New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter A - Medical Facilities-minimum Standards › Article 3 - Residential Care Facilities › Part 415 - Nursing Homes-minimum Standards › Administrative › Section 415.34 - Minimum Direct Resident Care Spending

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Purpose. This Section sets forth the
						requirements of the minimum direct resident care spending law set forth in
						Section
						2828 of the
						Public Health Law and applies to all residential health care facilities
						licensed pursuant to this Part, except as provided in subdivision (c) of this
						Section.
(b) Definitions. The
						definitions of this Section shall have the same meaning as those terms set
						forth in subdivision (2) of Section
						2828 of the
						Public Health Law. Additionally, the following terms shall have the following
						meanings:
(1) "Contracted out" shall mean
						services provided by registered professional nurses, licensed practical nurses,
						or certified nurse aides who provide services in a residential health care
						facility through contractual or other employment agreement, whether such
						agreement is entered into by the individual practitioner or by an employment
						agency on behalf of the individual practitioner. Such agreement may be oral or
						in writing.
(2) "Direct resident
						care" shall mean the following cost centers in the residential health care
						facility cost report:
(i) Nonrevenue Support
						Services - Plant Operation & Maintenance, Laundry and Linen, Housekeeping,
						Patient Food Service, Nursing Administration, Activities Program, Nonphysician
						Education, Medical Education, Medical Director's Office, Housing, Social
						Service, Transportation;
(ii)
						Ancillary Services - Laboratory Services, Electrocardiology,
						Electroencephalogy, Radiology, Inhalation Therapy, Podiatry, Dental,
						Psychiatric, Physical Therapy, Occupational Therapy, Speech/Hearing Therapy,
						Pharmacy, Central Services Supply, Medical Staff Services provided by licensed
						or certified professionals including and without limitation Registered Nurses,
						Licensed Practical Nurses, and Certified Nursing Assistant; and
(iii) Program Services - Residential Health
						Care Facility, Pediatric, Traumatic Brain Injury (TBI), Autoimmune Deficiency
						Syndrome (AIDS), Long Term Ventilator, Respite, Behavioral Intervention,
						Neurode-generative, Adult Care Facility, Intermediate Care Facilities,
						Independent Living, Outpatient Clinics, Adult Day Health Care, Home Health
						Care, Meals on Wheels, Barber & Beauty Shop, and Other similar program
						services that directly address the physical conditions of residents. Direct
						resident care does not include, at a minimum and without limitation,
						administrative costs (other than nurse administration), capital costs, debt
						service, taxes (other than sales taxes or payroll taxes), capital depreciation,
						rent and leases, and fiscal services.
(3) "Resident-facing staffing" shall mean all
						staffing expenses in the ancillary and program services categories on Exhibit H
						of the residential health care facility cost reports.
(4) "Revenue" shall mean the total operating
						revenue from or on behalf of residents of the residential health care facility,
						government payers, or third-party payers, to pay for a resident's occupancy of
						the residential health care facility, resident care, and the operation of the
						residential health care facility as reported in the residential health care
						facility cost reports submitted to the Department; provided, however, that
						revenue shall exclude:
(i) the average
						increase in the capital portion of the Medicaid reimbursement rate from the
						prior three years;
(ii) funding
						received as reimbursement for the assessment under Public Health Law section
						2807 d(2)(b)(vi), as reconciled pursuant to Public Health Law section 2807
						d(10)(c);
(iii) the capital per
						diem portion of the reimbursement rate for nursing homes; provided, however,
						that such exclusion shall not apply:
(a) for
						nursing homes that have an overall one-, two-, or three-star rating assigned
						pursuant to the inspection rating system of the U.S. Centers for Medicare and
						Medicaid Services (CMS rating); or
(b) to any amount of the capital per diem
						portion of the reimbursement rate that is attributable to a capital expenditure
						made to a corporation, other entity, or individual, with a common or familial
						ownership to the operator or the facility as reported under Public Health Law
						section 2803 x(1); and
(iv) any grant funds from the federal
						government for reimbursement of COVID-19 pandemic-related expenses, including,
						but not limited to, funds received from the federal emergency management agency
						or health resources and services administration.