habilitation
					 services provided to individuals identified as specialized populations by OPWDD
					 shall be determined under section
					 86-10.8 
					 of this Subpart. Adjustments may be made to the rate resulting from any final
					 audit findings or reviews.
(b)
(1) The State will set rates for Services
					 delivered to individuals with Developmental Disabilities as described below for
					 the following three services; effective July 1, 2019.
(i) Residential Habilitation - Supervised IRA
					 (Certified Site)
(ii) Residential
					 Habilitation - Supportive IRA (Certified Site)
(iii) Day Habilitation - Group and
					 Supplemental Group
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 86-10.4 - Reporting requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Providers shall report costs and maintain financial and statistical records in
					 accordance with 14 NYCRR Subpart 635-4.
(b)
Generally accepted accounting
					 principles (GAAP).
The completion of the financial and statistical report
						forms shall be in accordance with generally accepted accounting principles as
						applied to the provider unless the reporting instructions authorized specific
						variation in such principles. The State shall identify provider cost and
						providers shall submit cost data in accordance with generally accepted
						accounting principles (GAAP).
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 86-10.7 - 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
					 and/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 the
					 Department of Health its request by certified mail, return receipt requested,
					 within 90 days of the provider receiving the rate computation or with 90 days
					 of the first day of the rate period in question, whichever is later.
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 86-10.9 - Severability

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Subpart or its application to
						any person or circumstance is held to be invalid, the remainder of this Subpart
						and the application of that provision to other persons or circumstances will
						not be affected.
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 86-11 - Rate Setting for Non-state Providers: Intermediate Care Facilities for Persons with Developmental Disabilities › Section 86-11.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
On and after November 1, 2014, rates of reimbursement for
						intermediate care facilities for persons with developmental disabilities
						(ICF/DD) services, other than those provided by the Office for People With
						Developmental Disabilities, shall be determined in accordance with 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 86-11 - Rate Setting for Non-state Providers: Intermediate Care Facilities for Persons with Developmental Disabilities › Section 86-11.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart, the following terms shall have
						the following meanings:
(a)
Allowable costs.
Costs that are allowable under 14 NYCRR Subpart 635-6 or
						14 NYCRR section 681.14(f).
(b)
Base year.
The consolidated fiscal report period from which the
						initial period rate will be calculated. Such period shall be January 1, 2011
						through December 31, 2011 for providers reporting on a calendar year basis and
						July 1, 2010 through June 30, 2011 for providers reporting on a fiscal year
						basis.
(c)
Base
					 operating rate.
Reimbursement amount calculated by dividing annual
						reimbursement by applicable annual units of service, both in effect on June 30,
						2014.
(d)
Budget
					 neutrality adjustment.
Factor applied to adjust the proposed amount so that it
						is equivalent to the base amount of dollars.
(e)
Capital cost.
Costs that are related to the acquisition, lease,
						construction and/or long-term use of land, buildings and fixed equipment,
						leasehold improvements and vehicles.
(f)
Department of Health (DOH) regions.
Regions as defined by the department, assigned to
						providers based upon the geographic location of the provider's headquarters as
						reported on the consolidated fiscal report. Such regions are as follows:
(1) downstate: 5 boroughs of New York City,
					 Nassau, Suffolk and Westchester;
(2) Hudson Valley: Dutchess, Orange, Putnam,
					 Rockland, Sullivan, Ulster;
(3)
					 upstate Metro: Albany, Erie, Fulton, Genesee, Madison, Monroe, Montgomery,
					 Niagara, Onondaga, Orleans, Rensselaer, Saratoga, Schenectady, Warren,
					 Washington, Wyoming;
(4) upstate
					 Non-Metro: Any counties not listed in paragraph (1), (2) or (3) of this
					 subdivision.
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 86-11 - Rate Setting for Non-state Providers: Intermediate Care Facilities for Persons with Developmental Disabilities › Section 86-11.4 - Assessment

Current through Register Vol. 46, No. 28, July 10, 2024
Rates shall include the assessment described in section 43.04  of the Mental Hygiene
						Law.