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 86-2.31 - Recalibration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For rate years
					 1989, 1990 and 1991, notwithstanding any other provision of this Subpart and
					 subject to the provisions of paragraph (1) of this subdivision, payment rates
					 shall be adjusted in accordance with this subdivision to reflect a percentage
					 recalibration adjustment based on the change in each facility's case mix which
					 has been determined by the department to be due to factors other than changes
					 in patient population or condition. Such payment rate adjustments shall be
					 implemented utilizing the direct component of facility rates for such rate
					 years determined in accordance with sections
					 86-2.10
					 and
					 86-2.11 
					 of this Subpart.
(1) The percentage
					 recalibration adjustment provided for in this subdivision shall neither exceed
					 3.035 percent nor be less than 0 percent.
(2) The percentage recalibration adjustment
					 shall be calculated as follows for each facility.
(i) A statewide distribution of patients in
					 each patient classification group shall be determined by utilizing the patient
					 data for the assessment of all patients obtained in the patient assessment
					 period March 1, 1985 through September 30, 1985 (the 1985 period) conducted
					 pursuant to section
					 86-2.30 
					 of this Subpart.
(ii) The statewide
					 distribution of patients in each patient classification group shall be further
					 segregated by the following length of stay (LOS) groups.
(a) less than or equal to 90 days;
(b) greater than 90 days but less than or
					 equal to one year;
(c) greater than
					 1 year but less than or equal to two years;
(d) greater than two years but less than or
					 equal to three years;
(e) greater
					 than three years but less than or equal to four years;
(f) greater than four years but less than or
					 equal to five years; or
(g) greater
					 than five years.
(iii) A
					 statewide average initial case mix index for each LOS group for the 1985 period
					 shall be calculated by multiplying the initial distribution of patients in each
					 patient classification group within each LOS group times the case mix index for
					 each patient classification group as contained in Appendix 13-A herein and
					 dividing the sum of the results by the total number of patients in all patient
					 classification groups within each LOS group.
(iv) For each facility, a 1985 distribution
					 of patients in each patient classification group and a 1985 distribution of
					 patients by the LOS groups specified in subparagraph (ii) of this paragraph
					 shall be determined by utilizing the patient data for the assessment of all
					 patients obtained in the 1985 period, conducted pursuant to section
					 86-2.30 
					 of this Subpart. In the event a facility commenced operations after the patient
					 assessment period, March 1, 1985 through September 30, 1985 (the 1985 period)
					 but prior to January 1, 1988, or if the facility has the lesser of ten cases or
					 twenty percent of its patients in the distributions as determined in this
					 subparagraph for the 1985 period, or if the facility had undergone the
					 appointment of a receiver or the establishment of a new operator subsequent to
					 the 1985 period but prior to January 1, 1988 and had filed a new cost report in
					 accordance with the provisions of section
					 86-2.10(k) 
					 of this Subpart which was used in the calculation of the payment rate, the
					 distribution of patients to be used for the purposes of this subparagraph shall
					 be that distribution pertaining to the earliest full patient assessment period
					 conducted pursuant to section
					 86-2.30 
					 of this Subpart subsequent to the 1985 period or subsequent to the effective
					 date of the appointment of a receiver or the change in operator (the
					 "substituted 1985 period"), and such distribution shall be deemed the
					 facility's "substituted 1985 distribution" of patients for the calculations in
					 subparagraphs (vi) and (vii) of this paragraph. For purposes of this
					 subparagraph, the only patients to be included in the distributions shall be
					 patients that have been identified by the department as also having been
					 included in the patient assessment period July 1, 1988 through December 31,
					 1988.
(v) For each facility, a 1988
					 distribution of patients in each patient classification group and a 1988
					 distribution of patients by the LOS groups specified in subparagraph (ii) of
					 this paragraph shall be determined by utilizing the patient data obtained in
					 the patient assessment period July 1, 1988 through December 31, 1988. For
					 purposes of this subparagraph, the only patients to be included in the
					 distributions shall be patients that were admitted to the facility in which
					 they are presently residing before October 1, 1985 and have been identified by
					 the department as also having been included in the patient assessments during
					 the 1985 period. In the event a facility commenced operations after the patient
					 assessment period, March 1, 1985 through September 30, 1985 (the 1985 period)
					 but prior to January 1, 1988, or if the facility had the lesser of ten cases or
					 twenty percent of its patients in the distributions for the 1985 period as
					 determined pursuant to subparagraph (iv) of this paragraph, or if the facility
					 had undergone the appointment of a receiver or the establishment of a new
					 operator subsequent to the 1985 period but prior to January 1, 1988 and had
					 filed a new cost report in accordance with the provisions of section
					 86-2.10(k) 
					 of this Subpart which was used in the calculation of the payment rate, the
					 facility's substituted 1985 period, as defined in subparagraph (iv) of this
					 paragraph, shall be used in lieu of the 1985 period for the purposes of this
					 subparagraph, and the only patients to be included shall be patients that were
					 admitted to the facility in which they are presently residing before the end
					 date of the facility's substituted 1985 period and have been identified by the
					 department as also having been included in the patient assessments during the
					 substituted 1985 period.
(vi) A
					 percentage increase in case mix attributable to LOS shall, for each facility,
					 be determined as follows:
(a) A 1985
					 aggregate case mix index shall be determined by multiplying the facility's 1985
					 distribution of patients, or a substituted 1985 distribution of patients where
					 applicable, within each LOS group, determined pursuant to subparagraph (iv) of
					 this paragraph by the statewide average initial case mix index for each LOS
					 group for the 1985 period, as determined pursuant to subparagraph (iii) of this
					 paragraph, and dividing the sum of the results by the facility's total number
					 of patients in all LOS groups, as determined pursuant to subparagraph (iv) of
					 this paragraph.
(b) A 1988 LOS
					 adjusted case mix index shall be determined by multiplying the facility's 1988
					 distribution of patients within each LOS group determined pursuant to
					 subparagraph (v) of this paragraph by the statewide average initial case mix
					 index for each LOS group for the 1985 period, as determined pursuant to
					 subparagraph (iii) of this paragraph, and dividing the sum of the results by
					 the facility's total number of patients in all LOS groups, as determined
					 pursuant to subparagraph (v) of this paragraph.
(c) The 1985 aggregate case mix index shall
					 be subtracted from the 1988 LOS adjusted case mix index and the result divided
					 by the 1985 aggregate case mix index to arrive at the percentage increase in
					 case mix attributable to LOS.
(vii) An actual percentage increase in case
					 mix shall, for each facility, be determined as follows:
(a) A 1985 actual case mix index shall be
					 determined by multiplying the facility's 1985 distribution of patients, or a
					 substituted 1985 distribution of patients where applicable, in each patient
					 classification group, as determined pursuant to subparagraph (iv) of this
					 paragraph, by the case mix index for each patient classification group as
					 contained in Appendix 13-A herein and dividing the sum of the results by the
					 facility's total number of patients in all patient classification groups, as
					 determined pursuant to subparagraph (iv) of this paragraph.
(b) A 1988 actual case mix index shall be
					 determined by multiplying the facility's 1988 distribution of patients in each
					 patient classification group, as determined pursuant to subparagraph (v) of
					 this paragraph, by the case mix index for each patient classification group as
					 contained in Appendix 13-A herein and dividing the sum of the results by the
					 facility's total number of patients in all patient classification groups, as
					 determined pursuant to subparagraph (v) of this paragraph.
(c) The 1985 actual case mix index shall be
					 subtracted from the 1988 actual case mix index and the result divided by the
					 1985 actual case mix index to arrive at an actual percentage increase in case
					 mix.
(viii) Except as
					 provided in subparagraph (ix) of this paragraph, a percentage recalibration
					 adjustment shall be determined by annualizing the result obtained by
					 subtracting the percentage increase in case mix attributable to LOS determined
					 pursuant to subparagraph (vi) of this paragraph from the actual percentage
					 increase in case mix determined pursuant to subparagraph (vii) of this
					 paragraph.
(ix) If a facility had
					 undergone the appointment of a receiver or the establishment of a new operator
					 on or after January 1, 1988 but prior to January 1, 1992, and filed a new cost
					 report in accordance with the provisions of section
					 86-2.10(k) 
					 of this Subpart which was used in the calculation of a revised payment rate, or
					 for new facilities who received an initial operating certificate on or after
					 January 1, 1988 but prior to January 1, 1992, the percentage recalibration
					 adjustment provided for in this subdivision shall be 0 percent for such revised
					 rate or such new facilities.
(3) The operating portion of each residential
					 health care facility's rate of payment, as defined pursuant to section
					 86-2.10(a)(7) 
					 of this Subpart, shall be reduced by a per diem recalibration adjustment which
					 shall be determined as follows:
(i) The
					 percentage recalibration adjustment identified in subparagraph (2)(viii) of
					 this subdivision shall be applied to the direct component of the rate
					 determined in accordance with sections
					 86-2.10
					 and
					 86-2.11 
					 of this Subpart, to arrive at each facility's per diem recalibration adjustment
					 in 1983 base year dollars.
(ii)
					 Each facility's per diem recalibration adjustment in 1983 base year dollars
					 shall then be trended to the rate year by the applicable roll factor as defined
					 in section
					 86-2.10(a)(8) 
					 of this Subpart.