N.Y. Comp. Codes R. & Regs. tit. 10, § 86-13.3
(b) Rates shall be computed on the basis of a full 12 month base year CFR, adjusted in accordance with the methodology as provided in this section. The rate shall include operating cost components, facility cost components, and capital cost components as identified in applicable paragraphs. Such base year may be updated periodically, as determined by DOH.
(1) Operating component. Allowable operating costs shall include costs identified in the consolidated fiscal reports and reimbursement for such costs shall be inclusive of the following components: The final daily operating rate shall be determined by dividing the total provider operating revenue-adjusted, as determined by subparagraph (xxviii) of this paragraph, by the applicable provider rate sheet units for the initial period.
(xxvii) Statewide budget neutrality adjustment factor for operating dollars, which shall mean the quotient of the operating revenue from all provider rate sheets in effect on June 30, 2015, divided by provider operating revenue, as determined pursuant to subparagraph (xxvi) of this paragraph, for all providers.
(xxviii) Total provider operating revenue-adjusted, which shall mean the product of the provider operating revenue as determined pursuant to subparagraph (xxvi) of this paragraph and the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (xxvii) of this paragraph.
(2) Alternative operating component. For providers that did not submit a cost report or submitted a cost report that was incomplete for prevocational services for the base year, the final daily operating rate shall be a regional daily operating rate. This rate shall be the sum of: Such sum shall then be multiplied by the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (1)(xxvii) of this subdivision.
(3) Capital component. This schedule will specifically identify the differences, by capital reimbursement item, between the amounts reported on the certified cost report, and the reimbursable items, including depreciation, interest and lease cost from the schedule of approved reimbursable capital costs. The provider’s independent auditor will apply procedures to verify the accuracy and completeness of the capital reimbursement schedule. The department will retroactively adjust capital reimbursement based on the actual cost verification process as described in subparagraph (v) of this paragraph.
(vi) Capital reimbursement schedule. Beginning with the cost reporting period ending December 31, 2014, each provider shall submit to OPWDD, as part of the annual cost report, a capital reimbursement schedule.
(d) Respite (hourly and free-standing).
(1) Operating component. Allowable operating costs shall include costs identified in the consolidated fiscal reports and reimbursement for such costs shall be inclusive of the following components: The final daily operating rate shall be determined by dividing the total provider operating revenue-adjusted, as determined by subparagraph (xxvii) of this paragraph, by the applicable provider rate sheet units for the initial period.
(2) Alternative operating component. For providers that did not submit a cost report or submitted a cost report that was incomplete for free-standing or hourly respite services for the base year, the final daily operating rate shall be a regional daily operating rate. This rate shall be the sum of: Such sum shall then be multiplied by the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (1)(xxvi) of this subdivision.
(3) Capital component.
(i) For free-standing respite sites. Note:
(b) The capital rate shall be paid monthly.
Note:
The provisions of this paragraph do not apply to capital approved by OPWDD prior to July 1, 2015.
(iii) Cost verified rates for capital assets approved on or after July 1, 2015. The provider shall submit to the State supporting documentation of actual costs. Actual costs shall be verified by the State reviewing the supporting documentation of such costs. A provider submitting such actual costs shall certify that the reimbursement requested reflects allowable capital costs and that such costs were actually expended by such provider. Under no circumstances shall the amount included in the rate under this subparagraph exceed the amount authorized in the approval process. Capital costs shall be depreciated over a 25 year period for acquisition of properties or the life of the lease for leased sites. Capital improvements shall be depreciated over the life of the asset. The amortization of interest shall not exceed the life of the loan taken. Amortization or depreciation shall begin upon certification by the provider of such costs. Start-up costs may be amortized over a one year period beginning with site certification. If actual costs are not submitted to the State within two years from the date of site certification, the amount of capital costs included in the rate shall be zero for each period in which actual costs are not submitted.
(e) Prevocational (community-based).
(1) Fee schedule. Effective July 1, 2015, prevocational (community-based) services will be reimbursed according to the fee schedule below:
| Prevocational (community-based) | ||||
| Prevocational (community-based) | Unit of service | Individual (serving 1) | Group (serving 2) | Group (serving 3+) |
| 1 | Hourly | $41.57 | $25.98 | $20.78 |
| 2 | Hourly | $43.92 | $27.45 | $21.96 |
| 3 | Hourly | $42.90 | $26.81 | $21.45 |
(f) Supported employment.
(1) Fee schedule. Effective July 1, 2015, supported employment will be reimbursed according to the fee schedule below:
| Supported employment (intensive phase) | |||
| OPWDD region | Unit of service | Intensive-1 (serving 1) | Intensive-2 (serving 2+) |
| 1 | Hourly | $67.88 | $27.15 |
| 2 | Hourly | $62.19 | $24.88 |
| 3 | Hourly | $54.98 | $21.99 |
| Supported employment (extended phase) | |||
| OPWDD region | Unit of service | Extended-1 (serving 1) | Extended-2 (serving 2+) |
| 1 | Hourly | $67.88 | $27.15 |
| 2 | Hourly | $62.19 | $24.88 |
| 3 | Hourly | $54.98 | $21.99 |
(g) Residential habilitation (family care).
(1) Fee schedule. Effective July 1, 2015, residential habilitation (family care) will be reimbursed according to the fee schedule below:
| Residential habilitation (family care) – base fee | |||
| DOH region | Unit of service | Fee | |
| 1 | Daily | $42.06 | |
| 2 | Daily | $43.61 | |
| 3 | Daily | $35.58 | |
| 4 | Daily | $41.53 |
| Residential habilitation (family care) – difficulty of care (DOC) add-on | |||||||
| Unit of service | ISPM level 1 | ISPM level 2 | ISPM level 3 | ISPM level 4 | ISPM level 5 | ISPM level 6 | |
| Family care | Daily | $5.56 | $10.87 | $11.12 | $16.43 | $32.26 | $37.57 |
(c) Prevocational (site-based).