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› Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.85 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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› Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.86 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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› Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.87 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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› Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.88 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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› Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.89 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
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 86-2.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart, the following definitions shall
						apply:
(a) Residential health care
					 facility, medical facility or facility shall mean all facilities or
					 organizations covered by the term nursing home as defined in article 28 of the
					 Public Health Law, including hospital-based residential health care facilities,
					 and nursing facilities as defined in section 1919 of the Federal Social
					 Security Act, provided that such facility possesses a valid operating
					 certificate issued by the State Commissioner of Health and, where required, has
					 been established by the Public Health Council.
(b) Patient classification groups shall mean
					 patient categories contained in the classification system, Resource Utilization
					 Groups-II (RUG-II), which identifies the relative resource consumption required
					 by different types of long-term care patients as specified in Appendix 13-A,
					 infra.
(c) Case mix shall mean the
					 patient population of a facility as classified and aggregated into patient
					 classification groups.
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 86-2.2 - Financial and statistical data required

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each residential health care facility
					 shall complete and file, with the New York State Department of Health and/or
					 its agent, annual financial and statistical report forms supplied by the
					 department and/or its agent. Residential health care facilities certified for
					 title XVIII of the Federal Social Security Act (Medicare) shall use the same
					 fiscal year for title XIX of the Federal Social Security Act (Medicaid) as is
					 used for title XVIII. All residential health care facilities must report their
					 operations from January 1, 1977 forward on a calendar-year basis.
(1) Hospital-based residential health care
					 facilities whose affiliation changes to free- standing pursuant to section
					 86-2.34(a) 
					 of this Subpart shall complete and file the free-standing annual cost report
					 (RHCF-4) supplies by the department and/or its agent for the first full
					 calendar year following actual complete closure of the acute care beds of its
					 affiliated hospital.
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 86-2.3 - Uniform system of accounting and reporting

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Residential health care facilities shall
					 maintain their records in accordance with:
(1) section
					 414.13  of
					 Article 3 of Subchapter A of Chapter V of this Title; and
(2) for the 1980 calendar year in substantial
					 compliance, and thereafter in full compliance, with Article 9 of Subchapter A
					 of Chapter V of this Title. Substantial compliance shall be defined as the
					 result that would be expected from a good-faith effort taken by an informed,
					 responsible person.
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 86-2.4 - Generally accepted accounting principles

Current through Register Vol. 46, No. 28, July 10, 2024
The completion of the financial and statistical report
						forms shall be in accordance with generally accepted accounting principles as
						applied to the residential health care facility unless the reporting
						instructions authorized 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 86-2 - Residential Health Care Facilities › Section 86-2.5 - Accountant's certification

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The financial and statistical reports shall be certified by an independent
					 licensed public accountant or an independent certified public accountant. The
					 minimum standard for the term "independent" shall be the standard used by the
					 State Board of Public Accountancy.
(b) Effective with report periods beginning
					 on or after January 1, 1977, the requirements of subdivision (a) of this
					 section shall apply to residential health care facilities operated by units of
					 government of the State of New York heretofore exempt from the requirements of
					 this section except that those medical facilities for which an annual
					 reimbursement audit by a State agency is required by law shall be required to
					 comply herewith effective with report periods beginning on or after January 1,
					 1978.
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 86-2.6 - Certification by operator or officer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The financial and statistical reports
					 shall be certified by the operator of a proprietary medical facility, an
					 officer of a voluntary medical facility or the public official responsible for
					 the operation of a public medical facility.
(b) The form of the certification required in
					 subdivision (a) of this section shall be as prescribed in the annual fiscal and
					 statistical report forms provided by the State Commissioner of
					 Health.
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 86-2.7 - Audits

Current through Register Vol. 46, No. 28, July 10, 2024
All fiscal and statistical records and reports shall be
						subject to audit. All underlying books, records and documentation which formed
						the basis for the fiscal and statistical reports, filed by the residential
						health care facility with the department, shall be kept and maintained by the
						facility for a period of time not less than six years from the date of filing,
						or the date upon which the fiscal and statistical records were to be filed,
						whichever is the later date. In this respect, any rate of payment certified by
						the State Commissioner of Health based on the initial submission of base year
						data and reports will be construed to represent a provisional rate until such
						audit is performed and completed, at which time such rate or adjusted rate will
						be construed to represent the audited rate.
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 86-2.8 - Patient days

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A patient
					 day is the unit of measure denoting lodging provided and services rendered to
					 one patient between the census-taking hour on two successive days.
(b) In computing patient days, 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
					 patient day.
(c) For reimbursement
					 purposes residential health care facility days shall be determined by using the
					 higher of the minimum utilization factor of 90 percent of certified beds or the
					 actual patient days of care as furnished by the facility.
(d) Reserved bed patient days shall be
					 computed separately from patient days. A reserved bed patient day is the unit
					 of measure denoting an overnight stay away from the residential health care
					 facility for which the patient, or patient's third-party payor, provides per
					 diem reimbursement when the patient's absence is due to hospitalization or
					 therapeutic leave.
(e) In computing
					 reserved bed patient days, the day of discharge from the residential health
					 care facility shall be counted, but not the day of readmission.
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 86-2.11 - Adjustments to direct component of the rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Payments for 1986 and subsequent rate
					 years for the direct component of the rate as defined in section
					 86-2.10(c) 
					 of this Subpart shall be adjusted periodically as described in this section to
					 reflect changes in the case mix of facilities.
(b) Facilities shall report to the department
					 changes in patient case mix as follows:
(1)
					 Full reassessments. Facilities shall, on a schedule to be established by the
					 department, assess all their patients semiannually and submit patient review
					 instruments pursuant to section
					 86-2.30 
					 of this Subpart. The department shall consider, in developing such schedule,
					 that for each of the six months in a semiannual period, there would be
					 submitted approximately 1/6 of the assessments for all patients in the
					 State.
(2) Assessment of patients
					 admitted since the last assessment period. Three months from the date
					 facilities are scheduled to perform full reassessments, facilities shall assess
					 patients admitted and still residing in the facility since the last full
					 assessment period. Patient review instruments for such patients shall be
					 submitted pursuant to section
					 86-2.30 
					 of this Subpart on a schedule to be established by the department. The
					 department shall consider, in developing such schedule that for each of the six
					 months in a semiannual period, there would be submitted approximately 1/6 of
					 the assessments of such new admissions.
(3) Notification to department of patients
					 discharged since last assessment period. Facilities shall notify the department
					 of any patients assessed during the previous full reassessment period as
					 described in paragraph (1) of this subdivision and since discharged concurrent
					 with the submission required by paragraph (2) of this subdivision for patients
					 admitted since the last assessment 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 86-2 - Residential Health Care Facilities › Section 86-2.12 - Adjustments to basic rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To
					 the allowable basic rate prior to the addition of capital costs and
					 depreciation and interest related to movable equipment, there will be added a
					 factor to project allowable cost increases during the effective period of the
					 reimbursement rate. Such factor shall be determined as follows:
(1) The elements of a residential health care
					 facility's cost shall be weighted based upon data for the following categories:
(i) salaries;
(ii) employee health and welfare
					 expense;
(iii) nonpayroll
					 administrative and general expense;
(iv) nonpayroll household and maintenance
					 expense;
(v) nonpayroll dietary
					 expense; and
(vi) 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 86-2 - Residential Health Care Facilities › Section 86-2.13 - Adjustments to provisional rates based on errors

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Errors resulting from submission of
					 fiscal and statistical information by a residential health care facility may be
					 corrected if brought to the attention of the State Commissioner of Health
					 within 120 days of receipt of the commissioner's initial rate computation
					 sheet. Errors on the part of the State Department of Health resulting from the
					 rate computation process may be corrected if brought to the attention of the
					 commissioner within 120 days of receipt of the commissioner's initial rate
					 computation sheet. Subsequent errors on the part of the State Department of
					 Health resulting from the revision of a rate may be corrected if brought to the
					 attention of the commissioner within 30 days of receipt of the commissioner's
					 revised rate computation sheet. In no event, however, shall a facility have
					 less than 120 days from receipt of the initial rate computation sheets to bring
					 errors to the attention of the commissioner.
(b) Rate appeals pursuant to this section, if
					 not commenced within 120 days of receipt of the commissioner's initial rate
					 computation sheet, may be initiated at time of audit of the base year cost
					 figures at or prior to the audit exit conference. Such rate appeals shall be
					 recognized only to the extent that they are based upon errors in the cost
					 and/or statistical data submitted by the residential health care facility, or
					 by revisions initiated by a third-party fiscal intermediary, or in the case of
					 a governmental facility, by the sponsor government or errors made by the
					 Department of Health.
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 86-2.14 - Revisions in certified rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The State Commissioner of Health may consider only those applications for
					 revisions of certified rates which are based on:
(1) cost reports filed pursuant to section
					 86-2.2(e) 
					 of this Subpart. Such rate shall become effective on the first day of the
					 12-month period referred to in section
					 86-2.2(e) 
					 of this Subpart;
(2) six-month cost
					 reports filed pursuant to sections
					 86-2.10(k)(6) 
					 and/or 86- 2.15(e) of this Subpart. Such rate shall become effective on the
					 first day of the six-month period referred to in sections
					 86-2.10(k)(6)
					 and
					 86-2.15(e) 
					 of this Subpart;
(3) errors made by
					 the department in the rate calculation process and errors in data submitted by
					 a medical facility which have been brought to the attention of the commissioner
					 within the time limits prescribed in section
					 86-2.13 
					 of this Subpart. This paragraph shall not apply to the patient assessment
					 process as contained in section
					 86-2.30 
					 of this Subpart;
(4) significant
					 increases in the overall operating costs of a residential health care facility
					 resulting from the implementation of additional programs or services
					 specifically mandated for the facility by the commissioner;
(5) significant increases in the overall
					 operating costs of a residential health care facility resulting from capital
					 renovation, expansion, replacement or the inclusion of new programs or services
					 approved for the facility by the commissioner;
(6) requests for waivers of any provisions of
					 this Subpart for which waivers may be granted by the commissioner as prescribed
					 in specific sections;
(7)
					 alternative means of allocating costs in the cost-finding process which have
					 been submitted with the annual cost report (RHCF-4) and approved in accordance
					 with section
					 456.2(b) and
					 (c)  of this Title; and
(8) requests for relief from the provisions
					 of section
					 86-2.25 
					 of this Subpart relating to compensation of other than the administrative type
					 of services rendered by an operator or relative of an operator. Such request
					 must contain sufficient documentation to demonstrate that the services rendered
					 are necessary and are reasonably related to the efficient production of such
					 services.
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 86-2.15 - Rates for residential health care facilities without adequate cost experience

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) This subdivision shall apply where the
					 fiscal and statistical data of the facility are unavailable through no fault of
					 the provider or its agents, and due to circumstances beyond its control, or
					 when there is a new facility without adequate cost experience as set forth in
					 section 86-2.2(e)  of this
					 Subpart.
(2) The appointment of a
					 receiver or the establishment of a new operator for an ongoing facility shall
					 not be considered a new facility for the purposes of this section.
					 Reimbursement for such receiver or new operator shall be in accordance with
					 sections 86-2.10 and
					 86-2.11  of 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 86-2 - Residential Health Care Facilities › Section 86-2.16 - Less expensive alternatives

Current through Register Vol. 46, No. 28, July 10, 2024
Reimbursement for the cost of providing services may be
						the lesser of the actual costs incurred or those costs which could reasonably
						be anticipated if such services had been provided by the operation of joint
						central services or use of facilities or services which could have served
						effective alternatives or substitutes for the whole or any part of such
						service.
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 86-2.18 - Recoveries of expense

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Operating costs shall be reduced by the costs of services and activities which
					 are not properly chargeable to patient care. In the event that the State
					 Commissioner of Health determines that it is not practical to establish the
					 costs of such services and activities, the income derived therefrom may be
					 substituted for costs of these services and activities. Examples of activities
					 and services covered by this provision include:
(1) drugs and supplies sold to other than
					 employees for use outside the residential health care facility;
(2) telephone and telegraph services for
					 which a charge is made;
(3)
					 discount on purchases;
(4) living
					 quarters rented to persons other than employees;
(5) meals provided to special nurses or
					 patients' guests;
(6) operation of
					 parking facilities for community convenience;
(7) lease of office and other space of
					 concessionaires providing services not related to residential health care
					 facility service; and
(8) tuitions
					 and other payments for educational service, room and board and other services
					 not directly related to residential health care facility service.
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 86-2.21 - Capital cost reimbursement for proprietary residential health care facilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Definitions.
As used in this section, the following terms shall be
						defined as follows:
(1) Capital
					 indebtedness.
The term
capital indebtedness
shall mean
						all debt obligations of a facility that are:
(i) evidenced by a mortgage note or bond and
					 secured by a mortgage on the land, building or nonmovable equipment of a
					 facility or evidenced by a note incurred in accordance with subparagraph (ii)
					 of this paragraph;
(ii) incurred
					 for the purpose of financing the acquisition, construction or renovation of
					 land, building or nonmovable equipment (hereinafter called the "authorized
					 purpose"); and
(iii) found by the
					 commissioner to be reasonable, necessary and in the public interest with
					 respect to the facility in accordance with standards set forth in section
					 86-2.21(e)(3)(ii)  of this Subpart. Refinancing of capital indebtedness shall be
					 recognized only to the extent of the then unpaid balance of the debt being
					 refinanced.
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 86-2.22 - Movable equipment

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Necessary and reasonable expenses related to movable equipment (depreciation
					 computed on a straight-line method or accelerated under a double declining
					 balance or sum-of-the-years-digits method, interest on indebtedness, lease,
					 etc.) are considered allowable costs for residential health care facilities
					 subject to such ceilings as may be established and promulgated by the
					 Commissioner of Health.
(b) An arms
					 length lease purchase agreement with a nonrelated lessor involving equipment
					 entered into on or after October 23, 1992 which meets any one of the four
					 following conditions, establishes the lease as a virtual purchase.
(1) The lease transfers title of the
					 equipment to the lessee during the lease term.
(2) The lease contains a bargain purchase
					 option.
(3) The lease term is at
					 least 75 percent of the useful life of the equipment. This provision is not
					 applicable if the lease begins in the last 25 percent of the useful life of the
					 equipment.
(4) The present value of
					 the minimum lease payments (payments to be made during the lease term including
					 bargain purchase option, guaranteed residual value and penalties for failure to
					 renew) equals at least 90 percent of the fair market value of the leased
					 property. This provision is not applicable if the lease begins in the last 25
					 percent of the useful life of the equipment. Present value is computed using
					 the lessee's incremental borrowing rate, unless the interest rate implicit in
					 the lease is known and is less than the lessee's incremental borrowing rate, in
					 which case the interest rate implicit in the lease is used.
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 86-2.23 - Research

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All research
					 costs shall be excluded from allowable costs in computing reimbursement
					 rates.
(b) Research includes those
					 studies and projects which have as their purpose the enlargement of general
					 knowledge and understanding, are experimental in nature and hold no prospect of
					 immediate benefit to the hospital or its patients.
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 86-2.24 - Educational activities

Current through Register Vol. 46, No. 28, July 10, 2024
The costs of educational activities, less tuition and
						supporting grants, shall be included in the calculation of the basic rate,
						provided such activities are directly related to patient care
						services.
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 86-2.25 - Compensation of operators and relatives of operators

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reasonable compensation for operators or
					 relatives of operators for services actually performed and required to be
					 performed shall be considered as an allowable cost. The amount to be allowed
					 shall be equal to the amount normally required to be paid for the same service
					 provided by a nonrelated employee, as determined by the State Commissioner of
					 Health. Compensation shall not be included in the rate computation for any
					 services which the operator or relative of the operator is not authorized to
					 perform under New York State law or regulation.
(b) Any amount reported as compensation for
					 services rendered by an operator or relative of an operator shall not be
					 allowed in excess of the maximum allowance for full-time services in carrying
					 out his primary function.
(c) For
					 purposes of subdivision (a) of this section, in determining a reasonable level
					 of compensation for operators or relatives of operators the commissioner may
					 consider the quality of care provided to patients by the facility during the
					 year in question.
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 86-2.27 - Termination of service

Current through Register Vol. 46, No. 28, July 10, 2024
The Division of Health Care Financing in the Department
						of Health shall be notified immediately of the deletion of any previously
						offered service or of the withholding of services from patients paid for by
						government agencies. Such notifications shall include a statement indicating
						the date of the deletion or withholding of such service and the cost impact on
						the residential health care facility of such action. Any overpayments by reason
						of such deletion of previously offered service shall bear interest and be
						subject to penalties both in the manner provided in section
						86-2.7  of 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 86-2 - Residential Health Care Facilities › Section 86-2.28 - Return on investment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
					 rate year 1993, in computing the allowable cost of a proprietary residential
					 health care facility, there will be included, after subtracting for current and
					 noncurrent time deposits and equivalents, investments and construction in
					 progress, a reasonable return on average equity capital invested for necessary
					 and proper operation for patient care activities of a residential health care
					 facility and related organizations, as defined in section
					 86-2.26(a) 
					 of this Subpart. For purposes of this section, average equity capital shall
					 mean the difference between total assets less total liabilities averaged over
					 the applicable cost report period, including assets and liabilities
					 attributable to land, plant, fixed equipment and capital improvements thereto.
					 It shall also include the average equity capital of related organizations
					 proportionate with the percentage of a related organization's business with the
					 residential health care facility, as calculated in the annual report forms
					 filed in accordance with section
					 86-2.2 
					 of this Subpart.
(b) The allowable
					 average equity capital shall be further adjusted by subtracting the equity, as
					 that term is defined in section
					 86-2.21(a)(4) 
					 of this Subpart, upon which a return is calculated pursuant to section 86-
					 2.21(e)(6) of this Subpart. The return on investment for rate year January 1,
					 1993 shall be computed on the basis of allowable fiscal and statistical data
					 submitted by the facility for the fiscal year ended December 31, 1991, or other
					 applicable cost report period used to determine the capital component of the
					 1993 rate, in accordance with section
					 86-2.21 
					 of this Subpart. The return on investment for subsequent rate years shall be
					 based upon the annual cost report used by the department to determine the
					 capital component of the rate in accordance with section
					 86-2.21 
					 of this Subpart. The percentage to be used in computing the return on
					 investment shall be equal to the 26-week United States Treasury Bill rate in
					 effect on the second Wednesday of September of the year prior to the rate
					 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 86-2 - Residential Health Care Facilities › Section 86-2.29 - Payments to receivers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 commissioner may make noninterest-bearing payments to receivers, appointed
					 pursuant to Public Health Law, section
					 2810, according to the terms set forth in
					 this section and subject to the availability of moneys therefor.
(b) No such payments shall be made unless the
					 commissioner reasonably anticipates that repayment shall be made prior to or
					 upon termination of the receivership.
(c) Any such payment to a receiver shall be
					 pursuant to a written agreement between such receiver and the commissioner. The
					 amount of such payment shall not exceed the facility's anticipated Medicaid
					 revenue for a four-week period. When the commissioner is the receiver, no
					 written agreements shall be required, but the commissioner shall comply with
					 all other provisions of this section.
(d) A receiver may request a payment upon a
					 showing that:
(1) there is a need for such
					 funds based on the financial condition of the facility;
(2) there are debts that were incurred prior
					 to the receivership, which must be paid by the receiver to assure uninterrupted
					 patient care; or
(3) funds are not
					 otherwise available to correct serious or life-threatening structural
					 deficiencies other than alterations prohibited in Public Health Law, section
					 2810 (2)(c).
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 86-2.30 - Residential health care facilities patient assessment for certified rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purpose
					 of determining reimbursement rates effective January 1, 1986 and thereafter,
					 for governmental payments, each residential health care facility shall, on an
					 annual basis or more often as determined by the department pursuant to this
					 Subpart, assess all patients to determine case mix intensity using the patient
					 review criteria and standards promulgated and published by the department
					 (patient review instrument [PRI] and instructions: patient review instrument)
					 and specified in subdivision (i) of this section.
(b)
(1) The
					 patient review form (PRI) shall be submitted according to a written schedule
					 determined by the department. Such written schedule shall be established by the
					 Commissioner of Health with notice to residential health care facilities.
					 Extension of the time for filing may be granted upon application received prior
					 to the due date of the patient review forms and only in circumstances where the
					 residential health care facility establishes, by documentary evidence, that the
					 patient review forms cannot be submitted by the due date for reasons beyond the
					 control of the facility.
(2) Rate
					 schedules shall not be certified by the Commissioner of Health unless
					 residential health care facilities are in full compliance with the requirements
					 of this section. Compliance with the assessment requirements of this section
					 shall include, but not be limited to, the timely filing of properly certified
					 patient review forms (PRI) which are complete and accurate. Failure of a
					 residential health care facility to file the patient review form (PRI) pursuant
					 to the written schedule established pursuant to this subdivision, shall subject
					 the residential health care facility to the provisions of section
					 86-2.2(c)  of 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 86-2 - Residential Health Care Facilities › Section 86-2.32 - Nurse aide competency exam

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Definitions. For purposes of this section, the following definitions shall
					 apply:
(1) Rate shall mean the aggregate
					 governmental payment to the facility per patient day as defined in section
					 86-2.8  of
					 this Subpart.
(2) Nurse aide
					 trainee shall mean a person as defined in section
					 414.1(b)(8) 
					 of this Title.
(3) Nurse aide shall
					 mean a person as defined in section
					 414.1(b)(7) 
					 of this Title.
(4) Program
					 coordinator shall mean a person as defined in section
					 414.1(b)(26) 
					 of this Title.
(5) Primary
					 instructor shall mean a person as defined in section
					 414.1(b)(27) 
					 of this Title.
(6) Clinical skills
					 evaluator shall mean a person as defined in section
					 414.1(b)(28) 
					 of this Title who is qualified to administer the clinical section of the nurse
					 aide competency exam.
(7) The
					 competency examination shall mean the clinical skills examination and the
					 written or oral competency examination required of nurse aides by section 2803-j  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 86-2 - Residential Health Care Facilities › Section 86-2.33 - Dementia pilot demonstration projects

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Payment rates shall be adjusted by the
					 addition of a per diem amount as determined by the commissioner pursuant to
					 this section for residential health care facilities participating in pilot
					 demonstration projects for the development of additional knowledge and
					 experience in the area of dementia care and to improve the quality of care and
					 treatment of patients with dementia.
(b) The adjustment to payment rates provided
					 for in this section shall be made for qualifying residential health care
					 facilities (RHCF's) applying for and receiving the approval of the commissioner
					 for participation in such projects. Acceptable uses of such adjustments shall
					 include but shall not be limited to:
(1)
					 increasing the availability of programs and resources for dementia
					 patients;
(2) training staff to
					 manage behavior or promote effective care of dementia patients;
(3) arranging the environment in ways that
					 produce positive outcomes for dementia patients; and/or
(4) maintaining and promoting autonomy and
					 decisionmaking on the part of dementia patients.
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 86-2.34 - Affiliation changes

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 hospital-based residential health care facility as defined in section 86-
					 2.10(a)(13) of this Subpart whose affiliated hospital closes its acute care
					 beds shall notify the department within 30 days of actual complete closure of
					 such beds. Such residential health care facility shall have its affiliation
					 status changed to free-standing effective as of the date of actual complete
					 closure.
(b) For purposes of
					 establishing the allowable indirect component of the rate pursuant to section
					 86-2.10(d) 
					 of this Subpart, a hospital-based residential health care facility whose
					 affiliation changes to free-standing under circumstances described in
					 subdivision (a) of this section may apply to the department at the same time
					 notice of closure is given pursuant to subdivision (a) of this section for a
					 three-year phase in of its free-standing affiliation for reimbursement purposes
					 effective the beginning of the next calendar year following actual complete
					 closure of its acute care beds.
(1) For the
					 rate effective January 1st of the calendar year following actual complete
					 closure of the affiliated hospital's acute care beds, the mean indirect price
					 per day determined pursuant to section
					 86-2.10(d)(4)(i) 
					 of this Subpart shall be determined by summing the product of multiplying the
					 mean indirect price per day of the appropriate hospital-based peer group by.75
					 and the product of multiplying the mean indirect price per day of the
					 appropriate free-standing peer group by.25.
(2) For the rate effective January 1st of the
					 second calendar year following actual complete closure of the affiliated
					 hospital's acute care beds, the mean indirect price per day determined pursuant
					 to section
					 86-2.10(d)(4)(i) 
					 of this Subpart shall be determined by summing the product of multiplying the
					 mean indirect price per day of the appropriate hospital-based peer group by.50
					 and the product of multiplying the mean indirect price per day of the
					 appropriate free-standing peer group by.50.
(3) For the rate effective January 1st of the
					 third calendar year following actual complete closure of the affiliated
					 hospital's acute care beds, the mean indirect price per day determined pursuant
					 to section
					 86-2.10(d)(4)(i) 
					 of this Subpart shall be determined by summing the product of multiplying the
					 mean indirect price per day of the appropriate hospital-based peer group by.25
					 and the product of multiplying the mean indirect price per day of the
					 appropriate free-standing peer group by.75.
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 86-2.36 - Scheduled short-term care

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Residential health care facilities which provide scheduled short-term care for
					 residents in accordance with Part 410 of this Title shall be paid a per diem
					 rate of reimbursement for such services which is the average per diem rate of
					 reimbursement for the facility as established pursuant to this
					 Subpart.
(b) The requirements of
					 sections
					 86-2.11
					 and
					 86-2.30 
					 of this Subpart relating to resident assessments and the submission of case mix
					 information to the department shall not apply to scheduled short-term care in
					 accordance with Part 410 of this Title.
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 86-2.37 - Submission of resident assessments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective November 1, 1992 and
					 thereafter, residential health care facilities shall submit to the department
					 the data contained in the comprehensive assessment and review of assessments
					 (quarterly reviews) required to be completed by facilities in accordance with
					 section
					 415.11 
					 of this Title and section 483.20 of 42 CFR (Minimum Data Set Plus for Nursing
					 Home Resident Assessment and Care Screening [MDS
Image
]), using a
					 telecommunications process based on electronic mail or if directed by the
					 department, other electronic medium such as computer tape or floppy disc. This
					 submission shall be made consistent with the department' s data submission
					 specifications for the MDS
Image
and shall use the
					 department-provided submission preparation computer software when preparing the
					 MDS
Image
data
					 for transmission.
(1) Electronic submission of
					 the MDS
Image
data shall occur no later than six weeks after the assessment start date which
					 the facility indicates in section A of the MDS
Image
document.
(2) The electronic
					 submissions shall include all assessments and quarterly reviews with an
					 assessment start date of November 1, 1992 and thereafter, completed by the
					 facilities in accordance with section
					 415.11 
					 of this Title.
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 86-2.38 - Nursing home incentive payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The commissioner shall make rate
					 adjustments, subject to the availability of funds therefore, to certain
					 residential health care facilities who demonstrate to the satisfaction of the
					 commissioner that they can meet or exceed defined quality measures.
(b) Initial awards shall be based on a
					 residential health care facility's performance for pressure ulcer quality of
					 care for chronic care residents.
(c) The commissioner shall make two sets of
					 awards as follows:
(1) an award shall be made
					 for the best performers for the evaluation period;
(2) an award shall be made to residential
					 health care facilities with the best improvement in pressure ulcer care between
					 a base and evaluation period except that facilities in the bottom quarter
					 percentile of all eligible residential health care facilities for this
					 evaluation period shall not be eligible for such an award if, even after their
					 improvement in pressure ulcer care, they still remain in the bottom quarter
					 percentile of all eligible residential health care facilities; and
(3) residential health care facilities that
					 qualify are eligible to receive an award in both categories of
					 awards.
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 86-2.39 - Closures, mergers, acquisitions, consolidations and restructurings

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
					 residential health care facilities.
(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;
					 or
(4) facilities impacted by the
					 merger, acquisition, consolidation or restructuring of other health care
					 facilities.