(1)
Payment for alternate level of care services. Payment for alternate level of
care services will be made in accordance with subdivision (c) of this section,
unless there is a significant excess of operational beds at the hospital or at
hospitals in the Office of Mental Health region in which the hospital is
located. If a significant excess exists in the hospital or in the region,
payment for alternate level of care services will be made at the statewide
average skilled nursing facility or health-related facility rate, as
appropriate, weighted by total patient days, at the time the alternate level of
care services are furnished.
(2)
Significant excess of operational beds. A significant excess of operational
beds exists at a hospital if the hospital's base year occupancy rate, excluding
alternate level of care days, is less than 80 percent, as stated on the
operating certificate issued by the Office of Mental Health. A significant
excess of operational beds exists at hospitals in an Office of Mental Health
region if the overall occupancy rate for hospitals in the region is less than
80 percent. The commissioner may determine that no excess exists if, within 30
days following notice to the hospital by the commissioner of the hospital's
base year occupancy rate, the hospital demonstrates to the satisfaction of the
commissioner:
(i) the occupancy rate for the
year following the base year, excluding alternate level of care days, was not
less than 80 percent of the certified bed capacity in that year;
(ii) the hospital has reduced or has applied
to reduce its certified bed capacity by the number of beds necessary to reach
an occupancy rate of 80 percent, excluding alternate level of care days, in the
base year; or
(iii) the occupancy
rate of 80 percent may be reached by reducing certified bed capacity by no more
than three beds or one percent of total certified bed capacity.
The commissioner may determine that no excess exists if,
within 30 days following the close of the calendar quarter during which the
alternate level of care services were furnished, the hospital demonstrates to
the satisfaction of the commissioner that the occupancy rate during that
quarter, excluding alternate level of care days, was not less than 80 percent
of the certified bed capacity in that quarter.
(3) Procedure for determining occupancy
rates. The commissioner will notify each hospital of its base year occupancy
rate at the time the hospital is notified of its certified rate in accordance
with Part 577 of this Title. After the expiration of the 30-day period
described in paragraph (2) of this subdivision, the commissioner will notify
each hospital whether a significant excess of operational beds exists at the
hospital and at hospitals in the Office of Mental Health region in which the
hospital is located.
