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 86-2.9 - Adult day health care in residential health care facilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except as
					 specifically identified in subdivision (g), rates for residential health care
					 facility services for adult day health care registrants shall be computed on
					 the basis of the allowable costs, as reported by the residential health care
					 facility, and the total number of visits by adult day health care registrants,
					 as defined in Part 425 of this Title, for which services were delivered
					 pursuant to Article 6 of Subchapter A of Chapter V of this Title subject to the
					 maximum daily rate provided for in this section.
(b) For adult day health care programs
					 without adequate cost experience, rates will be computed based upon annual
					 budgeted allowable costs, as submitted by the residential health care facility
					 and the total estimated annual number of visits by adult day health care
					 registrants, as defined in Part 425 of this Title, for which services were
					 delivered pursuant to Article 6 of Subchapter A of Chapter V of this Title
					 subject to the maximum daily rate provided for in this section.
(c) Allowable costs shall include, but are
					 not limited to, the following:
(1) applicable
					 salary and nonsalary operating costs;
(2) cost of transportation; and
(3) appropriate portion of capital costs,
					 allocated according to instructions accompanying the RHCF-4 report.
(i) Notwithstanding any provision to the
					 contrary, effective January 1, 2015, for leases originating prior to December
					 31, 2018 and being renewed beyond such date, residential health care facilities
					 that lease property from a non-related organization in order to operate an
					 adult day health care program consistent with this section shall receive
					 reimbursement from the department related to the cost of such lease. In the
					 event that there is no historic cost, the department shall reimburse such adult
					 day health care program for the lesser of the aggregate lease costs reported to
					 the department during calendar year 2013, or the amount actually paid to the
					 lessor for such lease in the calendar year two years prior to the claim for
					 reimbursement pursuant to this subdivision, provided that such reimbursement
					 shall not exceed any applicable maximum daily rate as provided for in this
					 section. If the lease reported for that year does not span the calendar year,
					 the first twelve months of the lease shall constitute the amount paid for such
					 lease in a calendar year for the calculation above.
(ii) Beginning January 1, 2019, any
					 residential health care facility that seeks to be reimbursed for costs related
					 to newly leased property from a non-related organization in order to operate an
					 adult day health care program consistent with this section shall, prior to
					 entering into the lease, demonstrate to the satisfaction of the commissioner
					 that: the adult day health care program meets a public need; such program would
					 enable participants to remain in the community, in the least restrictive
					 setting, and avoid institutionalization; and the leased property is the most
					 cost effective option for the facility to operate the adult day health care
					 program. Upon determination that the proposed or existing program
					 satisfactorily meets each of these requirements, the commissioner may grant
					 reimbursement for the lease payment. In the event that no historic cost is
					 available, such adult day health care program will receive the lesser of the
					 lease cost reported during the calendar year 2013 or the actual lease payment
					 for the first twelve months of operation, regardless of any subsequent changes
					 or renewals to such lease or ownership of the facility operations or the leased
					 premises, provided that such reimbursement shall not exceed any applicable
					 maximum daily rate as provided for in this section. If the lease reported for
					 that year does not span the calendar year, the first twelve months of the lease
					 shall constitute the amount paid for such lease in a calendar year for the
					 calculation above.