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 86-13 - Rates for Non-State Providers of Prevocational Services (Site-based) and Respite (Hourly and Free-standing), and fees for Prevocational Services (Community-based), Residential Habilitation (Family Care) and Supported Employment › Section 86-13.3 - Rates for prevocational services (site-based), respite (hourly and free-standing), prevocational services (community-based), supported employment, and residential habilitation (family care)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) There shall be one provider-wide rate for
					 each provider of prevocational services (site-based), except that rates for
					 prevocational services provided to individuals identified as specialized
					 populations by OPWDD shall be determined under section
					 86-13.8 
					 of this Subpart. Adjustments may be made to the rate resulting from any final
					 audit findings or reviews.
(b)
					 Rates shall be computed on the basis of a full 12 month base year CFR, adjusted
					 in accordance with the methodology as provided in this section. The rate shall
					 include operating cost components, facility cost components, and capital cost
					 components as identified in applicable paragraphs. Such base year may be
					 updated periodically, as determined by DOH.
(c)
Prevocational (site-based).
(1) Operating component. Allowable operating
					 costs shall include costs identified in the consolidated fiscal reports and
					 reimbursement for such costs shall be inclusive of the following components:
(i)
Regional average direct care
					 wage
, which shall mean the quotient of base year salaried direct care
					 dollars (including production staff) for each provider in a DOH region,
					 aggregated for all such providers in such region, divided by base year salaried
					 direct care hours (including production staff) for each provider in a DOH
					 region, aggregated for all such providers in such region.
(ii)
Regional average
					 employee-related component
, which shall mean the quotient of the sum
					 of vacation leave accruals and total fringe benefits for the base year for each
					 provider in a DOH region, aggregated for all such providers in such region,
					 divided by base year salaried direct care dollars (including production staff)
					 for each provider in a DOH region, aggregated for all such providers in such
					 region, and such quotient shall be multiplied by the applicable regional
					 average direct care wage as determined by subparagraph (i) of this
					 paragraph.
(iii)
Regional
					 average program support component
, which shall mean the quotient of
					 the sum of transportation related-participant, staff travel, participant
					 incidentals, expensed adaptive equipment, sub-contract raw materials,
					 participant wages-non-contract, participant wages-contract, participant fringe
					 benefits, staff development, supplies and materials-non-household, other-OTPS,
					 lease/rental vehicle, depreciation-vehicle, interest-vehicle, other-equipment,
					 other than to/from transportation allocation, salaried support dollars
					 (excluding housekeeping and maintenance staff) and salaried program
					 administration dollars for the base year for each provider in a DOH region,
					 aggregated by all such providers in such region, divided by the total base year
					 salaried direct care dollars (including production staff) of all providers in a
					 DOH region, and such quotient shall be multiplied by the applicable regional
					 average direct care wage as determined pursuant to subparagraph (i) of this
					 paragraph.
(iv)
Regional
					 average direct care hourly rate-excluding general and administrative
					 costs
, which shall mean the sum of the applicable regional average
					 direct care wage as determined pursuant to subparagraph (i) of this paragraph,
					 the applicable regional average employee-related component as determined
					 pursuant to subparagraph (ii) of this paragraph, and the applicable regional
					 average program support component as determined pursuant to subparagraph (iii)
					 of this paragraph.
(v)
Regional average general and administrative component
, which
					 shall mean the quotient of the sum of the insurance-general and agency
					 administration allocation for the base year for each provider in a DOH region,
					 aggregated for all such providers in such region, divided by (the sum of total
					 program/site costs and other than to/from transportation allocation, less the
					 sum of food, repairs and maintenance, utilities, expensed equipment, household
					 supplies, telephone, lease/rental equipment, depreciation equipment, total
					 property-provider paid, housekeeping and maintenance staff, salaried clinical
					 dollars, and contracted clinical dollars for the base year for each provider in
					 a DOH region, aggregated for all providers in such region). The regional
					 average direct care hourly rate-excluding general and administrative costs, as
					 determined pursuant to subparagraph (iv) of this paragraph, shall then be
					 divided by (one minus the applicable regional average general and
					 administrative quotient), from which the applicable regional average direct
					 care hourly rate-excluding general and administrative costs, as computed in
					 subparagraph (iv) of this paragraph, shall be subtracted.
(vi)
Regional average direct care
					 hourly rate
, which shall mean the sum of the applicable regional
					 average direct care wage as determined pursuant to subparagraph (i) of this
					 paragraph, the applicable regional average employee-related component as
					 determined pursuant to subparagraph (ii) of this paragraph, the applicable
					 regional average program support component as determined pursuant to
					 subparagraph (iii) of this paragraph, and the applicable regional average
					 general and administrative component as computed in subparagraph (v) of this
					 paragraph.
(vii)
Provider
					 average direct care wage
, which shall mean the quotient of base year
					 salaried direct care dollars (including production staff) divided by the base
					 year salaried direct care hours (including production staff) of a
					 provider.
(viii)
Provider
					 average employee-related component
, which shall mean the quotient of
					 the sum of vacation leave accruals and fringe benefits for the base year for
					 each provider, divided by base year salaried direct care dollars (including
					 production staff) of a provider, and such quotient shall be multiplied by the
					 provider average direct care wage as computed in subparagraph (vii) of this
					 paragraph.
(ix)
Provider
					 average program support component
, which shall mean the quotient of
					 the sum of transportation related-participant, staff travel, participant
					 incidentals, expensed adaptive equipment, sub-contract raw materials,
					 participant wages-non-contract, participant wages-contract, participant fringe
					 benefits, staff development, supplies and materials-non-household, other-OTPS,
					 lease/rental vehicle, depreciation-vehicle, interest-vehicle, other-equipment,
					 other than to/from transportation allocation, salaried support dollars
					 (excluding housekeeping and maintenance staff) and salaried program
					 administration dollars for the base year for a provider, divided by the base
					 year salaried direct care dollars (including production staff) of such
					 provider, and such quotient shall be multiplied by the provider average direct
					 care wage as computed in subparagraph (vii) of this paragraph.
(x)
Provider average direct care
					 hourly rate-excluding general and administrative costs
, which shall
					 mean the sum of the provider average direct care wage as determined pursuant to
					 subparagraph (vii) of this paragraph, the provider average employee-related
					 component as determined pursuant to subparagraph (viii) of this paragraph, and
					 the provider average program support component as determined pursuant to
					 subparagraph (ix) of this paragraph for each provider.
(xi)
Provider average general and
					 administrative component
, which shall mean the quotient of the sum of
					 insurance-general and agency administration allocation for the base year for a
					 provider, divided by (the sum of total program/site costs and other than
					 to/from transportation allocation less the sum of food, repairs and
					 maintenance, utilities, expensed equipment, household supplies, telephone,
					 lease/rental equipment, depreciation equipment, insurance - property and
					 casualty, total property-provider paid, housekeeping and maintenance staff,
					 salaried clinical dollars, and contracted clinical dollars for a provider) for
					 the base year. The provider average direct care hourly rate-excluding general
					 and administrative costs, as computed in subparagraph (x) of this paragraph,
					 shall then be divided by (one minus the applicable provider average general and
					 administrative quotient), from which the provider average direct care hourly
					 rate-excluding general and administrative costs, as computed in subparagraph
					 (x) of this paragraph, shall be subtracted.
(xii)
Provider average direct care
					 hourly rate
, which shall mean the sum of the provider average direct
					 care wage as determined pursuant to subparagraph (vii) of this paragraph, the
					 provider average employee-related component as determined pursuant to
					 subparagraph (viii) of this paragraph, the provider average program support
					 component as determined pursuant to subparagraph (ix) of this paragraph, and
					 the provider average general and administrative component as determined
					 pursuant to subparagraph (xi) of this paragraph.
(xiii)
Provider direct care
					 hours
, which shall mean the quotient of the sum of base year salaried
					 direct care hours (including production staff) and base year contracted direct
					 care hours, divided by the billed units for the base year, and such quotient
					 shall be multiplied by rate sheet units for the initial period.
(xiv)
Regional average clinical
					 hourly wage
, which shall mean the quotient of base year salaried
					 clinical dollars for each provider in a DOH region, aggregated for all such
					 providers in such region, divided by base year salaried clinical hours for each
					 provider in a DOH region, aggregated for all such providers in such
					 region.
(xv)
Provider
					 average clinical hourly wage
, which shall mean the quotient of base
					 year salaried clinical dollars of a provider divided by base year salaried
					 clinical hours of such provider.
(xvi)
Provider salaried clinical
					 hours
, which shall mean the quotient of base year salaried clinical
					 hours of a provider, divided by the billed units for the base year, and such
					 quotient shall be multiplied by the rate sheet units for the initial period for
					 such provider.
(xvii)
Regional average contracted clinical hourly wage
, which shall
					 mean the quotient of contracted clinical dollars for each provider in a DOH
					 region, aggregated for all such providers in such region, divided by the base
					 year contracted clinical hours for each provider in a DOH region, aggregated
					 for all such providers in such region.
(xviii)
Provider contracted clinical
					 hours
, which shall mean the quotient of a provider"TMs contracted
					 clinical hours for the base year, divided by the billed units for the base
					 year, and such quotient shall be multiplied by rate sheet units for the initial
					 period.
(xix)
Provider
					 direct care hourly rate-adjusted for wage equalization factor
, which
					 shall mean the sum of the provider average direct care hourly rate, as
					 determined pursuant to subparagraph (xii) of this paragraph, multiplied by 0.75
					 and the applicable regional average direct care hourly rate, as determined
					 pursuant to subparagraph (vi) of this paragraph, multiplied by 0.25.
(xx)
Provider clinical hourly wage -
					 adjusted for wage equalization factor
, which shall mean the sum of the
					 provider average clinical hourly wage, as determined pursuant to subparagraph
					 (xv) of this paragraph, multiplied by 0.75 and the applicable regional average
					 clinical hourly wage, as computed in subparagraph (xiv) of this paragraph,
					 multiplied by 0.25.
(xxi)
Provider reimbursement for direct care hourly rate
, which
					 shall mean the product of the calculated provider direct care hours as
					 determined pursuant to subparagraph (xiii) of this paragraph and the provider
					 direct care hourly rate-adjusted for wage equalization factor as computed in
					 subparagraph (xix) of this paragraph.
(xxii)
Provider reimbursement for
					 clinical hourly wage
, which shall mean the product of the provider
					 salaried clinical hours as determined pursuant to subparagraph (xvi) of this
					 paragraph and the provider clinical hourly wage-adjusted for wage equalization
					 factor as determined pursuant to subparagraph (xx) of this paragraph.
(xxiii)
Provider reimbursement from
					 contracted clinical hourly wage
, which shall mean the product of the
					 provider contracted clinical hours as determined pursuant to subparagraph
					 (xviii) of this paragraph and the applicable regional average contracted
					 clinical hourly wage as determined pursuant to subparagraph (xvii) of this
					 paragraph.
(xxiv)
Provider
					 facility reimbursement
, which shall mean the quotient of the sum of
					 food, repairs and maintenance, utilities, expensed equipment, household
					 supplies, telephone, lease/rental equipment, depreciation equipment, insurance
					 - property and casualty, housekeeping and maintenance staff, and program
					 administration property the base year for a provider, divided by provider
					 billed units for the base year, and such quotient shall be multiplied by rate
					 sheet units for the initial period.
(xxv)
Provider to/from transportation
					 reimbursement
, which shall mean the quotient of the to/from
					 transportation allocation for the base year, divided by the provider billed
					 units for the base year, and such quotient shall be multiplied by rate sheet
					 units for the initial period.
(xxvi)
Provider operating
					 revenue
, which shall mean the sum of provider reimbursement for direct
					 care hourly rate, as determined pursuant to subparagraph (xxi) of this
					 paragraph, the provider reimbursement for clinical hourly wage as determined
					 pursuant to subparagraph (xxii) of this paragraph, the provider reimbursement
					 from contracted clinical hourly wage as determined pursuant to subparagraph
					 (xxiii) of this paragraph, the provider facility reimbursement as determined
					 pursuant to subparagraph (xxiv) of this paragraph, and provider to/from
					 transportation reimbursement as determined pursuant to subparagraph (xxv) of
					 this paragraph.
(xxvii)
Statewide budget neutrality adjustment factor for operating
					 dollars
, which shall mean the quotient of the operating revenue from
					 all provider rate sheets in effect on June 30, 2015, divided by provider
					 operating revenue, as determined pursuant to subparagraph (xxvi) of this
					 paragraph, for all providers.
(xxviii)
Total provider operating
					 revenue-adjusted
, which shall mean the product of the provider
					 operating revenue as determined pursuant to subparagraph (xxvi) of this
					 paragraph and the statewide budget neutrality adjustment factor for operating
					 dollars as determined pursuant to subparagraph (xxvii) of this paragraph.
The final daily operating rate shall be determined by
						dividing the total provider operating revenue-adjusted, as determined by
						subparagraph (xxviii) of this paragraph, by the applicable provider rate sheet
						units for the initial period.