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 86-2.10 - Computation of basic rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Definitions.
For purposes of this section, the following definitions
						shall apply:
(1)
Direct
					 price
shall mean the monetary amount established for the direct
					 component of the rate, based on the direct costs of all facilities after
					 application of the regional direct input price adjustment factor, divided by
					 patient days and the average statewide case mix index.
(2)
Indirect price
shall
					 mean the monetary amount established for the indirect component of the rate,
					 based on the indirect costs for each facility in a peer group, after
					 application of a regional indirect price adjustment factor, divided by total
					 peer group patient days.
(3)
Peer group
shall mean a set of facilities distinguished by
					 like characteristics which are grouped for purposes of comparing costs and
					 establishing payment rates using such criteria as affiliation
					 (
i.e.,
hospital-based or freestanding) case mix index
					 (
i.e.,
high intensity, case mix index greater than.83, or low
					 intensity, case mix index less than or equal to.83), and size
					 (
i.e.,
less than 300 beds or 300 or more beds).
(4)
Cost center
shall mean
					 categories into which related costs are grouped in accordance with and defined
					 in Part 455 of this Title.
(5)
Case mix index
shall mean the numeric weighting of each
					 patient classification group in terms of relative resource utilization as
					 specified in Appendix 13-A,
infra.
(6)
Rate
shall mean the
					 aggregate governmental payment to facilities per patient day as defined in
					 section 86-2.8  of this Subpart, for the
					 care of Medicaid payments which include a direct, indirect, noncomparable and
					 capital component.
(7)
Operating portion of the rate
shall mean the portion of the
					 rate consisting of the direct, indirect and noncomparable components after
					 application of the roll factor promulgated by the department.
(8)
Roll factor
shall mean
					 the cumulative result of multiplying one year's trend (inflation) factor times
					 one or more other years trend factor(s) which is used to inflate costs from a
					 base period to a rate period.
(9)
Capital costs
shall mean costs reported in the depreciation,
					 leases and rentals, interest on capital debt and/or major movable equipment
					 depreciation cost centers, as well as costs reported in any other cost center
					 under the major natural classification of depreciation, leases and rentals on
					 the facilities annual cost report (RHCF-4).
(10)
Base
shall mean, as
					 applicable to cost or price, a minimum cost or price.
(11)
Ceiling
shall mean, as
					 applicable to cost or price, a maximum cost or price.
(12)
Corridor
shall mean the
					 difference between a base and a ceiling.
(13)
Hospital-based
shall
					 mean as follows:
(i) For facilities receiving
					 initial operating certificates prior to January 1, 1983,
hospital-
					 based
shall mean those facilities that are considered by the Federal
					 Health Care Financing Administration (HCFA) to be hospital-based or
					 hospital-related (as pertaining to cost allocation) and which derive and report
					 costs on the basis of a Medicare cost allocation methodology from an affiliated
					 hospital.
(ii) For facilities
					 receiving operating certificates after January 1, 1983, the commissioner shall
					 review and determine whether or not such facilities are hospital-based
					 utilizing the following criteria:
(a) the
					 nature of any construction approval received pursuant to section 2802  of the
					 Public Health Law;
(b) the nature
					 of any establishment approval received pursuant to section 2801-a  of the Public
					 Health Law;
(c) the architectural
					 configuration of the residential health care facility unit as related to the
					 hospital physical plant;
(d) the
					 method and amount of cost allocation;
(e) whether a determination that such a
					 facility is hospital-based would result in the efficient and economic operation
					 of such facility.