New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter F - Finance; Claims for Reimbursement by Social Services Districts
Article 1 - Reimbursement and Claims
Part 609 - Conditions And Standards For Reimbursement Claiming
Section 609.5 - Conditions of cost reimbursement

Universal Citation: 18 NY Comp Codes Rules and Regs § 609.5

Current through Register Vol. 46, No. 39, September 25, 2024

Except as otherwise required for particular programs or activities, costs must be claimed as directed by the department and in accordance with the general reimbursement and allocation principles and conditions described in department regulations.

(a) Administrative surveys or management studies. Reimbursement will be available for the cost of surveys or management studies made by private agencies only when prior written approval has been obtained from the department and the survey or management study is conducted in accordance with department requirements. Requests for approval under this subdivision should contain the following information:

(1) the reason for the survey or management study;

(2) the scope of the survey or management study;

(3) the information needed to be collected during the survey or management study;

(4) the potential sources of the information;

(5) the objectives or constraints imposed upon the survey or management study;

(6) the potential problems;

(7) the tentative schedule for completion;

(8) the format for recommendations by the party conducting the survey or study;

(9) the cost effectiveness indications to be contained in the recommendations of the survey or management study; and

(10) a personnel resource statement indicating the availability of qualified and adequate staff, including the identification of a project director.

(b) Medical examinations. Reimbursement is available for administrative costs of medical examinations and consultations required for:

(1) program determinations, such as eligibility or employability;

(2) foster parents and day care providers; and

(3) establishing child support responsibility.

(c) Transportation costs. Reimbursement is available for transportation costs as administrative costs only when reimbursable expense does not include any transportation tax and:

(1) payment is not made directly to a provider, vendor or other entity within the context of a specified program; or

(2) the transportation costs are for a recipient, his or her representative or witnesses, including transportation costs related to child care, when such costs are reasonably relevant to a fair hearing and have been authorized by a social services official pursuant to department regulations; or

(3) payments are made to recipients of medical assistance, their legal guardians, family members or attendants; or

(4) expenditures are made for bus passes, or for bus or subway tokens, where the costs are not identified to the recipients or clients.

(d) Reserved accommodations. Reimbursement is available for payments made to certified foster boarding homes for assuring that adequate accommodations will be available for immediate reception and proper care of children for whom the commissioner has responsibility to provide foster care only when:

(1) payments for reserved accommodations are based upon a rate that does not exceed 50 percent of the rate of payment when a child is in the home;

(2) the total number of reserved accommodations does not exceed five percent of the total number of certified boarding home beds in use on the last day of the previous month or other period reported in accordance with department requirements; and

(3) the home is not reimbursed solely for reserved accommodations without being utilized for the care of a foster child for a period in excess of three consecutive months.

(e) Electronic data processing (EDP) equipment and operations. Reimbursement is available for the cost of the acquisition and operation of EDP equipment only when prior approval has been obtained from the department.

(f) Office space. Reimbursement is available only for costs supported as an actual outlay incurred in providing office space representing a benefit to a social services district. Rental charges claimed must not exceed actual cost. Before commitments are made for the construction, reconstruction, conversion or purchase of a public building in which a social services district is to occupy office space, local social services officials must consult with the department for the purpose of determining whether the proposed plans will adequately meet the needs of the district. The department must also be consulted regarding plans for repairs or alterations to either publicly or privately owned office space occupied or to be occupied by a social services district.

(1) Privately owned space. Reimbursement of rent paid by a governmental entity on behalf of a social services district for the use of space in a privately owned building will be based on the actual rent paid by such entity. Where it is necessary for the governmental entity to pay, in addition to the rent, certain maintenance costs such as fuel, light, power, water, real estate taxes, insurance or materials, supplies and contractual services for cleaning, decorating and recurring repairs, reimbursement will be based on actual payments made. Reimbursement for repairs and alterations of a nonrecurring nature may be claimed, provided:

(i) the cost of repairs and alterations plus the rent paid does not exceed comparable commercial rent;

(ii) the repairs and alterations are necessary to meet the particular office needs of the social services district and the cost is to be borne by the responsible governmental entity under the terms of the lease;

(iii) the proposed repairs and alterations will not unreasonably enhance the value of the property for the landlord upon the termination of the lease; and

(iv) the costs of major repairs and alterations are spread over the life of the lease and the amount of reimbursement to be paid during a particular claiming period is determined by multiplying the total cost of the repairs and/or alterations by a fraction in which the length of the claiming period is the numerator and the total duration of the lease is the denominator.

(2) Publicly owned space. Office space occupied by a governmental entity in a building owned by another governmental entity or subdivision will be considered to be publicly owned space. Reimbursement for interest costs will be available to the extent that federal participation is available for interest incurred to finance the capital expenditures for office space. Other capital investments in public buildings may be claimed only as maintenance costs in lieu of rent or as depreciation representing such costs. Capital investments include the following:

(i) construction of a building;

(ii) construction of an addition to a building;

(iii) purchase of a building and the repair, alteration or reconstruction of the building to make the space suitable for occupancy;

(iv) reconstruction or alteration of a building; and

(v) capital repairs and alterations of a nonrecurring nature.

(3) Maintenance in lieu of rent. Reimbursement will be available for the cost of service and maintenance in lieu of rent in public buildings when such costs can be identified as the expense of maintaining the space suitable for continuous occupancy.

(i) Reimbursement may be claimed for direct expenses of a social services district, including cleaning, fuel, light, power and water. Indirect expenses, including depreciation and allowable expenditures for maintenance incurred by other governmental entities or subdivisions, may also be claimed periodically at a monthly rate of 1/12 of the annual cost per square foot.

(ii) Maintenance costs in lieu of rent will not exceed the comparable rent of privately owned space in the community or similar location with equal convenience to the agency. Costs will be computed on the basis of an annual square-foot rate, which is a reasonable approximation of actual costs, unless actual costs can be determined and claimed on a current basis. Subsequent to the close of the district's fiscal year, the approximated costs claimed for the previous year shall be adjusted on the basis of actual cost.

(iii) Claims for reimbursement relating to space must be reconciled with a statement of approximated annual maintenance costs supported, except when otherwise instructed by the department, by three independent written appraisals of comparable rent. The statement will also include an estimate of total direct and indirect costs, a total cost rate per square foot for comparison purposes, and an indirect expense rate per square foot for use in claiming reimbursement.

(iv) Prior approval of the department is required for reimbursement whenever the total cost rate per square foot exceeds 75 percent of the lowest appraisal of comparable rent. The department will consider granting such approval only if the district submits to the department the necessary information on office space rental charges for publicly owned buildings and a statement, with supporting documentation, of estimated annual maintenance costs relating to space.

(v) For the first year of occupancy, the initial request for approval must be submitted no later than the end of the first quarter in which the space is occupied and the final schedules of estimated annual costs not later than the end of the second quarter. An extension of time may be requested if there is an unavoidable delay in the compilation of the necessary data, provided that the department is notified immediately in writing of the reasons for the expected delay.

(vi) Not later than six months following the close of the annual period upon which an estimated rate for maintenance in lieu of rent has been established, the rate must be revised based upon actual costs determined for the year.

(vii) Retroactive claims for reimbursement based upon a revised rate must be made before the last day for submission of the regular claim for the period including the sixth month of the next fiscal year and may include adjustments from and including the first month of the prior fiscal year. If, when calculating the actual costs for the prior year, it is found that total maintenance costs exceed 75 percent of the lowest appraisal of comparable rent, then the district must submit the information on office space rental charges in publicly owned buildings with its retroactive claim.

(viii) Maintenance in lieu of rent must be revised by the local district if there is any change in the amount of space occupied or if the district should occupy space in buildings other than the ones for which the rate was originally established.

(g) Care in facilities operated by social services districts.

(1) Costs of facilities operated by social services districts will include net actual expenditures made by the social services district for the operation and maintenance of the facility and capital costs described in this subdivision. Operation and maintenance may include the value of services and supplies furnished by other governmental entities for consumption or use in the facility, except when such services or supplies rendered the facility are a legal obligation of the entity rendering the service or supplies. The value of indirect expenditures for services and supplies must be computed at the actual cost to the entity rendering them to the facility, if such cost records are maintained, or, in the absence of cost records, a rate reasonably related to cost, but not to exceed the fair value of the supplies or services rendered.

(2) Costs of operation and maintenance of facilities by social services districts may not include capital costs or expenditures made for purposes not associated with the provisions of care of persons authorized to be cared for in such facilities by a social services district. Operation and maintenance costs may include expenditures for:

(i) personal services, consisting of employee salaries and fees for services of persons engaged in the maintenance and operation of the facility and the care of residents, including incidental payments to residents when made pursuant to law and payments made on behalf of employees to retirement funds, social security taxes, worker disability compensation funds or other salary-related benefits;

(ii) equipment, consisting of furniture and furnishings, kitchen and infirmary equipment, garage and shop equipment, motor vehicles and passenger cars, office and service equipment, and other equipment not included in capital expenditures;

(iii) supplies and materials, consisting of food, clothing, fuel, auto, office and other supplies and materials, motor vehicle materials, facility workshop materials, and other materials, including the wholesale value of products supplied by a farm or other production facility operated by the district which are consumed in the facility; and

(iv) other expenses, consisting of rent for office or buildings, other rents, telephone, lighting, travel, insurance, repairs to equipment, other repairs, and expenditures which are incurred for the operation and maintenance of the facility.

(3) Capital additions or improvements to facilities may be included in costs of care provided in social services facilities only when they are reimbursable.

(i) Nonreimbursable expenditures. Except for costs authorized in subparagraph (ii) of this paragraph, expenditures made for acquisition or development of land or for construction of, or for additions, improvements, alterations or replacements of a fixed and durable character to, buildings are not subject to reimbursement. Capital expenditures include:

(a) for new construction, all the initial equipment, supplies and furnishings installed in the facility to begin operations; and

(b) for total or partial conversion of a facility from domiciliary care to infirmary care, the cost of alterations to buildings and the cost of equipment, supplies and furnishings acquired in connection with the conversion.

(ii) Reimbursable costs. Reimbursement may be approved by the department for acquiring, reconstructing, rehabilitating or improving a shelter for adults, as defined in Part 491 of this Title, to the extent that funds are appropriated for this purpose.

(a) The following conditions for reimbursement must be observed:

(1) The proposed operator must be a social services district or a not-for-profit corporation or an otherwise lawfully established charitable organization or be a governmental entity or political subdivision which has entered into a contract or an agreement with a social services district for the provision of shelter services.

(2) The proposed operator must have received approval from the department pursuant to section 485.5 of this Title to operate a shelter for adults.

(3) The department must give approval prior to the acquisition, reconstruction, rehabilitation or improvement for which reimbursement will be sought.

(b) Reimbursement, or a pro rata portion thereof, provided under this subparagraph will not be permitted, or will be required to be returned, if the facility fails to commence operations within 18 months of approval or ceases to be operated as a certified shelter for adults within a period of seven years from the date when reimbursement is claimed.

(c) Reimbursement, or a pro rata portion thereof, provided under this subparagraph to a shelter other than one operated by a social services district will not be permitted, or will be required to be returned, if the shelter ceases to provide shelter services to adults under a contract or an agreement with the district within a period of seven years from the date such reimbursement is claimed. Any pro rata portion of funds attributable to a period during which the facility fails to provide shelter services will be required to be repaid to the department by the operator.

(4) Costs for certain classes of care must be excluded from costs of care provided in facilities operated by social services districts.

(i) Care not authorized under Social Services Law. When facilities providing authorized care are also used in part to provide other care not authorized under the Social Services Law, the costs of such other care must be excluded from costs of maintenance and operation of the facility when per capita daily costs are computed for the facility. Per diem rates will be computed periodically by the department from reports on operations of facilities and will be certified to social services districts when such adjustments are required to differentiate between authorized social services care and other care administered in the same facility.

(ii) Approved infirmary care. Care provided eligible recipients of supplemental security income (SSI) or medical assistance (MA) in approved public infirmary facilities will be excluded from total costs of maintenance and operation of the facility when per capita daily costs are computed for the facility, or for the infirmary, if a separate rate is computed for the infirmary. A social services district having an approved public infirmary may use the comprehensive per diem rate established by the department for the facility and the infirmary, as computed and certified annually by the department, or request the establishment of separate rates for the infirmary and for the remainder of the facility by submitting a request as instructed by the department. The comprehensive rate established by the department for facility and infirmary care will govern unless a district properly requests separate rates that are established by the department.

(5) When computing costs of care in facilities operated by social services districts, the following deductions must be made:

(i) Current receipts from or in behalf of patients receiving care.

(a) Payments for persons receiving care in facilities, including all current income received by a district for persons receiving care in the facility, but not including monies received by the district which represent recovery of assistance or care furnished by the district to an individual, will be applied against operation and maintenance costs of the facility.

(b) Receipts for specified groups of classes of cases for whose care the full cost is excludable from costs of operation and maintenance of the facility will not be applied as a deduction against current operation and maintenance costs of the facility, but will be used separately to offset the cost value applicable to such excluded care.

(c) Receipts will also include monies available for receipt by a social services district but which the district elects not to collect.

(ii) Miscellaneous receipts from sources other than residents. All revenues received by social services districts in the operation and maintenance of a facility from sources other than residents, including proceeds from sales of obsolete equipment or materials, repayments or refunds from vendors, payments by facility employees for meals and other miscellaneous revenue receipts, will be applied against operation and maintenance costs of the facility.

(h) Assistance or care not provided in facilities operated by social services districts.

(1) Costs for assistance or care not provided in facilities operated by social services districts may include:

(i) net actual expenditures properly made for qualified recipients to suppliers of appropriate assistance and care; and

(ii) expenditures for capital acquisition, reconstruction, rehabilitation or improvement of shelters for adults in accordance with provisions of department regulations.

(2) When a supplier of authorized hospital or other institutional care is a facility operated by a governmental entity and no cash transaction is involved in payment for care authorized by the social services official, costs will include the value of the services supplied.

(i) Other costs. Reimbursement will be available for administrative expenses incurred in relation to:

(1) cooperative agreements; or

(2) expenditures for foster care parents incurred for:

(i) awards; or

(ii) recognition dinners.

(j) Administrative cost reimbursement. For the State fiscal year beginning April 1, 1990, and ending March 31, 1991 (the 1990-91 State fiscal year), State reimbursement for administrative costs incurred by or reimbursed to each social services district for the determination of eligibility for and the amount of benefits in the income maintenance, medical assistance and food stamp programs will not exceed 105 percent of such costs incurred by or reimbursed to, whichever is less, such district in the State fiscal year beginning April 1, 1989 and ending March 31, 1990 (the 1989-90 State fiscal year). For the State fiscal year beginning April 1, 1991, and ending March 31, 1992 (the 1991-92 State fiscal year), State reimbursement for administrative costs incurred by or reimbursed to each social services district for the determination of eligibility for and the amount of benefits in the income maintenance, medical assistance and food stamp programs will not exceed such costs incurred by or reimbursed to, whichever is less, such district in the 1990-91 State fiscal year. For the State fiscal year beginning April 1, 1992, and ending March 31, 1993 (the 1992-93 State fiscal year), State reimbursement for administrative costs incurred by or reimbursed to each social services district for the determination of eligibility for and the amount of benefits in the income maintenance, medical assistance and food stamp programs will not be more than the incurred or reimbursed administrative costs, whichever is less, for such district in the 1991-92 State fiscal year. For the 1991-92 State fiscal year, individual district allocations will be reduced by the amount of expenditures associated with food stamp issuance that were formerly paid directly by such district but are currently reimbursed under the alternate food stamp issuance process. For the 1992-93 State fiscal year, individual district allocations will be reduced by the amount of expenditures associated with food stamp and/or public assistance benefit issuance that were formerly paid directly by such district but are currently reimbursed under the alternate food stamp issuance process, including any portion of that process used for the issuance of public assistance benefits. Costs relating to revenue maximization, cost containment (for the 1991-92 and 1992-93 State fiscal years only), employment and training services, Indian services (for the 1991-92 and 1992-93 State fiscal years only), activities related to implementing managed care programs (for the 1992- 93 State fiscal year only), corrective action efforts necessary to reduce public assistance error rates, fraud and abuse detection and case management services provided under title 4-B of article 6 of the Social Services Law are exempt from these reimbursement limitations if the social services district has submitted to the department a plan as required by this subdivision and the plan has been approved by the department.

(1) Exempt activities. Upon approval by the department of a plan submitted by a district pursuant to this subdivision, one or more of the activities listed in this subchapter, or any other activity which is included in the approved plan, to the extent that the costs of each such activity exceed the costs of such activity in the prior State fiscal year (except for activities described in subparagraph [iv] of this paragraph), will not be subject to the limit on State reimbursement as set forth in this subdivision. Such exempt activities include, but are not limited to, the following:

(i) Revenue maximization:

(a) conversions of pre-determination grants of aid to dependent children (PG-ADC) cases to ADC cases or to emergency assistance to needy families with children cases;

(b) third party health insurance, Medicare maximization or liability cost avoidance and recovery activities;

(d) conversion of MA federally nonparticipating activities to federally participating activities; or

(e) referrals for federally funded supplemental security income program eligibility determinations.

(ii) Corrective action efforts for public assistance, MA or food stamps programs:

(a) client income and resource verification staff;

(b) front end detection system measures;

(d) investigation of income or resources indicated on United States Internal Revenue Service non-salary income report (1099) forms; or

(e) activities related to verification of school attendance and Social Security number, earned or unearned income, application and all other eligibility related information, including, but not limited to, any information contained in reports generated by the Welfare Management System (WMS) or information identified by the department or the district in reports of agency error-prone activities.

(iii) Fraud and abuse detection efforts, including, but not limited to:

(a) investigations;

(b) prosecution referrals;

(d) claims establishment and collection activities;

(e) judicial and administrative disqualification proceedings, including preparation and support activities associated therewith; or

(f) activities related to the imposition of sanctions upon individuals who violate the requirements of assistance programs administered by the department or social services districts.

(iv) Case management services provided by social services district staff to clients under the Teenage Services Act (TASA), as described in Social Services Law, section 409-i, only for districts which report TASA costs as part of their administrative claims.

(v) Employment and training services, comprehensive employment program services and job opportunities and basic skills training (JOBS) program services (effective October 1, 1990), upon approval by the department of a district's JOBS plan submitted under section 385.17 of this Title.

(vi) Cost containment efforts provided by social services district staff during the 1991-92 and 1992-93 State fiscal years.

(vii) Indian services provided by social services district staff during the 1991-92 and 1992-93 State fiscal years.

(viii) Activities related to implementing managed care and the medical care coordinator programs during the 1992-93 State fiscal year.

(2) Plan submission.

(i) Each social services district requesting the designation of activities which will be exempt from the reimbursement limitations set forth in this subdivision must submit to the department a plan to include the following:

(a) a description of each activity for which an exemption is being requested;

(b) the gross costs of each such activity claimed during the last full calendar year ending prior to the current State fiscal year and the corresponding State share claimed and settled during the previous State fiscal year, together with an estimate of the gross costs for the subsequent calendar year and the State share to be settled during the subsequent State fiscal year;

(c) the number of full-time or full-time equivalent staff involved or to be involved in each activity for which an exemption is requested; and

(d) an estimate of the benefits received or to be received from each activity.

(ii) Employment and training activities described in a JOBS plan required and approved by the department will be considered to be part of the district plan submission and need not be submitted again in the district plan submission described in this paragraph. Such activities will be exempt activities upon acceptance of the JOBS plan by the department, regardless of whether or not any remaining district plan submission has been completed or approved by the department.

(iii) Plan submissions must be received by the department no later than the date specified in directives of the department which will be made available to each social services district.

(iv) The department will notify a district of the approval or disapproval of each activity by a date to be specified in directives of the department which will be made available to each social services district.

(3) Each social services district's claims will be examined to assure that State reimbursement of administrative costs for the district does not exceed the amounts set forth in this subdivision for the 1990-91 or the 1991-92 or the 1992-93 State fiscal years. The reimbursement limitations set forth in this subdivision apply to claims and supplemental claims for the calendar years ending December 31, 1990 and December 31, 1991, and December 31, 1992, and to supplemental claims for prior calendar years which would normally be settled during the 1990-91 or the 1991-92 or the 1992-93 State fiscal years. Except for initial limitations upon exempt activities prior to the approval of a plan, which may be restored after a plan is approved, there will be no limitation upon or reduction of State reimbursement for activities that the department has approved as exempt. Only those nonexempt administrative costs for which the State share of reimbursement does not exceed the prescribed percentage for such reimbursement attributable to State fiscal years, after adjusting such amounts to remove any expenditures which would be classified as exempt if they had been claimed during subsequent State fiscal years, will be reimbursed.

(4) Social services districts will report separately to the department the costs of each approved exempt activity which is included as part of the normal district claim submission in accordance with directions of the department issued pursuant to Part 600 of this Title.

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