New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIV - Office for People With Developmental Disabilities
Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities
Subpart 635-4 - Financial Reporting and Audit Requirements
Section 635-4.4 - Failure to file required financial and statistical reports
Current through Register Vol. 47, No. 12, March 26, 2025
(a) Each provider shall submit all cost reports in the form and format and by the method specified by OPWDD so that OPWDD receives them no later than June 1st for providers reporting on the January 1st through December 31st period or December 1st for providers reporting on the July 1st through June 30th period.
(b) If the provider fails to file a cost report, in the form and format and by the method specified by OPWDD, on or before the due date, the provider shall be subject to a reduction in reimbursement under subdivision (d) of this section.
(c) A provider may make a written request for a waiver of reduction in reimbursement due to extraordinary and/or unforeseeable circumstances beyond its control, such as a natural disaster, or other circumstance as determined by the OPWDD commissioner, which will prevent it from filing the cost report by the due date. The application must contain detailed facts supporting the request, describe the extraordinary and/or unforeseeable circumstances and explain why the provider believes such circumstances will prevent it from filing the cost report by the due date.
(d) The reduction in reimbursement shall equal two percent of the total billed price(s), rate(s) and/or fee(s) in the payment systems beginning on the due date of the cost report, or the revised due date of the cost report if OPWDD has approved the provider's request for a waiver of the reduction in reimbursement in accordance with paragraph (c)(4) of this section, and continuing until the next regularly scheduled payment cycle following the last day of the month in which the cost report is received. For a provider subject to this sanction, the reduction shall apply to reimbursements for the following services: Intermediate Care Facilities for Persons with Developmental Disabilities, Comprehensive Health Home Care Management, Basic HCBS Plan Support, Crisis Services for Individuals with Intellectual and/or Developmental Disabilities, Day Treatment, Clinic Treatment Facilities, residential habilitation in individualized residential alternatives (IRAs) and community residences (CRs), and all other HCBS waiver services.
(e) Additional penalty applicable to providers of HCBS waiver services. If the cost report is still outstanding on the first day of the second month following the due date, the two percent penalty will be replaced by a 50 percent penalty on the first day of the eighth month following the due date. This penalty will continue until the next regularly scheduled payment cycle following the due date of the providers' cost report for the subsequent cost reporting period or the last day of the month in which the cost report is received, whichever is later. If OPWDD determines that a provider will likely be unable to meet its financial obligations with the imposition of the 50 percent penalty or if the provider fails to file the overdue cost report by the end of the provider's next cost report period, OPWDD may request that the provider voluntarily surrender its operating certificate for the HCBS services(s) and/or take action to revoke the provider's operating certificate in accordance with article 16 of the Mental Hygiene Law.
(f) The following chart provides the dates described in subdivisions (d) and (e) of this section:
| January 1st through December 31st filers | July 1st through June 30th filers | |
| Cost report due date | June 1st | December 1st |
| 2 percent penalty starts | June 1st | December 1st |
| Due date to avoid 50 percent penalty | August 1st | February 1st* |
| 50 percent penalty starts | February 1st* | August 1st* |
| Due date of cost report for next cost report period | June 1st* | December 1st |
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*These dates apply to the year subsequent to the year the cost report is due.
(g) If the provider discovers that a cost report submitted to OPWDD is incomplete, inaccurate or incorrect, the provider must submit a revised cost report.
(h) Upon OPWDD's review of a provider's cost report that has been submitted in accordance with the form and format specified in this Subpart, if OPWDD determines that a cost report is incomplete, inaccurate, incorrect or otherwise unacceptable, OPWDD shall send the provider a written notice. Such notice shall give the provider an opportunity to submit, within a 30 day period from receipt of such notice, a revised cost report or additional data, or a request for a waiver of reduction in reimbursement due to extraordinary and/or unforeseeable circumstances beyond the provider's control that prevent it from filing a revised cost report or submitting additional data within the 30 day period. A request must contain detailed facts supporting it, describe the extraordinary and/or unforeseeable circumstances and explain why the provider believes such circumstances will prevent it from filing a revised cost report or submitting additional data within 30 days.
(i) Revised cost reports submitted under this section must be certified by the provider's chief executive officer and, if requested by OPWDD, a public accountant who meets all the requirements specified in section 635-4.3(c)(2) of this Subpart.
(j) Calendar year 2014 cost reports.
(k) Any penalty imposed pursuant to this section because of a delinquent cost report for the periods specified in paragraphs (1) and (2) of this subdivision, shall cease as of the effective date of this section.
