SubPart 86-9 - Limited Home Care Services Agencies

Effective Date: 
Wednesday, December 31, 2008
Doc Status: 
Complete

Section 86-9.1 - Services

Section 86-9.1 Services

(a) Reimbursement is available under this Subpart only for the following services provided directly by limited home care services agencies, licensed by the department pursuant to section thirty-six hundred five of the Public Health Law, to eligible individuals who are residents of adult homes or enriched housing programs certified in accordance with article seven of the Social Services Law:

(1) Level II personal care services, as defined in 18 NYCRR section 505.14(a)(6)(ii), including related nursing supervision, authorized and provided in accordance with rules and regulations of the department, but not including Level I personal care services as defined in 18 NYCRR section 505.14(a)(6)(i); and

(2) the administration of subcutaneous and/or intramuscular injections and application of sterile dressings by a registered professional nurse, including associated nursing tasks. Reimbursement is available under this Subpart only for services provided by limited home care services agencies which are not services that must be provided to residents of adult homes or enriched housing programs pursuant to article seven of the Social Services Law and rules and regulations of the department.

Effective Date: 
Wednesday, December 31, 2008
Doc Status: 
Complete

Section 86-9.2 - Computation of the rates of payment

Section 86-9.2 - Computation of the rates of payment

(a) For purposes of this Subpart, rates of payment for Level II personal care services shall be calculated for two regions: a downstate region to consist of Bronx, Kings, New York, Queens and Richmond counties and an upstate region to consist of all other counties in New York State. For purposes of this Subpart, rates of payment for registered professional nurse services shall be calculated for two regions: a downstate region to consist of Rockland, Westchester, Nassau, Suffolk, Bronx, Kings, New York, Queens and Richmond counties and an upstate region to consist of all other counties in New York State.

(b) For each region, the unit of measure for which a limited home care services agency may bill for services rendered is a quarter hour.

(c) For purposes of this Subpart, the rate of payment for Level II personal care services for the downstate region shall be the weighted average January 1, 1997 Level II personal care rate for the downstate region. For purposes of this Subpart, the rate of payment for Level II personal care services for the upstate region shall be the weighted average January 1, 1997 Level II personal care rate for the upstate region for direct care and training, capital, and criminal checks, plus no more than fifteen percent of such rate for administrative expenses.

(d) For purposes of this Subpart, the rate of payment for registered professional nurse services for the downstate region for the administration of subcutaneous and/or intramuscular injections and application of sterile dressings shall be the average January 1, 1997 fee established for nursing services rendered by a registered professional nurse on a private practitioner basis for the downstate region. For purposes of this Subpart, the rate of payment for registered professional nurse services for the upstate region for the administration of subcutaneous and/or intramuscular injections and application of sterile dressings shall be the average January 1, 1997 fee established for nursing services rendered by a registered professional nurse on a private practitioner basis for the upstate region.

Effective Date: 
Wednesday, December 31, 2008
Doc Status: 
Complete