New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIV - Office for People With Developmental Disabilities
Part 690 - Day Treatment Services to Persons with Developmental Disabilities
Section 690.7 - Fee-setting and financial reporting for day treatment facilities
Universal Citation: 14 NY Comp Codes Rules and Regs ยง 690.7
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Rates of payment made for day treatment services rendered to title XIX recipients shall be at the levels set forth in the approved New York Medicaid State Plan. The rates shall be contingent upon Federal financial participation (FPP) and approval.
(b) Reporting requirements.
(1) Each provider shall
submit reports in accordance with the requirements of Subpart 635-4 of this
Title.
(2) Each provider shall
report on its cost report the amount of funded depreciation for each of its day
treatment programs and expenditures from funded depreciation for each of its
day treatment programs. See clauses
(d)(2)(ii)(d)-(e) and paragraph (e)(6) of
this section.
(3) For purposes of
this section a day treatment program shall be defined as budget-based if such
program did not submit a 12-month cost report for either the January 1, 1988
through December 31, 1988, or July 1, 1988 through June 30, 1989 cost-reporting
period. Budget information shall include 12 months of projected units of
service in accordance with clause (e)(1)(i)(c) of this
section, a participant roster and a completed Developmental Disabilities
Profile (DDP) for each participant.
(4) Each agency operating a day treatment
program shall submit, with its cost report, a listing of the persons who were
enrolled in the program during the period covered by the cost report.
(c) Allowable capital and utility costs.
(1) General conditions.
(i) To be considered allowable, costs must be
properly chargeable to necessary care rendered in accordance with the
requirements of this Part and any applicable codes, rules, regulations and
laws.
(a) Except where specific rules
concerning allowability of costs are stated herein or in Subpart 635-6 of this
Title, the Medicare Provider Reimbursement Manual, commonly referred to as
HIM-15 shall be used to determine the allowability of costs. Said guidelines
are published by the U.S. Department of Health and Human Services' Health Care
Financing Administration (HCFA). The HIM-15 document is available from:
The HIM-15 document is available from:
Health Care Financing Administration
Division of Communication Services
Production and Distribution Branch
Room 577, East High Rise Building
6325 Security Boulevard
Baltimore, MD 21207
It may be reviewed in person during regular business hours at the:
(1) NYS Department of State, 41
State Street, Albany, NY 12207; or
(2) by appointment at the NYS Office for
People With Developmental Disabilities, Division of Revenue Management, 30
Russell Road, Albany, NY 12206.
(b) Where specific rules stated herein or
HIM-15 are silent concerning the allowability of costs, the commissioner shall
determine allowability of costs based on reasonableness and relationship to the
provision of care and generally accepted accounting principles.
(c) As determined by the commissioner,
expenses or portions of expenses reported by an individual day treatment
program that are not reasonably related to the efficient and economical
provision of care in accordance with any applicable certification standards
because of either the nature or amount of the item, shall not be
allowed.
(2)
Capital costs.
(i) Notwithstanding
subparagraph (iv) of this paragraph, in the case of any provider which has been
notified by OPWDD on or after July 1, 1986 that there is a preliminary
reservation of State aid funds for a capital grant pursuant to Mental Hygiene
Law, section
41.18(c) or 41.23, the
basis for computing depreciation on the day treatment program which is the
subject of the capital grant shall include the day treatment program's
depreciable project costs which were funded with such capital grant, provided
that the provider has not repaid the entire principal owed on the real property
of the day treatment program. If the depreciable project costs are adjusted
after audit, the basis for computing depreciation on the day treatment program
will be changed to such adjusted depreciable project costs. Upon full repayment
of principal, the basis for depreciation for the day treatment program will
cease to include the amount of the capital grant. Any provider which receives
such a capital grant shall enter into certain assurances with the OPWDD whereby
the provider agrees that:
(a) the difference
between depreciation in the fee attributable to the day treatment program's
depreciable project costs (other than depreciation attributable to the
provider's equity in the day treatment program's real property at the time such
property is put into use as a day treatment program) and the principal which is
repaid shall be deposited in an investment approved by the commissioner. The
commissioner's approval shall be based on whether the investment is secure,
bears interest, is liquid, and is appropriate to the purpose for which it is
being made;
(b) except as provided
in clause (e) of this subparagraph, withdrawals from such
investment shall be made only for the purpose of repayment of indebtedness owed
on the real property of the facility;
(c) each withdrawal must be signed by the
commissioner; and
(d) if the
provider ceases to operate the facility as a day treatment program for persons
with developmental disabilities, or as any facility certified by OPWDD, it will
repay to the OPWDD the balance on deposit in the secure investment at the time
of such cessation, including interest earned on the investment;
(e) with the commissioner's approval based on
cost savings, a provider may use withdrawals from the investment cited in
clause (b) of this subparagraph for repayment of indebtedness
owed on the real property of another facility which received a capital grant
under this subparagraph or under subparagraph (ii) of this paragraph, or if
there is no such other facility which is mortgaged, for the repayment of
indebtedness owed on the real property of another facility which is mortgaged
under the same mortgage as the facility;
(f)
depreciable project
costs shall mean those acquisition and construction costs of a day
treatment program which have been approved, either before or after audit, by
the New York State Office of the State Comptroller or by OPWDD's designee. Such
costs shall not include the cost of the land.
(ii) Notwithstanding subparagraph (iv) of
this paragraph, any provider which has been notified by OPWDD before July 1,
1986 that there is a preliminary reservation of State aid funds for a capital
grant pursuant to Mental Hygiene Law, section
41.18(c) or 41.23, may
apply to the commissioner to have the basis for computing depreciation on the
facility include the day treatment program's depreciable project costs which
were funded with the capital grant. Such application must be submitted to the
commissioner on or before December 31, 1986 on the forms prescribed by the
commissioner. Such application shall be granted at the discretion of the
commissioner upon a showing that inclusion in the depreciation basis of the day
treatment program's depreciable project costs which were funded with the
capital grant is necessary to the financial viability of the facility and will
not impede the day treatment program's efficient and economical operation. If
the commissioner approved such application, the day treatment program's fee
shall be revised retroactive to July 1, 1986 to include in the depreciation
basis the day treatment program's depreciable project costs which were funded
with the capital grant, and the provider shall enter into certain assurances
described in subparagraph (i) of this paragraph. Upon full repayment of
principal, the basis for depreciation for the day treatment program will cease
to include the amount of the capital grant. If the depreciable project costs
are adjusted after audit, the basis for computing depreciation on the day
treatment program will be changed to such adjusted depreciation project
costs.
(iii) For any real property
transaction on or before December 31, 1985 resulting in a change of ownership,
and resulting in a transaction that is not an at-arm's-length transaction, as
defined in clause (i)(b) of this paragraph, the historical
cost of the asset shall be limited to the seller's net book value.
(iv) Restricted funds are funds expended by
the day treatment program, which include grants, gifts, and income from
endowments, whether cash or otherwise, which must be used only for a specific
purpose as designated by the donor or grant instrument. Except as provided for
in subparagraphs (i) and (ii) of this paragraph, restricted funds are to be
deducted from the designated costs when determining allowable capital costs.
The commissioner may waive the provisions of this section at his discretion
only in those instances where the provider makes a reasonable demonstration
that the imposition of the requirements of this section would cause undue
financial harm to the ongoing operation of the day treatment program.
(v)
Start-up costs are those
costs which are incurred from the period the provider receives approval
pursuant to the certification of need process for a facility to become a day
treatment program to the date the first individual is admitted. However, costs
incurred during the period from the first admission to the effective date of
the initial Medicaid certification shall not be considered as start-up costs.
(a) OPWDD will reimburse a facility for all
allowable start-up costs incurred in the preparation of the facility during
that six-month period prior to the date of the first admission. The
commissioner may grant an extension of the six-month limit for good cause
shown. However, under no circumstances shall a facility be allowed
reimbursement of start-up costs for any period of time exceeding 18 months
prior to the date of the first admission.
(b) Allowable start-up costs may include, but
are not limited to:
(1) personal service
expenses;
(2) utility
expenses;
(3) taxes;
(4) insurance expenses;
(5) employee training expenses;
(6) housekeeping expenses;
(7) repair and maintenance expenses;
and
(8) administrative
expenses.
(c) Any costs
that are properly identifiable as organization costs or capitalizable as
construction costs shall be classified as such and excluded from start-up
costs.
(d) If all portions of the
day treatment program's facility are prepared at the same time, start-up costs
shall be accumulated in a single deferred account and shall be amortized from
the date of the first admission. However, if only portions of the day treatment
program's facility are prepared (i.e., preparation of a floor
or wing), start-up costs shall be capitalized and amortized separately. In
either case, start-up costs shall be amortized over a period not to exceed 60
months from the date of the first admission.
(d) Fee-setting.
(1) For the purpose of setting the day
treatment fee, units of service shall include the total number of half-day
units of service (more than three hours but less than five hours), the number
of full-day units of service (five hours or more) and partial day units of
service (such as in the amount of at least 11/2 hours but less than three
hours). Units of service are billable in the above amounts based on a unit of
service per person per day. Billable services include the initial contact
visit, enrollment for completing a preliminary screening, and services for
individuals formally admitted to the day treatment program in accordance with
section
690.5
of this Part.
(i) Units of service for the
fee-setting calculation shall utilize projected or actual units of service as
follows:
(a) For the April 1, 1991 through
December 31, 1991 fee-setting calculation, actual units of service shall be
from the January 1, 1988 through December 31, 1988 cost report, for facilities
in Region II or III, including those programs in Region I designated or elected
to a Region II or III reporting year-end and fiscal cycle in accordance with
subparagraph (b)(1)(iv) of this section and excluding those programs in Regions
II and III designated or elected to a Region I reporting year-end and fiscal
cycle in accordance with subparagraph (b)(1)(iv) of this section. For the July
1, 1991 to June 30, 1992 fee-setting calculation, actual units of service shall
be from the July 1, 1988 through June 30, 1989 cost report, for programs in
Region I, including those programs in Regions II and III designated or elected
to a Region I reporting year-end and fiscal cycle in accordance with
subparagraph (b)(1)(iv) of this section and excluding those programs in Region
I designated or elected to a Region II or III reporting year-end and fiscal
cycle in accordance with subparagraph (b)(1)(iv) of this section.
(b) For the January 1, 1992 through December
31, 1992, April 1, 1992 through March 31, 1993, and July 1, 1992 through June
30, 1993 fee-setting calculations, and thereafter, actual units of service
shall be from the cost report, submitted in accordance with paragraph (b)(1) of
this section, two years prior to the period for which the fee is being set. For
example, for the fee period of January 1, 1997 through December 31, 1997, the
units of service shall be those reported on the cost report for the period of
January 1, 1995 through December 31,1995. For programs for which OPWDD has not
received such cost report at the time of the fee-setting calculation, OPWDD
shall utilize the units of service paid for through the Medicaid Management
Information System (MMIS), during the required cost report period.
(c)
Projected units of
service shall mean the estimated monthly attendance multiplied by the
expected number of days the program will be open for each month. This
computation shall be made for each month and summed and annualized for the
number of months in the fee period. Projected units of service will be used in
the absence of actual units of service from the cost reports required pursuant
to clause (a) or (b) of this subparagraph.
Projected units of service will be required upon issuance of an operating
certificate for a new site or an amended operating certificate reflecting a
change in capacity. Projected units of service shall be utilized for
fee-setting purposes until a full-year cost report, subsequent to the cost
report period in which the issuance of an operating certificate for a new site
occurred, is used for fee-setting purposes. Projected units of service shall
also be utilized for fee-setting purposes until a full-year cost report,
subsequent to the cost report period in which the change in capacity occurred,
is utilized for fee-setting purposes. If the estimated units of service have
not been received by OPWDD by the date required, OPWDD shall utilize the units
of service paid for through the MMIS, beginning with the program's initial
certification or the first full month since the change in certified capacity
occurred. If the available MMIS units of service are for less than a 12-month
period, they shall be annualized for fee-setting purposes.
(2) Fee base period.
(i) For facilities in Regions II and III,
excluding those facilities in Regions II and III designated or elected to a
Region I reporting year end and fiscal cycle in accordance with Subpart 635-4
of this Title, the base period shall be from January 1st to December 31,
1988.
(ii) For facilities in Region
I, including those facilities in Regions II and III designated or elected to a
Region I reporting year-end and fiscal cycle in accordance with Subpart 635-4
of this Title and excluding those facilities in Region I designated or elected
to a Region II or III reporting year-end and fiscal cycle in accordance with
Subpart 635-4 of this Title the base period shall be from July 1, 1988 to June
30, 1989.
(iii) For facilities in
Region I designated or elected to a Region II or III reporting year- end and
fiscal cycle in accordance Subpart 635-4 of this Title, the base period shall
be January 1st to December 31, 1988.
(iv) All dollar amounts cited in this section
shall reflect base period costs for the period of January 1, 1988 through
December 31, 1988.
(3)
The fee for day treatment facilities shall be a fixed amount plus operating,
capital, and transportation component add-ons. The fixed amount and operating
component add-ons shall reflect base period costs and shall be subject to trend
factors pursuant to paragraph (6) of this subdivision. As appropriate, OPWDD
shall apply trend factors to the fixed amount and each facility's total
reimbursable operating components as determined by this section. Such trend
factors shall be applied only to the fixed amount and the operating components
with the capital and transportation components added to this result to utilize
in calculating the final fee.
(i) The
operating component add-ons shall be case mix, case mix intensity, salary,
staff training and utilities. Day treatment programs that have submitted cost
reports that contain full year costs for the periods January 1, 1988 through
December 31, 1988 and July 1, 1988 through June 30, 1989 shall also be eligible
to qualify for either cap adjustment component add-on or an allocation
adjustment component add-on. In addition, day treatment programs in Region II
and III that participated in the salary enhancement plan pursuant to chapter 54
of the Laws of 1988 shall also receive a salary enhancement cost adjustment
component add- on. Operating component add-ons shall reflect base year costs
and shall be subject to a trend factor pursuant to paragraph (6) of this
subdivision.
(ii) The capital
component shall include property, equipment, and start up costs pursuant to
paragraph (c)(2) of this section. The capital component will not be subject to
a trend factor.
(iii) For the April
1, 1991 through December 31, 1991 fee period, day treatment programs in Regions
II and III including those programs in Region I designated or elected to a
Region II or III reporting year-end and fiscal cycle in accordance with Subpart
635-4 of this Title shall also receive an annualization cost component
add-on.
(iv) Effective July 1,
1995, the fixed amount shall be $36.67.
(v) The operating component add-ons shall be
computed as follows. Such component add-ons shall be added to the fixed amount.
(a) Case mix component. The developmental
disabilities profile (DDP) shall be administered to each person attending the
day treatment program. The DDP may be reviewed in person during regular
business hours at the:
(1) NYS Department of
State, 41 State Street, Albany, NY 12207; or by appointment at the:
(2) NYS Office for People With Developmental
Disabilities, Division of Revenue Management, 30 Russell Road, Albany, NY
12206.
(a) Utilizing
the individual's adaptive, maladaptive, and health/medical DDP scores, each
person's scores shall be assigned as follows to its corresponding DDP
percentile level. For facilities whose fee period is July 1st through June
30th, this provision applies to the fee periods July 1, 1994 through June 30,
1996, and thereafter. For facilities whose fee period is January 1st through
December 31st, this provision applies to the fee periods January 1, 1994
through December 31, 1995 and thereafter. Corrected or updated DDP scores shall
be implemented in accordance with paragraph (7) of this subdivision. The total
number of persons assigned to each percentile level shall be multiplied by the
dollar amount associated with that percentile level. Total dollars for each
percentile level shall be summed together and divided by the number of persons
for whom there are DDP scores.
REGION I
For the period July 1, 1994 through June 30, 1995:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| (I) 0 - 39.99 | <239 | <34 | <3 | 0 |
| (II) 40 - 69.99 | >or=239 | >or=34 | >or=3 | 2.11 |
| <333 | <92 | <7 | ||
| (III) 70 - 89.99 | >or=333 | >or=92 | >or=7 | 4.22 |
| <410 | <132 | <11 | ||
| (IV) >or=90 | >or=410 | >or=132 | >or=11 | 8.72 |
For the period(s) beginning July 1, 1995:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| (I) 0 - 39.99 | <242 | <39 | <4 | 0 |
| (II) 40 - 69.99 | >or=242 | >or=39 | >or=4 | 2.11 |
| <338 | <97 | <8 | ||
| (III) 70 - 89.99 | >or=338 | >or=97 | >or=8 | 4.22 |
| <420 | <133 | <12 | ||
| (IV) >or=90 | >or=420 | >or=136 | >or=12 | 8.72 |
REGIONS II AND III
For the period January 1, 1994 through December 31, 1994:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| (I) 0 - 39.99 | <239 | <34 | <3 | 0 |
| (II) 40 - 69.99 | >or=239 | >or=34 | >or=3 | 2.11 |
| <333 | <92 | <7 | ||
| (III) 70 - 89.99 | >or=333 | >or=92 | >or=7 | 4.22 |
| <410 | <132 | <11 | ||
| (IV) >or=90 | >or=410 | >or=132 | >or=11 | 8.72 |
For the period(s) beginning January 1, 1995:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| (I) 0 - 39.99 | <242 | <39 | <4 | 0 |
| (II) 40 - 69.99 | >or=242 | >or=39 | >or=4 | 2.11 |
| <338 | <97 | <8 | ||
| (III) 70 - 89.99 | >or=338 | >or=97 | >or=8 | 4.22 |
| <420 | <133 | <12 | ||
| (IV) >or=90 | >or=420 | >or=136 | >or=12 | 8.72 |
(1) Individual
scores shall be assigned to percentile level I if all three of the individuals'
DDP scores are less than the 40th percentile of all DDP scores.
(2) Individual scores shall be assigned to
percentile level II if the individual has one DDP score on any one dimension is
equivalent to or that is greater than the 40th percentile and less than the
70th percentile.
(3) Individual
scores shall be assigned to percentile level III, if the individual has one DDP
score on any one dimension that is equal to or greater than the 70th percentile
and less than the 90th percentile.
(4) Individual scores shall be assigned to
percentile level IV if the individual has one DDP score on any one dimension
that is greater than or equal to the 90th percentile.
(b) Case mix intensity component add-on. The
highest single DDP percentile ranking for each individual program participant
in any one of the three DDP scoring dimensions, adaptive, maladaptive and
health/medical, shall be summed and divided by the total number of program
participants with DDP scores, yielding an average percentile level for each
program. For facilities whose fee period is July 1st through June 30th, this
provision applies to the fee periods July 1, 1994 through June 30, 1996 and
thereafter. For facilities whose fee period is January 1st through December
31st, this provision applies to the fee periods January 1, 1994 through
December 31, 1995 and thereafter. Corrected or updated DDP scores shall be
implemented in accordance with paragraph (7) of this subdivision. The add-on
shall be allowed as follows:
REGION I
For the period July 1, 1994 through June 30, 1995:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| <75th | <350 | <100 | <8 | 0 |
| 75 - 79.99 | >or=350 | >or=100 | NA | .88 |
| <366 | <110 | |||
| 80 - 84.99 | >or=366 | >or=110 | >8 | 3.52 |
| <385 | <121 | <10 | ||
| 85 - 89.99 | >or=385 | >or=121 | =10 | 13.20 |
| <410 | <132 | |||
| 90 - 92.99 | >or=410 | >or=132 | >or=11 | 30.80 |
| <431 | <140 | <13 | ||
| >92.99 | >or=431 | >or=140 | >or=13 | 39.60 |
For the period(s) beginning July 1, 1995:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| 75th | <354 | <105 | <8 | 0 |
| 75 - 79.99 | >or=354 | >or=105 | =8 | 0.88 |
| <371 | <117 | |||
| 80 - 84.99 | >or=371 | >or=117 | =9 | 3.52 |
| <392 | <125 | |||
| 85 - 89.99 | >or=392 | >or=125 | >or=10 | 13.20 |
| <420 | <136 | <12 | ||
| 90 - 92.99 | >or=420 | >or=136 | >=12 | 30.80 |
| <441 | <144 | |||
| >92.99 | >or=441 | >or-144 | >12 | 39.60 |
REGIONS II AND III
For the period January 1, 1994 through December 31, 1994:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| <75th | <350 | <100 | <8 | 0 |
| 75 - 79.99 | >or=350 | >or=100 | NA | 0.88 |
| <366 | <110 | |||
| 80 - 84.99 | >or=366 | >or=110 | >8<10 | 3.52 |
| <385 | <121 | |||
| 85 - 89.99 | >or=385 | >or=121 | =10 | 13.20 |
| <410 | <132 | |||
| 90 - 92.99 | >or=410 | >or=132 | >=11 | 30.80 |
| <431 | <140 | <13 | ||
| >92.99 | >or=431 | >or=140 | >or=13 | 39.60 |
For the period(s) beginning January 1, 1995:
| Percentile | Adaptive | Maladaptive | Health/Medical | $ Add-On |
| 75th | <354 | <105 | <8 | 0 |
| 75 - 79.99 | >or=354 | >or=105 | =8 | 0.88 |
| <371 | <117 | |||
| 80 - 84.99 | >or=371 | >or=117 | =9 | 3.52 |
| <392 | <125 | |||
| 85 - 89.99 | >or=392 | >or=125 | >or=10 | 13.20 |
| <420 | <136 | <12 | ||
| 90 - 92.99 | >or=420 | >or=136 | =12 | 30.80 |
| <441 | <144 | |||
| >92.99 | >or=441 | >or=144 | >12 | 39.60 |
(c)
Staff training component. The add-on shall be $.32.
(d) For day treatment programs required to
independently pay utilities, the utilities component shall be the amount of
utilities as reported in the most recent cost report divided by the units of
service pursuant to paragraph (1) of this subdivision.
(1) The utilities amount shall reflect the
costs on an annual basis trended by an amount to be determined by the
commissioner.
(2) A day treatment
program shall receive the statewide median for utilities if the most recent
cost report is not available, or does not cover the full period of the cost
report.
(3) Utilities may be
updated to reflect documented actual costs and/or cost increases due to
expansion of the physical plant approved pursuant to paragraph (c)(2) of this
section.
(e) Salary
component. The salary component of the fee shall be computed as follows:
(1) An agency salary per FTE shall be
computed for each agency. The agency salary per FTE shall be equal to the total
agency day treatment noncontracted personal service costs reported on the
appropriate January 1, 1988 through December 31 1988 or July 1, 1988 through
June 30, 1989 cost reports divided by total reported agency day treatment FTE's
and the result is multiplied by. 9533 in order to reflect a median day
treatment salary for each agency. The noncontracted personal service costs
reported on the January 1, 1988 through December 31, 1988 cost report shall be
inclusive of nine months of salary enhancement for programs that participated
in the salary enhancement program of chapter 54 of the Laws of 1988. The agency
salary for programs defined as budget based will be adjusted to reflect the
agency salary of other existing day treatment programs operated by the
provider. If the provider does not operate other day treatment programs, the
day treatment agency salary shall be equal to the agency salary of ICF/DDs
and/or community residences operated by the providers. Day treatment agency
salaries derived from other day treatment programs or ICF/DD and/or community
residence programs operated by the provider shall be adjusted by. 9533 to
reflect median day treatment agency salary. Budget based programs will be
considered to be in a deficit (I) in accordance with subclause
(v)(e)(3) of this paragraph. If the provider
does not operate other day treatment or ICF/DD programs, the agency salary per
FTE shall be equal to the day treatment statewide salary of $16,799.
(2) The agency salary per FTE shall be
compared to the day treatment statewide salary of $16,799.
(3) Surplus/deficit (I). A surplus/deficit
analysis shall be computed for each day treatment program that filed a 12-month
cost report for January 1, 1988 through December 31, 1988 or July 1, 1988
through June 30, 1989. The surplus/deficit analysis shall be computed using the
actual units of service from the 1988 cost report and, as appropriate, either
the January 1, 1990 or July 1, 1990 day treatment fixed amount and operating
cost components in effect as of October 1, 1990, detrended to the base period.
The trend factor used to detrend Region I fixed amount and operating cost
components is 15.66 percent. The trend factor used to detrend Region II and III
fixed amount and operating cost components is 13.65 percent. The detrended
fixed amount and operating cost components shall be compared to the program
specific operating costs from the appropriate cost report so as to determine
the site specific surplus or deficit. The surplus or deficit derived from this
analysis shall be titled surplus/deficit (I). The surplus/deficit (I) shall not
be computed for sites defined as budget based except as assigned in subclause
(1) of this clause.
(4) Salary component add-ons in accordance
with the schedule identified below shall be added to fixed amount for each day
treatment site.
(i) If the agency salary per
FTE pursuant to subclause (1) of this clause is greater than
the 50th percentile of the statewide day treatment industry and the day
treatment program is experiencing a surplus (I) in accordance with subclause
(3) of this clause, the salary component shall be
$6.10.
(ii) If the agency salary
per FTE pursuant to subclause (1) of this clause is greater
than the 50th percentile of the day treatment industry and the day treatment
program is experiencing a deficit (I) in accordance with subclause
(3) of this clause, the salary component shall be $6.10 plus
the amount of costs equal to the agency salary per FTE divided by the statewide
salary of $16,799 multiplied by $29.09, minus $29.09. The 21.2 percent fringe
factor is added to this amount.
(iii) If the agency salary per FTE pursuant
to subclause (1) of this clause is greater than the 40th
percentile or equal to the day treatment statewide salary of $16,799, the
salary component add-on shall be $6.10.
(iv) If the agency salary per FTE pursuant to
subclause (1) of this clause is equal to or greater than the
30th percentile or less than the 40th percentile of the day treatment industry,
the salary component add-on shall be $3.89.
(v) If the agency salary per FTE pursuant to
subclause (1) of this clause is equal to or greater than the
20th percentile or less than the 30th percentile of the day treatment industry,
the salary component add-on shall be $2.37.
(vi) If the agency salary per FTE pursuant to
subclause (1) of this clause is equal to or greater than the
10th percentile or less than the 20th percentile of the day treatment industry,
the salary component add-on shall be $1.50.
(vii) If the agency salary per FTE pursuant
to subclause (1) of this clause is less than the 10th
percentile of the day treatment industry, the salary component add-on shall be
$0.
(f)
Salary enhancement cost adjustment component add-on. The fixed amount for day
treatment programs that participated in the salary enhancement plan pursuant to
chapter 54 of the Laws of 1988 during the period January 1, 1988 through
December 31, 1988 and submitted a 12-month cost report for the same period,
shall receive a salary enhancement cost adjustment component add-on. Budget
based day treatment programs in Regions II and III whose agency salary per FTE
pursuant to subclause (1) of this clause, is equal to the
agency salary of other existing day treatment programs operated by the same
provider shall also receive the salary enhancement cost adjustment component
add-on. The salary enhancement cost adjustment component may be revised to
reflect additional FTE's for programs that have experienced a capacity change
resulting in the issuance of a new operating certificate.
(1) The salary enhancement cost adjustment
component shall be calculated as follows:
(i)
For day treatment programs in Region II, the total number of direct care and
support FTE's shall be multiplied by 25 percent of $1,900 and increased by a
fringe benefit factor of. 212 percent and divided by the units of service
pursuant to paragraph (1) of this subdivision.
(ii) For day treatment programs in Region
III, the total number of direct care and support FTE's shall be multiplied by
25 percent of $1,690 and increased by a fringe benefit factor of. 212 percent
and divided by the units of service pursuant to paragraph (1) of this
subdivision.
(g) Cap adjustment component add-on and
allocation component add-on.
(1) In order to
determine eligibility for either the cap adjustment component add-on or the
allocation component add-on, a surplus/deficit analysis shall be computed for
each day treatment program using operating fees determined in accordance with
subparagraph (iv) and clauses (v)(a)-(f) of
this paragraph and the actual units of service from the 1988 cost report. Such
operating fee revenues shall be compared to program specific operating costs
from either the January 1, 1988 through December 31, 1988 or July 1, 1988
through June 30, 1989 cost reports. The surplus or deficit derived from this
analysis shall be titled surplus/deficit (II).
(2) Day treatment programs determined to be
in a deficit (II) pursuant to subclause (1) of this clause
that received salary components in accordance with subparagraph (4)(ii) of this
subdivision shall receive a cap adjustment component equal to the deficit (II)
divided by the units of service pursuant to paragraph (1) of this
subdivision.
(3) Day treatment
programs determined to be in a deficit (II) pursuant to subclause
(1) of this clause, that received salary components in
accordance with subparagraphs (4)(iii) through (vii) of this subdivision shall
receive an allocation component equal to $3.07.
(vi) The property and capital equipment
component add-on shall be equal to the amount of allowable capital costs as
defined in paragraph (c)(2) of this section and Subpart 635-6 of this Title,
divided by the units of service figure. At the onset of each fee period the
OPWDD shall review the property and equipment component add-on for substantial
material changes and if said changes conform to the requirements of paragraph
(c)(2) of this section and Subpart 635-6 of this Title, the property and
capital equipment shall be revised to reflect said changes.
(vii) Effective July 1, 1996, there shall be
a separate transportation component add-on to the facility's fee. This
component add-on for each day treatment facility shall be determined using the
following methodology.
(a) Using a
payment/rate data sample from calendar years 1995 and 1996, the weighted
transportation average shall be calculated by dividing the aggregate
transportation payments by the aggregate transportation units of service on a
facility specific basis. One round trip shall equal one unit of service.
(1) The weighted transportation average for
each day treatment facility shall be ranked among all day treatment facilities
statewide.
(i) If a facility's weighted
transportation average is $11.16 or less, the weighted transportation average
shall be held 100 percent harmless.
(ii) If a facility's weighted transportation
average exceeds $11.16, 40 percent of the weighted transportation average shall
be held harmless.
(2)
After deducting the 40 percent to be held harmless, the net weighted
transportation average for each site (i.e., the remaining 60
percent of the weighted transportation average) shall be re-ranked. Based on
the new percentile rankings, a percentage offset shall be deducted from the net
weighted transportation average. A facility's percentage offset shall be
determined by locating its net weighted transportation average
(i.e., the remaining 60 percent of the weighted transportation
average) in the following table.
| Percentile Rank | Net Weighted Transportation Average | Percentage Offset |
| 5 or < | $0 - $7.25 | 5 |
| 6 to 9 | $7.26 - $8.12 | 7.5 |
| 10 to 29 | $8.13 - $10.19 | 10 |
| 30 to 49 | $10.20 - $13.31 | 12.5 |
| 50 to 59 | $13.32 -$13.79 | 15 |
| 60 to 69 | $13.80 - $14.00 | 16.5 |
| 70 to 79 | $14.01 - $14.96 | 20 |
| 80 to 84 | $14.97 - $15.76 | 22.5 |
| 85 or > | Over 15.76 | 25 |
(3)
The amount remaining after the application of the percentage offset (the 60
percent of the weighted transportation average reduced by the offset percentage
in the table above) shall be added to the hold harmless amount to determine a
facility's modified weighted transportation average.
(i) If the modified weighted transportation
average falls below $11.16, the modified weighted transportation average shall
be adjusted to $11.16.
(ii) If the
modified weighted transportation average exceeds $30, the modified weighted
transportation average shall be adjusted to $30.
(4) The modified weighted transportation
average shall be multiplied by the total to and from day treatment
transportation units and divided by the total day treatment units of service to
create a day treatment transportation component add-on. This shall be a
separate component added to the day treatment fee.
(b) If an agency currently providing day
treatment does not have to and from transportation payment/rate data available
for a particular facility for the period used to calculate the modified
weighted transportation averages, or if an agency opens a new day treatment
facility, the modified weighted transportation average shall be equal to the
lesser of the facility's budgeted amount for transportation based on the
transportation requirements of the person(s) to be transported to and from the
day treatment facility or the average of the modified weighted transportation
averages for all other day treatment facilities operated by the
agency.
(c) If an agency does not
currently operate a day treatment facility, and opens a day treatment facility
or if an agency does not have to and from transportation payment/rate data for
any of its day treatment facilities for the period used to calculate the
modified weighted transportation averages, the modified weighted transportation
average shall be equal to the lesser of the facility's budgeted amount for
transportation based on the transportation requirements of the person(s) to be
transported to and from the day treatment facility or the average of the
modified weighted transportation averages for all day habilitation programs
operated by the agency as described in section
635-10.5(c)(2)
of this Title.
(d) If the agency
does not currently operate a day treatment facility or day habilitation
program, the modified weighted transportation average shall be equal to the
lesser of the new day treatment facility's budgeted amount for transportation
based on the transportation requirements of the person(s) to be transported to
and from the day treatment facility or 75 percent of the regional modified
weighted transportation average associated with transporting individuals to and
from day treatment facilities. The table below shows the regional modified
weighted transportation averages:
| Region | Average | 75 Percent of Average |
| 1 | $21.37 | $16.03 |
| 2 | $21.17 | $15.88 |
| 3 | $15.97 | $11.98 |
(e)
Agencies that operated only day habilitation programs prior to July 1, 1996,
and opened a day treatment facility for the first time between July 1, 1996 and
September 3, 1996 shall receive a one time fee adjustment if the agency
received 75 percent of the regional modified weighted transportation average
for day treatment transportation and is now receiving either the day treatment
facility's budgeted transportation amount or the average of the agency's day
habilitation modified weighted transportation averages. The one time fee
adjustment shall be either:
(1) a one time fee
increase if the lesser of the need-based budgeted transportation amount or the
average of the agency's day habilitation modified weighted transportation
averages is greater than 75 percent of the regional modified weighted average
for transportation to and from day treatment facilities; or
(2) a one time fee decrease if the lesser of
the need-based budgeted transportation amount or the average of the agency's
day habilitation modified weighted transportation average is less than 75
percent of the regional modified weighted average for transportation to and
from day treatment facilities.
(4) For the January 1, 1991 to December 31,
1991 and the July 1, 1991 to June 30, 1992 fee periods, and thereafter, the
final fee shall be equal to the property and equipment component calculated in
accordance with clause (3)(v)(h) of this subdivision plus the
greater of subparagraph (i) or (ii) of this paragraph. For January 1, 1992 to
December 31, 1992 and the July 1, 1992 to June 30, 1993 fee periods, the final
fee shall be equal to the property and equipment component calculated in
accordance with clause (3)(v)(h) of this subdivision plus
subparagraph (ii) of this paragraph:
(i) for
Region I facilities and those facilities designated or elected to a Region I
year- end and fiscal reporting cycle, 99.5 percent of the fixed fee and
operating components contained in the June 30, 1991 fee trended to the July 1,
1991 to June 30, 1992 fee period. For Region II and III facilities and those
facilities designated or elected to a Region II or III year-end reporting and
fiscal cycle, 99.5 percent of the fixed amount and operating components
contained in the December 31, 1990 fee trended to January 1, 1991 to December
31, 1991 fee period. Trend factors shall be applied in accordance with
paragraph (6) of this subdivision; or
(ii) the fixed fee and operating components
determined in accordance with paragraph (3) of this subdivision trended to the
appropriate fee period. The final fee for day treatment programs that did not
have a fee in effect on December 31, 1990 or June 30, 1991, shall be equal to
this fee.
(iii) Effective July 1,
1996, there shall be an efficiency adjustment as described herein and applied
as a reduction to the calculated operating component of the fee.
(a) The efficiency adjustment shall be a
percentage reduction based on the $10.12 associated with total agency and
program administration in the fixed component of the fee. Except as provided
for in clause (b) of this subparagraph, all cost and revenue
information, used to determine the efficiency adjustment percentages, shall be
based on reported cost and revenue information for the calendar 1992 or 1992-93
cost reporting year. Each provider shall be assigned a percentage value from
the table at subclause (3) of this clause, based on total
program cost, a program surplus/deficit group designation and an administration
percentage group designation.
(1)
Determination of program surplus/deficit group. A determination shall be made
as to whether each provider has a program surplus or deficit, for the combined
total of all community residence and day treatment programs and all residential
habilitation and day habilitation services. Surplus/deficit shall equal gross
revenue (less any prior period adjustments) minus allowable costs.
(i) For those providers with a reported
deficit, this deficit shall be considered the final deficit amount for the
purpose of this calculation.
(ii)
For those providers with a reported program surplus, a certain portion of that
surplus shall be exempted to establish an adjusted surplus. The adjusted
surplus shall be the reported surplus minus the exempt amount. Exempt amounts
shall be determined as follows. For providers whose total program costs are:
(A) less than $1 million, the exempt amount
shall be $10,000;
(B) between $1
million and less than $3 million, the exempt amount shall be $22,500;
(C) between $3 million and $7 million, the
exempt amount shall be $35,000;
(D)
over $7 million, the exempt amount shall be $40,000.
(iii) The reported deficit or the adjusted
surplus shall be given one of the following designations used to determine the
efficiency adjustment percentage in the table at the end of this section:
(A) S2 if the adjusted surplus is equal to or
greater than $200,000;
(B) S1 if
the adjusted surplus is from $20,000 to $199,999;
(C) BE if the reported deficit is not greater
than ($19,999) or the adjusted surplus is not greater than $19,999 (BE - break
even);
(D) D1 if the reported
deficit is from ($20,000) to ($199,999);
(E) D2 if the reported deficit is equal to or
greater than ($200,000).
(2) Determination of a calculated
administration percentage group. A determination shall be made of a provider's
calculated administration cost, where administration percentage shall equal the
sum of agency administration plus the program administration divided by the
result of total operating cost minus the sum of capital costs, agency
administration and program administration. There shall be five group
designations that express the calculated administration percentage as a
departure from the average percentage for all provider agencies. Those
percentages centered around the average are designated with the abbreviation
AVG. There are also two group designations for percentages over the average,
abbreviated OA2 and OA1 and two designations for under the average, abbreviated
UA2 and UA1. These abbreviations appear in the table of percentages at the end
of this section as well as in the following regional tables. Each provider's
assignment to one of the five group designations shall be based on the
provider's calculated administration percentage, total program cost and elected
or assigned region (refer to subdivision [a] of this section). Each provider's
administration percentage group designation shall be determined using the
following tables.
REGION ONE
Program Cost in Millions of Dollars (< less than; > greater than)
| < $1 | $1 to < $3 | $3 to $7 | > $7 | |
| Administration Percentage | Group | |||
| .3100 PLUS | .4500 PLUS | .4500 PLUS | .4500 PLUS | OA2 |
| .2600.3099 | .3500.4499 | .3500.4499 | .3500.4499 | OA1 |
| .2300.2599 | .3200.3499 | .3200.3499 | .2800.3499 | AVG |
| .1900.2299 | .2500.3199 | .2400.3199 | .2400.2799 | UA1 |
| .0000.1899 | .0000.2499 | .0000.2399 | .0000.2399 | UA2 |
REGION TWO
Program Cost in Millions of Dollars (< less than; > greater than)
| < $1 | $1 to < $3 | $3 to $7 | > $7 | |
| Administration Percentage | Group | |||
| .3100 PLUS | .4500 PLUS | .3500 PLUS | .3500 PLUS | OA2 |
| .2900.3099 | .3500.4499 | .2800.3499 | .2500.3499 | OA1 |
| .2150.2899 | .3200.3499 | .2500.2799 | .1900.2499 | AVG |
| .1900.2149 | .2500.3199 | .2000.2499 | .1700.1899 | UA1 |
| .0000.1899 | .0000.2499 | .0000.1999 | .0000.1699 | UA2 |
REGION THREE
Program Cost in Millions of Dollars (< less than; > greater than)
| < $1 | $1 to < $3 | $3 to $7 | > $7 | |
| Administration Percentage | Group | |||
| .4200 PLUS | .3500 PLUS | .2800 PLUS | .4200 PLUS | OA2 |
| .3300.4199 | .2700.3499 | .2550.2799 | .3300.4199 | OA1 |
| .2400.3299 | .2250.2699 | .2300.2549 | .2400.3299 | AVG |
| .1851.2399 | .1900.2249 | .2100.2299 | .1851.2399 | UA1 |
| .0000.1850 | .0000.1899 | .0000.2099 | .0000.1850 | UA2 |
(3)
Determination of the efficiency adjustment percentage. Each provider shall be
assigned an efficiency adjustment percentage value from the following table,
based on the surplus/ deficit group designation and the administration
percentage group designation. The amount associated with the administration
component of the fixed fee shall be determined by multiplying the
administration component of the fixed fee times the units of service. The
resulting total amount shall then be reduced by an efficiency adjustment
percentage.
| S2 | S1 | BE | D1 | D2 | |
| OA2 | 17.00% | 16.00% | 15.00% | 14.00% | 13.00% |
| OA1 | 16.25% | 15.25% | 14.25% | 13.25% | 12.25% |
| AVG | 15.50% | 14.50% | 13.50% | 12.50% | 11.50% |
| UA1 | 14.75% | 13.75% | 12.75% | 11.75% | 10.75% |
| UA2 | 14.00% | 13.00% | 12.00% | 11.00% | 10.00% |
(i) New day
treatment program sites operating subsequent to the 1992 or 1992-93 cost
reporting period shall be assigned the cell value designated for the rest of
the day treatment programs operated by the provider agency.
(ii) New agencies operating day treatment
programs subsequent to the 1992 or 1992-93 cost reporting period shall be
assigned the center cell value, i.e., AVG-BE, in the table
found in this subclause.
(b) Providers may request that OPWDD use a
more recent cost reporting period, as an alternative to their 1992 or 1992-93
reporting period, to determine the efficiency adjustment percentage as
described herein. Approval to use an alternative reporting period shall be
granted if, upon a fiscal review by the commissioner, it is determined that the
cost report for the alternative reporting period more accurately reflects the
provider's current financial status. For the purpose of determining the
efficiency adjustment percentage only, providers may submit corrections to
their 1992 or 1992-93 cost report. Such corrections shall be certified by a
certified public accountant. Providers may request the use of an alternative
reporting period or may submit corrections to their 1992 or 1992-93 cost report
only once. Such requests or corrections shall be made in writing and received
by OPWDD by December 31, 1996. Providers shall also have until December 31,
1996 to notify OPWDD of errors made in calculating the efficiency
adjustment.
(5) The final adjusted fee shall be equal to
the final fee determined in paragraph (4) of this subdivision, except as
provided below:
(i) Day treatment programs in
Regions II and III including those programs in Region I designated or elected
to a Region II and III year-end reporting and fiscal cycle shall receive the
annualization component add-on for the period April 1, 1991 to December 31,
1991. The annualization component add-on shall be equal to the difference
between the fee in effect on March 31, 1991 and the April 1, 1991 final fee
calculated pursuant to paragraph (4) of this subdivision for the period January
1, 1991 to March 31, 1991 divided by the units of service pursuant to paragraph
(1) of this subdivision. The annualization component add-on shall be added to
the final fee determined in accordance with paragraph (4) of this subdivision,
and the resulting fee shall be considered the final adjusted fee.
(ii) Effective January 1, 1999, a cost of
living add-on may be included in the final adjusted fee. This add-on will be an
increase to the fee due to a 2.5 percent increase in salaries and salary
related fringe benefits. Inclusion of the add-on is subject to a resolution of
the facility's governing body that funding received will be used solely to
effect a 2.5 percent increase beginning with the lowest paid employees. To be
deemed reimbursable, both the resolution and an implementation plan must be
submitted by the facility and approved by the commissioner.
(iii) Facilities initially certified as day
treatment facilities on or after April 30, 1999 shall be deemed to have met the
requirements for an approved cost of living add-on described in subparagraph
(ii) of this paragraph, and a corresponding factor shall be included in the
final adjusted fee.
(iv) Effective
July 1, 2000, day treatment facilities may be eligible for a salary enhancement
add-on to be included in their final adjusted fee. This add-on will be an
increase to the fee to recognize the costs of a $750 annual salary increase per
full time equivalent, plus salary related fringe benefits, for direct care and
support workers. Inclusion of the add-on is subject to the provider agency
submitting a resolution of its governing body that funding received will be
used to effect this salary increase. To receive the add-on the agency must
submit the resolution and implementation plan to OPWDD and the commissioner
must approve them.
(v) Facilities
initially certified as day treatment facilities on or after April 1, 2001 shall
be deemed to have met the requirements for an approved salary enhancement
add-on described in subparagraph (iv) of this paragraph, and a corresponding
factor shall be included in the final adjusted fee.
(vi) Effective January 1, 2003, day treatment
programs may be eligible for a cost of living adjustment (COLA) add-on to be
included in their final adjusted fee. This add-on is a three percent increase
to the personal service portion of allowed reimbursement, for expenditures
related to recruitment and retention of staff for the period of April 1, 2002
through March 31, 2003. On or after January 1, 2003, eligible facilities will
receive an amount that they would have received if the COLA add-on were added
to the final adjusted fee on December 1, 2002. The provider is required to
submit to OPWDD a letter of attestation, signed by the executive director and
president or equivalent of the governing body, which details how the COLA is
expended.
(vii) Facilities
initially certified on or after April 1, 2003 shall be deemed to have met the
requirements for an approved COLA add-on described in subparagraph (vi) of this
paragraph, and a corresponding factor shall be included in the final adjusted
fee.
(viii) Effective April 1,
2005, costs incurred as a result of requests for criminal history record checks
under section 16.33 of the Mental Hygiene Law and
section 845-b of the Executive Law shall be
allowable costs and shall be considered part of the fee.
(ix) The day treatment facility shall be
responsible for the cost of services which:
(a) are necessary to meet the needs while
attending the program; and
(b)
which prior to August 1, 2004 could have been met by home health aide or
personal care services separately billed to Medicaid.
(6) OPWDD shall employ any or all
of the following trend factor components:
(i)
Region I. The following trend factor shall be applied to the fee in effect on
June 30th of the prior year:
(a) 5.71 percent
for 1988-89 to 1989-90 including those facilities in Regions II and III
designated or elected to a Region reporting year-end and fiscal cycle and
excluding those facilities in Region I designated or elected to a Regions II
and III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of
this Title.
(b) 7.51 percent for
1989-90 to 1990-91 including those facilities in Region II and III designated
or elected to a Region I reporting year-end and fiscal cycle and excluding
those facilities in Region I designated or elected to a Region II or III
reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(c) 6.24 percent for 1990-91
to 1991-92 including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(d) 4.85 percent for 1991-92
to 1992-93 including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(e) 3.73 percent for 1992-93
to 1993-94, including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(f) 3.79 percent for 1993-94
to 1994-95, including those facilities in Regions II or III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(g) 3.16 percent for 1994-95
to 1995-96, including those facilities in Regions II or III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(h) 0.00 percent for 1995-96
to 1996-97, including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(i) 0.00 percent for 1996-97
to 1997-98, including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(j) 0.00 percent for 1997-98
to 1998-99, including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(k) 0.00 percent for 1998-99
to 1999-2000, including those facilities in Regions II and III designated or
elected to a Region I reporting year-end and fiscal cycle and excluding those
facilities in Region I designated or elected to a Region II or III reporting
year-end and fiscal cycle in accordance with Subpart 635-4 of this
Title.
(l) 0.00 percent for
1999-2000 to 2000-2001, including those facilities in Regions II and III
designated or elected to a Region I reporting year-end and fiscal cycle and
excluding those facilities in Region I designated or elected to a Region II or
III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of
this Title.
(m) 0.00 percent for
2000-2001 to 2001-2002, including those facilities in Regions II and III
designated or elected to a Region I reporting year-end and fiscal cycle and
excluding those facilities in Region I designated or elected to a Region II or
III reporting year-end and fiscal cycle in accordance with subparagraph
(b)(1)(iv) of this section.
(n)
0.00 percent for 2001-2002 to 2002-2003, including those facilities in Regions
II and III designated or elected to a Region I reporting year-end and fiscal
cycle and excluding those facilities in Region I designated or elected to a
Region II or III reporting year-end and fiscal cycle in accordance with
subparagraph (b)(1)(iv) of this section.
(o) 0.00 percent for 2002-2003 to 2003-2004,
including those facilities in Regions II and III designated or elected to a
Region I reporting year-end and fiscal cycle and excluding those facilities in
Region I designated or elected to a Region II or III reporting year-end and
fiscal cycle in accordance with subparagraph (b)(1)(iv) of this
section.
(p) 0.00 percent for
2003-2004 to 2004-2005, including those facilities in Regions II and III
designated or elected to a Region I reporting year-end and fiscal cycle and
excluding those facilities in Region I designated or elected to a Region II or
III reporting year-end and fiscal cycle in accordance with subparagraph
(b)(1)(iv) of this section.
(q)
0.00 percent for 2004-2005 to 2005-2006, including those facilities in Regions
II and III designated or elected to a Region I reporting year-end and fiscal
cycle and excluding those facilities in Region I designated or elected to a
Region II or III reporting year-end and fiscal cycle in accordance with
subparagraph (b)(1)(iv) of this section.
(ii) Regions II and III. The following trend
factor shall be applied to the fee in effect on December 31st of the prior
year:
(a) 5.71 percent 1988 to 1989, including
those facilities in Region I designated to Region II or III and excluding those
facilities in Region II or III designated to Region I in accordance with
Subpart 635-4 of this Title.
(b)
7.51 percent for 1989 to 1990, including those facilities in Region I
designated or elected to Regions II or III and excluding those facilities in
Region II and III designated or elected to Region I in accordance with Subpart
635-4 of this Title.
(c) 6.24
percent for 1990 to 1991, including those facilities in Region I designated or
elected to Region II or III and excluding those facilities in Region II or III
designated or elected to Region I in accordance with Subpart 635-4 of this
Title.
(d) 4.85 percent for 1991 to
1992, including those facilities in Region I designated or elected to Region II
or III and excluding those facilities in Region II or III designated or elected
to Region I in accordance with Subpart 635-4 of this Title.
(e) 3.73 percent for 1992 to 1993, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with Subpart 635-4 of this Title.
(f) 3.79 percent for 1993 to 1994, including
those facilities in Region I designated or elected to Regions II and III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with Subpart 635-4 of this Title.
(g) 3.16 percent for 1994 to 1995, including
those facilities in Region I designated or elected to Region II and III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with Subpart 635-4 of this Title.
(h) 0.00 percent for 1995 to 1996, including
those facilities in Region I designated or elected to a Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with Subpart 635-4 of this Title.
(i) 0.00 percent for 1996 to 1997, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with Subpart 635-4 of this Title.
(j) 0.00 percent for 1997 to 1998, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with Subpart 635-4 of this Title.
(k) 0.00 percent for 1998 to 1999, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(l) 0.00 percent for 1999 to 2000, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(m) 0.00 percent for 2000 to 2001, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(n) 0.00 percent for 2001 to 2002, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(o) 0.00 percent for 2002 to 2003, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(p) 0.00 percent for 2003 to 2004, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(q) 0.00 percent for 2004 to 2005, including
those facilities in Region I designated or elected to Region II or III and
excluding those facilities in Region II or III designated or elected to Region
I in accordance with subparagraph (b)(1)(iv) of this section.
(iii) Regions I, II, and III.
(a) Effective January 1, 2006, facilities in
all three regions may be eligible to receive a variable trend factor for
employee health care enhancement (HCE).
(1)
Providers are eligible to have a variable trend factor included in their fee if
they submitted a completed 2005 OPWDD survey on health care benefits for all
full- and part-time employees.
(2)
Based on a survey of providers, OPWDD determined a benchmark of health care
benefits offered to employees by providers. In September 2005, OPWDD notified
those providers if their health care benefits were at, above, or below the
benchmark.
(3) Providers whose
employee health care benefits are below the benchmark may apply to OPWDD for a
variable trend factor to be effective January 1, 2006 and to be calculated as
follows:
(i) For providers which reported on
the survey that no health care benefits are offered, OPWDD determined a
variable trend factor for each provider based on the total number of employees
reported multiplied by $2,500, except that if there are any employees who were
reported on the survey and to whom the provider chooses not to offer funding
from the variable trend factor, the variable trend factor based on the total
number of employees reported will be reduced by the number of excluded
employees reported multiplied by $2,500. The funding from this variable trend
factor must be used to establish employee health care benefits or to reduce
employee out- of-pocket health-related expenses.
(ii) For providers which reported on the
survey that employee health care benefits are offered to some or all employees,
OPWDD determined a variable trend factor for each provider based on the total
number of employees reported multiplied by $325, except that if there are any
employees who were reported on the survey and to whom the provider chooses not
to offer funding from the variable trend factor, the variable trend factor
based on the total number of employees reported will be reduced by the number
of excluded employees reported multiplied by $325. The funding from this
variable trend factor must be used to enhance employee health care benefits or
to reduce employee out-of-pocket health-related expenses.
(4) Effective January 1, 2006, providers may
receive a variable trend factor that would have been received during the period
of April 1, 2004 through December 31, 2005 if the variable trend factor
described in clause (c) of this subparagraph had been paid.
Providers whose employee health care benefits are below the benchmark may apply
to OPWDD for the variable trend factor as follows:
(i) For providers which reported on the
survey that no employee health care benefits are offered, no variable trend
factor for the period of April 1, 2004 through December 31, 2005 is
available.
(ii) For providers which
reported on the survey that employee health care benefits are offered to some
or all employees, OPWDD determined a variable trend factor for each provider
based on the total number of employees reported multiplied by $325, except that
if there are any employees who were reported on the survey and to whom the
provider chooses not to offer funding from this variable trend factor, the
variable trend factor based on the total number of employees reported will be
reduced by the number of excluded employees reported multiplied by $325. The
annual allocation of $325 will be adjusted for the 21-month period of April 1,
2004 through December 31, 2005. Funding from this variable trend factor must be
used to reimburse health care expenses paid by employees.
(5) In order to receive a variable trend
factor described in clause (c) or (d) of this
subparagraph, the provider must send to OPWDD a completed written application
submitted in the form and format specified by the commissioner.
(6) Funding from the variable trend factor is
contingent upon OPWDD's approval of the application. OPWDD will base its
decision on whether the application is complete; whether it complies with the
requirements of this subparagraph; and whether the application recognizes the
provider's lowest paid employees. OPWDD may request additional information
and/or documentation as needed before approving the application.
(7) Payment of the variable trend factor
described in clause (c) or (d) of this
subparagraph shall be subject to the provider submitting a resolution by its
governing body that funds received will be used to implement the plans
described in the provider's approved application. To receive the variable trend
factor, the provider must submit the resolution and the commissioner must
approve it.
(b)
Effective October 1, 2006, facilities are eligible for a trend factor of 2.8
percent to the operating portion of the fee. This trend factor is for
expenditures related to the promotion of recruitment and retention of staff or
to respond to other critical non-personal service costs during the period of
April 1, 2006 through March 31, 2007. In order to receive this trend factor,
the provider is required to submit to OPWDD a letter of attestation, signed by
the executive director and president or equivalent of the governing body, which
details how the trend factor monies are expended. Facilities initially
certified on or after April 1, 2007 shall be deemed to have met the
requirements for the letter of attestation required by this clause.
(c)
Employee health care enhancement
II.
(1) Effective January 1, 2007
providers may be eligible to receive a variable trend factor for health care
enhancement II (HCE II). Provides must use these funds to establish or enhance
employee health care benefits or to reduce employee out of pocket health care
expenses.
(2) In order to receive
the variable trend factor described in this subdivision, the provider must have
sent to OPWDD a completed written application by July 31, 2006, unless this
deadline was extended by the commissioner.
(3) Receipt of the variable trend factor is
contingent upon OPWDD's approval of the application. OPWDD shall decide whether
to approve the application based on whether the application is complete;
whether it complies with the requirements of this subdivision; and whether the
application recognizes the provider's lowest paid employees. OPWDD may request
additional information and/or documentation, or revisions to an application,
before approving the application.
(4) The variable trend factor for HCE II is
available at either $2,500 per employee or $425 per employee, as follows:
(i) The variable trend factor at the $2,500
level is determined by OPWDD based on the total number of employees included in
the provider's approved HCE II application multiplied by $2,500. Funding at the
$2,500 level is available to providers which:
(A) submitted an application for HCE II
variable trend factor at the $2,500 level; and
(B) do not offer health care benefits;
and
(C) were insufficiently funded
for health care, as determined by OPWDD. Affected providers were notified by
OPWDD of this determination.
(ii) The variable trend factor at the $425
level is determined by OPWDD based on the total number of employees included in
the provider's approved HCE II application multiplied by $425. Funding at the
$425 level is available to providers which:
(A) offer health care benefits to some or all
employees and submitted an application for the HCE II variable trend factor at
the $425 level; or
(B) applied for
HCE II variable trend factor at the $2,500 level but received funding at the
$2,500 per employee level pursuant to clause (c) of this
subparagraph; or
(C) submitted an
application at the $2,500 level but have sufficient funding for health care, as
determined by OPWDD. Affected providers were notified by OPWDD of this
determination.
(5) The application submitted to OPWDD shall
include plans for the expenditure of the HCE II variable trend factor in
conformance with this subdivision. Such HCE II plans shall assure that all
employees included in the application are entitled to some benefit from HCE II,
although the value per employee may be lesser or greater than $2,500 or $425
per employee. Higher paid employees whose earnings exceed a salary cap
established by the provider may be excluded from receipt of any HCE II funds if
these funds are reallocated to lower paid staff.
(6) A provider approved to receive HCE II
variable trend factor pursuant to item
(c)(4)(ii) of this
subparagraph shall receive an amount that would have been paid if the HCE II
initiative had been implemented April 1, 2006.
(7) Payment of the HCE II variable trend
factor shall be subject to the provider submitting a resolution by its
governing body that funds received shall be used to implement the plans
described in the provider's approved application. To receive the variable trend
factor the provider must submit the resolution and the commissioner must
approve it.
(8) A fee revised by
OPWDD pursuant to this subdivision shall not be considered final unless and
until approved by the State Division of the Budget.
(d) Effective June 1, 2007, facilities are
eligible for a trend factor of 2.3 percent to the operating portion of the fee.
This trend factor is for expenditures related to the promotion of recruitment
and retention of staff or to respond to other critical non-personal service
costs during the period of April 1, 2007 through March 31, 2008. From June 1,
2007 to March 31, 2008, facilities will be reimbursed operating costs that
result in a full annual trend factor of 2.3 percent as if the trend factor were
reimbursed from April 1, 2007 through March 31, 2008. In order to receive this
trend factor, the provider is required to submit to OPWDD a letter of
attestation, signed by the executive director and president or equivalent of
the governing body, which details how the trend factor monies are expended.
Facilities initially certified on or after April 1, 2008 shall be deemed to
have met the requirements for the letter of attestation required by this
clause.
(e) Employee health care
enhancement III.
(1) Effective January 1, 2008
providers may be eligible to receive a variable trend factor for the health
care enhancement III (HCE III) included in their fee.
(2) Variable trend factor. Based on a survey
of providers' historical data as of January 1, 2005, OPWDD determined a
benchmark of health care benefits offered to employees by providers. Prior to
September 30, 2007, OPWDD notified those providers which OPWDD deemed eligible
for an HCE III variable trend at the benchmark level. Providers deemed eligible
for an HCE III variable trend below the benchmark level were mailed
applications with instructions.
(i) Providers
deemed eligible for the HCE III variable trend factor at the benchmark level
shall receive an amount equaling 1.0 percent of the operating costs exclusive
of any HCE III component contained in the fee in effect on January 1, 2008 net
of any funding provided pursuant to item (iii) of this
subclause. Providers which also operate programs and services eligible for the
3.0 percent funding level increase under this Chapter may not receive this 1.0
percent variable trend factor unless they have declined the 3.0 percent funding
level increase in the eligible programs and services. Providers which receive
this 1.0 percent variable trend factor may not apply for the employee health
care variable trend factor described in item (ii) of this
subclause.
(ii) Providers deemed
eligible for the HCE III variable trend factor below the benchmark level may
apply to OPWDD to receive an amount equaling 1.0 percent of the operating costs
exclusive of any HCE III component contained in the fee in effect on January 1,
2008 net of any funding provided pursuant to item (iii) of
this subclause.
(A) Providers shall use these
funds to establish or enhance employee health care benefits and/or to reduce
employee out-of-pocket health care expenses and/or to offset the portion of
premium increases paid by the provider which exceeds the portion of the trend
factor or COLA applicable to those premium increases. Providers shall assure
that benefits resulting from this additional funding recognize their lower paid
employees.
(B) In order to receive
the variable trend factor described in this item, the provider must have sent
to OPWDD a completed application and attestation received or postmarked by
October 1, 2007, unless the deadline was extended by the commissioner. In the
application and attestation, the provider must have indicated its intended use
of the funds; agreed to obtain a resolution by December 31, 2007 from its
governing body authorizing such use; and agreed to maintain on file the
resolution as well as records detailing the distribution of HCE III
funds.
(C) Funding is contingent
upon OPWDD's approval of the application and attestation. OPWDD shall decide
whether to approve the application and attestation based on whether it is
complete and conforms to the requirements of this subdivision. OPWDD may
request additional information or documentation before approving the
application and attestation.
(iii) A provider approved to receive an HCE
III variable trend factor pursuant to item (i) or
(ii) of this subclause shall receive an amount that would have
been paid if the HCE III initiative has been implemented April 1,
2007.
(3) A fee revised
by OPWDD pursuant to this clause shall not be considered final unless and until
approved by the State Division of the Budget.
(f) Effective August 1, 2008, facilities are
eligible for a trend factor of 3.2 percent to the operating portion of the fee.
This trend factor is for expenditures related to the promotion of recruitment
and retention of staff or to respond to other critical non-personal service
costs during the period of April 1, 2008 through March 31, 2009. From August 1,
2008 to March 31, 2009, facilities will be reimbursed operating costs that
result in a full annual trend factor of 3.2 percent as if the trend factor were
reimbursed from April 1, 2008 through March 31, 2009. In order to receive this
trend factor, a provider which did not submit a Letter of Attestation for
2007-2008 is required to submit to OPWDD a Letter of Attestation, signed by the
Executive Director and President or equivalent of the governing body, which
details how the trend factor monies are expended. Facilities initially
certified on or after April 1, 2009 shall be deemed to have met the
requirements for the Letter of Attestation required by this clause.
(g) From April 1, 2009 to March 31, 2010 the
trend factor shall be 0.00 percent for all facilities.
(h) Health care adjustments (HCA) IV and V.
(1) Variable trend factor. Effective November
1, 2009, providers may be eligible to receive a variable trend factor for the
health care adjustments IV and V included in their fees.
(2) Benchmark providers and non-benchmark
providers. Based on a survey of providers' historical data as of January 1,
2005, OPWDD determined a benchmark of health care related benefits offered to
employees by providers. Prior to October 31, 2007, OPWDD notified those
providers which OPWDD deemed eligible for the HCE III variable trend factor at
the benchmark level. Providers eligible for HCE III variable trend factor at
the benchmark level are eligible for the HCA IV and HCA V variable trend
factors at the benchmark level. All other providers are eligible for the HCA IV
and HCA V variable trend factors below the benchmark level.
(3) Funding.
(i) Providers eligible for HCA IV and HCA V
funding at the benchmark level.
(A) The
variable trend factors for HCA IV and HCA V for benchmark providers shall be
1.0 percent of the allowable operating costs used in establishing the provider
specific fees. Each adjustment shall be applied sequentially to effect
compounding of the adjustments.
(B)
Providers which also operate programs and services eligible for the 3.0 percent
funding level increase under this Chapter may not receive these 1.0 percent
variable trend factor increases unless they have declined the 3.0 percent
funding level increase in the eligible programs and services. Providers which
receive these 1.0 percent variable trend factor increases may not apply for
employee health care funding described in item (ii) of this
subclause.
(ii)
Providers eligible for HCA IV and HCA V funding below the benchmark level may
apply to OPWDD to receive the variable trend factors.
(A) The HCA IV and HCA V variable trend
factors for providers eligible for funding below the benchmark shall be 1.0
percent of the allowable operating costs used in establishing the provider
specific fees. Each adjustment shall be applied sequentially to effect
compounding of the adjustments.
(B)
Providers shall use these funds first to offset health care premium increases.
Remaining funds shall be used to establish or enhance employee health care
related benefits and/or to reduce employee out-of-pocket health care related
expenses.
(C) In order to receive
the HCA IV and HCA V variable trend factors, the provider must have sent to
OPWDD a completed application and attestation received or postmarked no later
than September 11, 2009 unless the deadline was extended by the commissioner.
In the application and attestation, the provider must have indicated its
intended use of the funds; agreed to obtain a resolution by October 31, 2009
from its governing body authorizing such use; and agreed to maintain on file
the resolution as well as records detailing the distribution of HCA IV and HCA
V funds.
(D) The variable trend
factor is contingent upon OPWDD's approval of the application and attestation
based on whether it is complete and conforms to the requirements of this
subdivision. OPWDD may request additional information or documentation before
approving the application and attestation.
(4) Catch-up provisions. Effective November
1, 2009, benchmark providers which do not receive any HCA funding at the 3.0
percent level and non-benchmark providers with approved applications shall be
eligible to receive additional funding for HCA IV in an amount that would have
been received for the period of April 1, 2008 through October 31, 2009 if the
1.0 percent variable trend factor had been implemented on April 1, 2008.
Effective November 1, 2009 benchmark providers which do not receive any HCA
funding at the 3.0 percent level and non-benchmark providers with approved
applications shall be eligible to receive additional funding for HCA V in an
amount that would have been received for the period of April 1, 2009 through
October 31, 2009 if the 1.0 percent variable trend factor had been implemented
on April 1, 2009. Nothing in this subclause shall entitle a provider to receive
payment for services which have not been provided.
(5) Consolidation of HCE and HCA funds
effective January 1, 2010.
(i) Effective
January 1, 2010, the HCE I through III and HCA IV and HCA V variable trend
factors included in the fee shall be consolidated into a single discrete
amount. For purposes of determining this amount, OPWDD shall combine the HCE I
through III and HCA IV and HCA V variable trend factors contained in the
initial fee in effect on January 1, 2010. OPWDD shall use this fixed amount as
the HCA variable trend factor for the fee periods beginning on or after January
1, 2010.
(ii) Effective January 1,
2010, with the consolidation of the health care adjustments, non-benchmark
providers shall use HCE I, II and III funds first to either offset health care
premium increases and/or to maintain benefits that were established and funded
with previous HCE I, II and III receipts. Remaining funds shall be used to
establish or enhance employee health care related benefits and/or to reduce
employee out-of-pocket health care related expenses. Non-benchmark providers
shall continue to use HCA IV and V funds first to offset health care premium
increases. Remaining funds shall be used to establish or enhance employee
health care related benefits and/or to reduce employee out-of-pocket health
care related expenses. Health care enhancement/adjustment funds included in the
fees for services delivered on or after July 6, 2011 shall be used by
non-benchmark providers for the purposes described in this item and/or for any
other options that continue and/or enhance existing health care benefits and/or
improve the recruitment and/or retention of the provider's lower paid
employees. However, in using these funds accordingly, non-benchmark providers
may establish which priorities serve the needs of such employees. Additionally,
on July 6, 2011, health care enhancement/adjustment funding shall be included
in the reimbursable cost category of fringe benefits in the fee.
(6) Provider's distribution of HCA
IV and HCA V funds is subject to audit to ensure conformity with the
requirements of this paragraph and distribution of funds consistent with the
provider's approved application.
(i) From April 1, 2010 to March 31, 2011 the
trend factor shall be 0.00 percent for all facilities.
(j) Health care adjustments (HCA) VI.
(1) Variable trend factor. Effective October
1, 2010, providers may be eligible to receive a variable trend factor for the
health care adjustment (HCA) VI included in their fees.
(2) Benchmark providers and non-benchmark
providers. Based on a survey of providers' historical data as of January 1,
2005, OPWDD determined a benchmark of health care related benefits offered to
employees by providers. Prior to October 31, 2007, OPWDD notified those
providers which OPWDD deemed eligible for the health care enhancement (HCE) III
variable trend factor at the benchmark level. These providers are "benchmark
providers" and are eligible for HCA VI funding at the benchmark level. All
other providers ("non-benchmark providers") are eligible for the HCA VI funding
below the benchmark level.
(3)
Funding.
(i) Providers eligible for HCA VI
funding at the benchmark level.
(A) The
variable trend factor for HCA VI for benchmark providers shall be 1.0 percent
of the allowable operating costs used in establishing the provider specific
fees in effect on April 1, 2010.
(B) Providers which also operate programs and
services eligible for the 3.0 percent funding level increase under this Chapter
may not receive the 1.0 percent variable trend factor increase unless they have
declined the 3.0 percent funding level increase in the eligible programs and
services.
(C) Providers eligible
for funding at the benchmark level may not apply for HCA VI variable trend
factor funding described in item (ii) of this
subclause.
(ii)
Providers eligible for HCA VI funding below the benchmark level may apply to
OPWDD to receive the variable trend factor.
(A) The HCA VI variable trend factor for
providers eligible for funding below the benchmark shall be 1.0 percent of the
allowable operating costs used in establishing the provider specific fees in
effect on April 1, 2010.
(B)
Providers shall use these funds first to offset health care premium increases.
Remaining funds shall be used to establish or enhance employee health care
related benefits and/or to reduce employee out-of-pocket health care related
expenses. Health care adjustment funds included in the fees for services
delivered on or after July 6, 2011 shall be used by non-benchmark providers for
the purposes described in this subitem and/or for any other options that
continue and/or enhance existing health care benefits and/or improve the
recruitment and/or retention of the provider's lower paid employees. However,
in using these funds accordingly, non-benchmark providers may establish which
priorities serve the needs of such employees. Additionally, on July 6, 2011,
health care adjustment funding shall be included in the reimbursable cost
category of fringe benefits in the fee.
(C) In order to receive the HCA VI variable
trend factor, the provider must have sent to OPWDD a completed application and
attestation received or postmarked no later than August 13, 2010 unless the
deadline was extended by the commissioner. In the application and attestation,
the provider must have indicated its intended use of the funds; agreed to
obtain a resolution by September 30, 2010 from its governing body authorizing
such use; and agreed to maintain on file the resolution as well as records
detailing the distribution of HCA VI variable trend factor funds.
(D) The variable trend factor is contingent
upon OPWDD's approval of the application and attestation based on whether it is
complete and conforms to the requirements of this subdivision. OPWDD may
request additional information or documentation before approving the
application and attestation.
(iii) Effective October 1, 2010, benchmark
providers which do not receive any HCA VI funding at the 3.0 percent level and
non-benchmark providers with approved applications shall be eligible to receive
additional funding for HCA VI variable trend factor in an amount that they
would have received if the HCA VI variable trend factor had been in effect for
the period from April 1, 2010 through September 30, 2010. Nothing in this item
shall entitle a provider to receive payment for services which have not been
provided.
(4) Provider's
distribution of HCA VI variable trend factor funds is subject to audit to
ensure conformity with the requirements of this paragraph and distribution of
funds consistent with the provider's approved application.
(iv) Where appropriate,
the commissioner may use some combinations in whole or in part of the yearly
components to project cost data into the appropriate fee
period.
(7) The
commissioner may make corrections or adjustments to the fees based upon the
following:
(i) Errors which occurred in the
computation of the fee.
(ii) Final
audit findings made in accordance with subdivision (f) of this
section.
(iii) The day treatment
provider may request corrections to the fee within 90 days of receipt of the
fee. Such requests for corrections are limited to errors in a cost report
pursuant to subparagraph (b)(4)(iii) of this section, corrections to the DDP,
and corrections to the transportation component add-on pursuant to subparagraph
(3)(vii) of this subdivision. If corrections to the DDP would result in an
increase to the final adjusted fee, the commissioner may independently review
the corrected DDPs. During the period when the commissioner is reviewing the
provider-submitted revised DDP data, both the raw score and the percentile
charts found in clauses (3)(v)(a) and (b) of
this subdivision, in effect at that time, and that were used to calculate the
fee for the prior fee period, shall be utilized for fee-setting purposes until
the commissioner's review is completed. Should the commissioner's review verify
the provider-submitted revisions to the DDP data, said revised DDP data shall
be utilized for fee-setting purposes retroactive to the first day of the fee
period. The case mix component add-on and the case mix intensity component
add-on may be recalculated only if there is a 10-percent or greater change in
participants resulting from either a change in certified capacity or a turnover
in program participants, or a correction to the DDP score approved by the
commissioner. Day treatment programs must report to the Bureau of Rate Setting
all participant change greater than 10 percent.
(iv) Adjustment to actual units of service.
(a) OPWDD may, upon request from a day
treatment facility, adjust the units of service used for the facility's
calculation for the prior fee period to actual units of service delivered
during such fee period. However, such adjustment will be limited to situations
where the agency demonstrated it was in a deficit situation for the prior fee
period and had, for reasons beyond its control, not been able to deliver the
units of service used to calculate the fee for the prior fee period.
(b) The day treatment provider must request
adjustments to the facility's actual units of service within 150 days of the
fiscal reporting period for which said adjustment is sought.
(8) All fees, and any
corrections to fees shall not be considered final, unless approved by the
director of the Division of the Budget.
(9) Funded depreciation.
(i) Applicability. Paragraph (6) of this
subdivision shall apply to all day treatment programs except those governed by
subparagraphs (c)(2)(i) and (ii) of this section. Paragraph (6) of this
subdivision shall apply to day treatment programs which were governed by clause
(c)(2)(ii)(d) or (e) of this section but
which are no longer governed by either such clause because the provider has
repaid the entire principal owed on the real property of the day treatment
programs.
(ii) Effective July 1,
1986, for any fee period during which the reimbursement attributable to
depreciation on a day treatment program's real property, excluding equipment,
exceeds the provider's principal repayment obligations on indebtedness
attributable to such real property, such provider shall fund depreciation by
depositing such difference in an interest bearing checking account or other
secure investment. If the provider operates more than one day treatment program
governed by paragraph (6) of this subdivision the provider may maintain one
funded depreciation account for two or more day treatment programs. The
provider shall not commingle such funded depreciation account(s) with other
monies of the provider. The provider shall not be required to fund depreciation
attributable to the provider's equity in such real property. The provider may
expend the funds in such account, including accrued interest, to retire all or
a portion of the indebtedness attributable to such real property, or for
building improvements and/or fixed equipment necessary to the day treatment
program.
(10) The day
treatment fees in effect for the period March 29, 1991 through March 31, 1991
for Region II and III facilities and including those programs in Region I
designated or elected to a Region II or III reporting year-end and fiscal cycle
in accordance with Subpart 635-4 of this Title, determined in accordance with
the day treatment fee-setting methodology pursuant to this section in effect on
March 28, 1991 shall remain in effect through March 31, 1991. The day treatment
fees for the period March 29, 1991 through June 30, 1991 for Region I
facilities including those Region II and III facilities designated or elected
to a Region I reporting year-end and fiscal cycle in accordance with Subpart
635-4 of this Title, determined in accordance with the day treatment
fee-setting methodology pursuant to this section in effect on March 28, 1991
shall remain in effect through June 30, 1991.
(e) Case mix methodology.
(1) DDP factor scores shall be determined in
accordance with subparagraphs (i) through (iii) of this paragraph.
(i) The adaptive factor score shall be
computed by subtracting from 500 the sum of the adaptive indexes. The adaptive
indexes are self care, daily living, cognitive, communication and motor.
(a) SELF-CARE
| TOTAL SUPPORT Completely dependent | ASSISTANCE Requires lots of hands-on help | SUPERVISION Requires mainly verbal prompts | INDEPENDENT Starts and finishes without prompts or help | |
| Toileting/bowels | 0 | 1 | 2 | 3 |
| Toileting/bladder | 0 | 1 | 2 | 3 |
| Taking a shower/ bath | 0 | 1 | 2 | 3 |
| Brushing teeth/ cleaning dentures | 0 | 1 | 2 | 3 |
| Brushing/combing hair | 0 | 1 | 2 | 3 |
| Selecting clothes appropriate to weather | 0 | 1 | 2 | 3 |
| Putting on clothes | 0 | 1 | 2 | 3 |
| Undressing self | 0 | 1 | 2 | 3 |
| Drinking from a cup or glass | 0 | 1 | 2 | 3 |
| Chewing and swallowing food | 0 | 1 | 2 | 3 |
| Feeding self | 0 | 1 | 2 | 3 |
The self care items shall be assigned points as follows: 0 = Total support, 1 = Assistance, 2 = Supervision, 3 = Independent. The self care index is obtained by dividing the total number of points by the total possible points (33) and multiplying by 100. The self care index is computed from all items for which information is provided. In the case of missing information, the total points possible is reduced accordingly.
(b) DAILY LIVING
| TOTAL SUPPORT Completely Dependent | ASSISTANCE Requires lots of hands-on help | SUPERVISION Requires mainly verbal prompts | INDEPENDENT Starts and finishes without prompts or help | |
| Making bed | 0 | 1 | 2 | 3 |
| Cleaning room | 0 | 1 | 2 | 3 |
| Doing laundry | 0 | 1 | 2 | 3 |
| Using telephone | 0 | 1 | 2 | 3 |
| Shopping for a simple meal | 0 | 1 | 2 | 3 |
| Preparing foods that do not require cooking | 0 | 1 | 2 | 3 |
| Using stove or microwave | 0 | 1 | 2 | 3 |
| Crossing street in residential neighborhood | 0 | 1 | 2 | 3 |
| Using public transportation for a simple direct trip | 0 | 1 | 2 | 3 |
| Managing own money | 0 | 1 | 2 | 3 |
The daily living items shall be assigned points as follows: 0 = Total support, 1 = Assistance, 2 = Supervision, 3 = Independent. The daily living index is obtained by dividing the total number of points by the total possible points (33) and multiplying by 100. The daily living index is computed from all items for which information is provided. In the case of missing information, the total points possible is reduced accordingly.
(c) COGNITIVE
Sort objects by size
Correctly spell first and last name
Tell time to nearest five minutes (digital or analog)
Distinguish between right and left
Count ten or more objects
Understand simple functional signs
(e.g., EXIT, restrooms)
Do simple addition and subtraction of figures
Read and comprehend simple sentences
Read and comprehend newspaper or magazine articles
The cognitive index is equal to the total number of "yes" responses to the cognitive questions divided by 9 and multiplied by 100. Each "yes" response is equal to 1. In the case of missing information, the divisor (9) must be reduced accordingly.
(d) COMMUNICATION
Understands the meaning of "No"
Understands one-step directions (e.g., "Put on your coat.")
Understands two-step directions (e.g., "Put on your coat, then go outside.")
Understands a joke or story
Indicates a "Yes" or "No" response to a simple question
Asks simple questions
Relates experiences when asked
Tells a story, joke, or the plot of a television show
Describes realistic plans in detail
The communication index is equal to the total number of "yes" responses to the communication questions divided by 9 and multiplied by 100. Each "yes" response is equal to 1. In the case of missing information, the divisor (9) must be reduced accordingly.
(e) MOTOR
Walks independently or walks independently but with difficulty (no corrective device)
Can roll from back to stomach
Can pull self to standing
Can walk up and down stairs alternating feet from step to step
Can pick up a small object
Can transfer an object from hand to hand
Can mark with pencil, crayon or chalk
Can turn pages of a book one at a time
Can copy a circle from an example
Can cut with scissors along a straight line
The motor index is equal to the total number of "yes" responses to the mobility and motor questions divided by 10 and multiplied by 100. Each "yes" response is equal to 1. In the case of missing information, the divisor (10) must be reduced accordingly.
(ii) The maladaptive score shall be computed
by subtracting from 200 the sum of the behavior frequency and behavior
consequences indexes.
(a) BEHAVIOR FREQUENCY
| NOT THIS YEAR | OCCASIONALLY Less than once a month | MONTHLY About once a month | WEEKLY About once a week | FREQUENTLY Several times a week | DAILY Once a day or more | |
| Has tantrums or emotional outbursts | 5 | 4 | 3 | 2 | 1 | 0 |
| Damages own or other's property | 5 | 4 | 3 | 2 | 1 | 0 |
| Physically assaults others | 5 | 4 | 3 | 2 | 1 | 0 |
| Disrupts other's activities | 5 | 4 | 3 | 2 | 1 | 0 |
| Is verbally or gesturally abusive | 5 | 4 | 3 | 2 | 1 | 0 |
| Is self-injurious | 5 | 4 | 3 | 2 | 1 | 0 |
| Teases or harasses peers | 5 | 4 | 3 | 2 | 1 | 0 |
| Resists supervision | 5 | 4 | 3 | 2 | 1 | 0 |
| Run or wanders away | 5 | 4 | 3 | 2 | 1 | 0 |
| Steals | 5 | 4 | 3 | 2 | 1 | 0 |
The behavior frequency Index assigned points as follows: 5 = not this year, 4 = occasionally, 3 = monthly, 2 = weekly, 1 =frequently, 0 = daily. The behavior frequency index shall be obtained by dividing the total number of points by the total number of possible points (50) and multiplying by 100. Behavior frequency index is computed for all items for which information is provided. The maximum points (50) is reduced by 5 for each missing answer.
(b) BEHAVIOR
CONSEQUENCES INDEX
Behavior problems currently prevent this person from moving to a less restrictive setting
Specific behavioral programming or procedures are required
Individual's environment must be carefully structured to avoid behavior problems
Because of behavior problems, staff must sometimes intervene physically with individual, e.g., physically restrain or guide individual from room
Because of behavior problems, a supervised "time-out" period is needed at least once a week
Because of behavior problems, person requires one-on-one supervision for many program activities
The behavior consequences index shall be equal to the number of "no" responses divided by 6 and multiplied by 100. Each "no" response is equal to 1. The score is computed based on the questions answered. The maximum points possible (6) must be reduced by 1 for each missing answer.
(iii) The health
medical factor score shall be computed by summing the points from the number of
medical conditions, the seizure score, the number of medications, the
medication support level, and the number of medical consequences to a maximum
of 31.
(a) MEDICAL CONDITIONS
Respiratory
(e.g., asthma, emphysema, cystic fibrosis)
Cardiovascular
(e.g., heart disease, high blood pressure)
Gastro-intestinal
(e.g., ulcers, colitis, liver and bowel difficulties)
Genito-Urinary
(e.g., kidney problems)
Neoplastic Disease
(e.g., cancer, tumors)
Neurological Diseases (e.g., MS, Organic Brain Syndrome, ALS, Huntington's disease)
The number of medical conditions shall be equal to the number of "yes" responses. Each "yes" response, is equal to 1.
(b) SEIZURE
Seizure History
Yes - 1
No - 0
Types of seizures individual has experienced in the last twelve months?
No seizures this year
Simple partial (Simple motor movements affected; no loss of awareness)
Complex partial (Loss of awareness)
Generalized - Absence (Petit Mal)
Generalized - Tonic-Clonic (Grand Mal)
Had some type of seizure - not sure of type
Frequency of seizures that involve loss of awareness and/or loss of consciousness?
1 None during past year
2 Less than once a month
3 About once a month
4 About once a week
5 Several times a week
6 Once a day or more
Seizure score. The number of seizure types identified to a maximum of (5) shall be added to the seizure frequency score calculated as follows: 0 = no history of seizures, 1 =no seizures in the last year, 2 through 7 = points assigned are one more than the number circled under Frequency. The maximum seizure score possible is 5 + 7 = 12.
(c) PRESCRIPTIONS.
Indicate all types of prescription medications received on an ongoing basis.
No prescription medications
Antipsychotic or antidepressant for behavior management (e.g.,Thorazine, Mellaril, Prolixin, Lithium, Elavil)
Antianxiety agent for behavior management (e.g., Librium, Valium)
Anticonvulsant
Diabetes medication
Other maintenance medications prescribed to treat an existing medical condition.
Prescribed medications is equal to the total number of medications circled. The maximum possible score is 5.
(d) MEDICATION SUPPORT
The level of support individual receives when taking prescription medications?
0 No medications received at Day Treatment Program
1 Independent (Individual is totally responsible for medication)
2 Supervision (Individual keeps own medication but needs verbal prompts from staff)
3 Assistance (Staff keeps medication and gives to individual for self-administration)
4 Total Support (Staff assumes total responsibility for giving medication, e.g., injection, in food, drops)
The level of support necessary for medications is scored as follows: 0 = no medications are necessary or no medications are given at the program, 1 = individual is independent in taking medication, 2 = individual requires supervision in taking medication, 3 = person needs assistance from staff in taking medication, 4 = person is totally dependent on staff to take mediations
(e) MEDICAL
CONSEQUENCES
Indicate whether or not individual:
Missed more than a total of two weeks of day programming due to medical conditions during the last year
Was hospitalized for medical problem in the last year
Presently requires direct care staff be trained in special health care procedures (e.g., ostomy care, positioning, adaptive devices)
Presently requires special diet planned by dietician, nutritionist, or nurse (e.g., high fiber, low calorie, low sodium, pureed)
Number of Medical Consequences shall be equal to the total number of "yes" responses. Each "yes" response is equal to 1. The maximum total is 4.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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