Part 86 Reporting and Rate Certifications for Facilities

(a) Effective for services provided on and after April 1, 2011 Medicaid payments for outpatient alcoholism and substance abuse services provided in outpatient clinic facilities licensed by the Office of Alcoholism and Substance Abuse Services (OASAS) pursuant to article 32 of the…

On and after July 1, 2015, rates of reimbursement for prevocational services (site based) and respite (hourly and free-standing) and fees for prevocational services (community-based), residential habilitation (family care) and supported employment, other than those provided by th…

As used in this Subpart, the following terms shall have the following meanings: Capital costs that are allowable under 14 NYCRR Subpart 635-6. In the case of prevocational and respite services, operating costs that are allowable under 14 NYCRR section 635-10.4. The consolidated f…

(a) There shall be one provider-wide rate for each provider of prevocational services (site-based), except that rates for prevocational services provided to individuals identified as specialized populations by OPWDD shall be determined under section 86-13.8 of this Subpart. Adjus…

(a) Providers shall report costs and maintain financial and statistical records in accordance with 14 NYCRR Subpart 635-4. The completion of the financial and statistical report forms shall be in accordance with generally accepted accounting principles as applied to the provider …

For years in which the department does not update the base year, subject to the approval of the Director of Budget, the department may use a compounded trend factor to bring base year costs forward to the appropriate rate period. The trend factor shall be taken from applicable ye…

The reimbursement methodology described in this Subpart for prevocational services (site-based) and respite (hourly and free-standing) will be phased-in over a two year period, with a year for purposes of the transition period meaning a 12 month period from July 1st to the follow…

(a) Arithmetic or calculation errors will be adjusted accordingly in instances that would result in a change of $5,000 or more in a provider’s annual reimbursement for prevocational services. (b) In order to request a rate correction in accordance with subdivision (a) of this sec…

Notwithstanding any other provisions of this Subpart, rates for individuals identified by OPWDD as qualifying for specialized template populations funding shall be as follows. As used in this section, downstate shall mean the counties of New York, Kings, Bronx, Queens, Richmond, …

If any provision of this Subpart or its application to any person or circumstance is held to be invalid, the remainder of this Subpart and the application of that provision to other persons or circumstances will not be affected.

As used in this Subpart, the following definitions shall apply: (a) Residential health care facility, medical facility or facility shall mean all facilities or organizations covered by the term nursing home as defined in article 28 of the Public Health Law, including hospital-bas…

For purposes of this section, the following definitions shall apply: (1) Direct price shall mean the monetary amount established for the direct component of the rate, based on the direct costs of all facilities after application of the regional direct input price adjustment facto…

(a) Payments for 1986 and subsequent rate years for the direct component of the rate as defined in section 86-2.10(c) of this Subpart shall be adjusted periodically as described in this section to reflect changes in the case mix of facilities. (b) Facilities shall report to the d…

(a) To the allowable basic rate prior to the addition of capital costs and depreciation and interest related to movable equipment, there will be added a factor to project allowable cost increases during the effective period of the reimbursement rate. Such factor shall be determin…

(a) Errors resulting from submission of fiscal and statistical information by a residential health care facility may be corrected if brought to the attention of the State Commissioner of Health within 120 days of receipt of the commissioner's initial rate computation sheet. Error…

(a) The State Commissioner of Health may consider only those applications for revisions of certified rates which are based on: (1) cost reports filed pursuant to section 86-2.2(e) of this Subpart. Such rate shall become effective on the first day of the 12-month period referred t…

(1) This subdivision shall apply where the fiscal and statistical data of the facility are unavailable through no fault of the provider or its agents, and due to circumstances beyond its control, or when there is a new facility without adequate cost experience as set forth in sec…

Reimbursement for the cost of providing services may be the lesser of the actual costs incurred or those costs which could reasonably be anticipated if such services had been provided by the operation of joint central services or use of facilities or services which could have ser…

(a) To be considered as allowable in determining reimbursement rates, costs shall be properly chargeable to necessary patient care. Except as otherwise provided in this Subpart, or in accordance with specific determination by the commissioner, allowable costs shall be determined …

(a) Operating costs shall be reduced by the costs of services and activities which are not properly chargeable to patient care. In the event that the State Commissioner of Health determines that it is not practical to establish the costs of such services and activities, the incom…

(a) Reported depreciation based on approved historical cost of buildings, fixed equipment and capital improvements thereto is recognized as a proper element of cost for voluntary and public residential health care facilities. Useful lives shall be the higher of the reported usefu…

(a) Each residential health care facility shall complete and file, with the New York State Department of Health and/or its agent, annual financial and statistical report forms supplied by the department and/or its agent. Residential health care facilities certified for title XVII…

(a) Necessary interest on both current and capital indebtedness is an allowable cost for all residential health care facilities. (b) To be considered as an allowable cost, debt generating interest shall be incurred to satisfy a financial need, and interest expense shall be at a r…

As used in this section, the following terms shall be defined as follows: (1) Capital indebtedness. The term capital indebtedness shall mean all debt obligations of a facility that are: (i) evidenced by a mortgage note or bond and secured by a mortgage on the land, building or no…

(a) Necessary and reasonable expenses related to movable equipment (depreciation computed on a straight-line method or accelerated under a double declining balance or sum-of-the-years-digits method, interest on indebtedness, lease, etc.) are considered allowable costs for residen…

(a) All research costs shall be excluded from allowable costs in computing reimbursement rates. (b) Research includes those studies and projects which have as their purpose the enlargement of general knowledge and understanding, are experimental in nature and hold no prospect of …

The costs of educational activities, less tuition and supporting grants, shall be included in the calculation of the basic rate, provided such activities are directly related to patient care services.

(a) Reasonable compensation for operators or relatives of operators for services actually performed and required to be performed shall be considered as an allowable cost. The amount to be allowed shall be equal to the amount normally required to be paid for the same service provi…

(a) A related organization shall be defined as any entity which the residential health care facility is in control of or is controlled by, either directly or indirectly, or an organization or institution whose actions or policies the facility has the power, directly or indirectly…

The Division of Health Care Financing in the Department of Health shall be notified immediately of the deletion of any previously offered service or of the withholding of services from patients paid for by government agencies. Such notifications shall include a statement indicati…

(a) For rate year 1993, in computing the allowable cost of a proprietary residential health care facility, there will be included, after subtracting for current and noncurrent time deposits and equivalents, investments and construction in progress, a reasonable return on average …

(a) The commissioner may make noninterest-bearing payments to receivers, appointed pursuant to Public Health Law, section 2810, according to the terms set forth in this section and subject to the availability of moneys therefor. (b) No such payments shall be made unless the commi…

(a) Residential health care facilities shall maintain their records in accordance with: (1) section 414.13 of Article 3 of Subchapter A of Chapter V of this Title; and (2) for the 1980 calendar year in substantial compliance, and thereafter in full compliance, with Article 9 of S…

(a) For the purpose of determining reimbursement rates effective January 1, 1986 and thereafter, for governmental payments, each residential health care facility shall, on an annual basis or more often as determined by the department pursuant to this Subpart, assess all patients …

(a) For rate years 1989, 1990 and 1991, notwithstanding any other provision of this Subpart and subject to the provisions of paragraph (1) of this subdivision, payment rates shall be adjusted in accordance with this subdivision to reflect a percentage recalibration adjustment bas…

For purposes of this section, the following definitions shall apply: (1) Rate shall mean the aggregate governmental payment to the facility per patient day as defined in section 86-2.8 of this Subpart. (2) Nurse aide trainee shall mean a person as defined in section 414.1(b)(8) o…

(a) Payment rates shall be adjusted by the addition of a per diem amount as determined by the commissioner pursuant to this section for residential health care facilities participating in pilot demonstration projects for the development of additional knowledge and experience in t…

(a) A hospital-based residential health care facility as defined in section 86-2.10(a)(13) of this Subpart whose affiliated hospital closes its acute care beds shall notify the department within 30 days of actual complete closure of such beds. Such residential health care facilit…

(a) Residential health care facilities which provide scheduled short-term care for residents in accordance with Part 410 of this Title shall be paid a per diem rate of reimbursement for such services which is the average per diem rate of reimbursement for the facility as establis…

(a) Effective November 1, 1992 and thereafter, residential health care facilities shall submit to the department the data contained in the comprehensive assessment and review of assessments (quarterly reviews) required to be completed by facilities in accordance with section 415.…

(a) The commissioner shall make rate adjustments, subject to the availability of funds therefore, to certain residential health care facilities who demonstrate to the satisfaction of the commissioner that they can meet or exceed defined quality measures. (b) Initial awards shall …

(a) The commissioner may grant approval of a temporary adjustment to the non-capital components of rates calculated pursuant to this Subpart for eligible residential health care facilities. (b) Eligible facilities shall include: (1) facilities undergoing closure; (2) facilities i…

The completion of the financial and statistical report forms shall be in accordance with generally accepted accounting principles as applied to the residential health care facility unless the reporting instructions authorized specific variation in such principles.

The non-capital cost components of residential health care facility (facility) Medicaid rates for inpatient services for periods on and after January 1, 2012, shall be in accord with the following: (a) Specialty facilities means those facilities or discrete units of facilities de…

(a) Subject to the availability of Federal financial participation, the capital cost components of the rates of eligible residential health care facilities for periods on and after the effective date of this regulation shall be adjusted in accordance with the following: (1) For t…

(a) For the calendar year 2013 and thereafter, the commissioner shall establish a residential health care facility quality pool for the purpose of making quality incentive payments to facilities meeting the criteria set forth in this section. This program shall be referred to as …

(a) The financial and statistical reports shall be certified by an independent licensed public accountant or an independent certified public accountant. The minimum standard for the term “independent” shall be the standard used by the State Board of Public Accountancy. (b) Effect…