VOLUME D (Title 10)

Article 9 - Residential Health Care Facility Uniform Reporting

Effective Date: 
Tuesday, December 23, 1980
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Part 450 - Applicability

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 450.1 - Applicability and relationship to reimbursement

Section 450.1 Applicability and relationship to reimbursement. (a) This Article is applicable to all residential health care facilities except those that are hospital-based, unless said residential health care facility was organized under article 28-A of the Public Health Law, in which case this Article applies regardless of whether or not such facility is hospital-based.

(b) This Article has been designed so that a uniform report for financial disclosure could be developed. This Article has not been designed to conform to or reflect reimbursement regulations, since they have and will continue to change. It is anticipated that an omnibus annual Medicaid cost report will reflect both the uniform reporting concepts and reimbursement regulations.
 

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Part 451 - Definitions

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 451.0 - General

Section 451.0 General. For the purposes of this Article, the following terms shall have the following meanings:

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Section 451.1 - Accelerated depreciation

451.1 Accelerated depreciation. Method of depreciation which generates a greater amount of expense in the earlier life of an asset, and less expense in the later years, than the straight-line method. The purposes for adopting such a method would be:

(a) operation of plant or equipment at more than normal speed, use or capacity; (b) a useful or economic life materially less than physical life;

(c) an excessive cost being written off during what is estimated to be the high-price period; and

(d) tax advantages arising from the use of declining-balance and sum-of-the-years methods.
 

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Section 451.2 - Accommodation fee

451.2 Accommodation fee. An advance payment or transfer of a specified amount of funds or property by, or on behalf of, an aged person to a facility as full or partial payment for the promise to provide accommodations for the remainder of the person's life.
 

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Section 451.3 - Accounting

451.3 Accounting. The art of recording, classifying and summarizing in a significant manner and in terms of money, transactions and events which are, in part at least, of a financial character, and interpreting the results thereof.

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Section 451.4 - Account control

451.4 Account control. The administrative procedures employed in maintaining the accuracy and propriety of transactions and the bookkeeping record thereof.
 

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Section 451.5 - Accounting manual

451.5 Accounting manual. A handbook of accounting policies, standards, and practices governing the accounts of a business enterprise or other entity; it includes the classification of accounts.
 

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Section 451.6 - Accounting period

451.6 Accounting period. The period of time for which an operating statement is customarily prepared (normally 12 months).
 

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Section 451.7 - Accounting policy

451.7 Accounting policy. The general principles and procedures under which the accounts of an organization are maintained and reported; any one such principle or procedure.
 

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Section 451.8 - Accrual basis

451.8 Accrual basis. The recognition of revenue when earned and expenses when incurred, together with acquired assets or related liabilities, without regard to the date of receipt or payment of cash.
 

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Section 451.9 - Accumulated income (or earnings or profit)

451.9 Accumulated income (or earnings or profit). Net income retained and not paid out in dividends or dissipated by subsequent losses; earned surplus or retained earnings.
 

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Section 451.10 - Activity

451.10 Activity. (a) The work, or one of several lines of work, carried on within any organization or organizational subdivision.

(b) The whole of the work carried on by any organization or individual.
 

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Section 451.11 - Actual cost

451.11 Actual cost. (a) Acquisition costs, net of discounts and allowances, but including transportation and storage (often averaged for internal transfer or inventory purposes).

(b) Payroll costs or other production costs.
 

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Section 451.12 - Actual time method

451.12 Actual time method. Depreciation expense based on the number of months the assets is owned in both the year of acquisition and the last year of an asset's life, as opposed to using a half year's depreciation in the year of acquisition and zero in the last year.
 

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Section 451.13 - Actuarial basis

451.13 Actuarial basis. A basis compatible with principles followed by actuaries; said of computations involving compound interest, retirement and mortality estimates, and the like.
 

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Section 451.14 - Additional (paid-in) capital

451.14 Additional (paid-in) capital. (a) Contributions of corporate stockholders credited to accounts other than capital stock.

(b) Sources:

(1) an excess over par or stated value received from the sale or exchange of capital stock;

(2) an excess of par or stated value of capital stock reacquired over the amount paid therefor; or

(3) an excess from recapitalization, often displayed on the balance sheet as a separate item or in combination with par or stated value and designated paid-in capital.

(c) known also as paid-in surplus.
 

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Section 451.15 - Adjusting (journal) entry

451.15 Adjusting (journal) entry. (a) The record made of an accounting transaction giving effect to the correction of an error, an accrual, a write-off, a provision for bad debts or depreciation, or the like.

(b) Auditing. Any change in the accounts required by an auditor, expressed in the form of a simple or compound journal entry.
 

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Section 451.16 - Administrative accounting

451.16 Administrative accounting. That portion of the accounting process generally associated with management: for example, the functions of the controller, internal auditing, and decisions as to prorations, valuations, reserves, charge-offs and reporting.
 

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Section 451.17 - Administrative expense

451.17 Administrative expense. A classification of expense incurred in the general directing of an enterprise as a whole, as contrasted with expense of a more specific function, such as nursing services or dietary, but not including income deductions. Items included under this heading vary with the nature of the business, but usually include salaries of top officers and other general office expense.
 

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Section 451.18 - Advance

451.18 Advance. (a) Payment of cash or the transfer of goods for which an accounting must be rendered by the recipient at some later date.

(b) A payment of a contract before its completion.

(c) The payment of wages, salaries or commissions before they have been earned.
 

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Section 451.19 - Age

451.19 Age. The number of years or other time periods an asset or asset group has remained in service at a given date.
 

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Section 451.20 - AICPA

451.20 AICPA. American Institute of Certified Public Accountants.
 

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Section 451.21 - Allocate

451.21 Allocate. (a) To charge an item or group of items of revenue or cost to one or more objects, activities, processes, operations or products, in accordance with cost responsibilities, benefits received, or other readily identifiable measure of application or consumption.

(b) To distribute the total cost of a lump-sum purchase over the items purchased or departments affected.

(c) To spread a cost systematically over two or more time periods.
 

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Section 451.22 - Allowance

451.22 Allowance. The difference between gross revenue from services rendered and amounts received (or to be received) from patients or third-party payors. Allowances are to be distinguished from uncollectible accounts resulting from credit losses.
 

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Section 451.23 - Allowable costs

451.23 Allowable costs. Documented costs which are necessary for the day-to-day operation of a provider, are directly or indirectly related to patient care, and are not expressly declared nonallowable by Federal or State regulations.
 

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Section 451.24 - Amortization

451.24 Amortization. The systematic distribution of the cost or other basis of a tangible or intangible asset over the estimated useful life of the asset.
 

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Section 451.25 - Apportionment

451.25 Apportionment. The distribution of a cost over several periods of time in proportion to anticipated benefits.
 

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Section 451.26 - Appreciation

451.26 Appreciation. Increase in value of property; the excess of the present value of property over book value.
 

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Section 451.27 - Article 2-A facility

451.27 Article 2-A facility. A residential health care facility organized under article 28-A of the Public Health Law.
 

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Section 451.28 - Assets

451.28 Assets. Economic resources of an enterprise which are recognized and measured in conformity with generally accepted accounting principles.
 

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Section 451.29 - Audit

451.29 Audit. (a) The examination of contracts, orders and other original documents for the purpose of substantiating individual transactions before their settlement.

(b) Any systematic investigation or appraisal of procedures or operations for the purpose of determining conformity with prescribed criteria; the work performed by an internal auditor.

(c) Auditing. An exploratory, critical review, by a public accountant, of the underlying internal controls and accounting records of a business enterprise or other economic unit, precedent to the expression by him of an opinion of the propriety ("fairness") of its financial statements.
 

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Section 451.30 - Available beds

451.30 Available beds. Health facility beds which are maintained and staffed for the provision of patient care.
 

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Section 451.31 - Average daily inpatient census

451.31 Average daily inpatient census. Average number of inpatients (based on the daily inpatient census) present each day for a given period of time.
 

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Section 451.32 - Average length of stay

451.32 Average length of stay. The average number of days of service rendered to each inpatient discharged during a given period.
 

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Section 451.33 - Average life

451.33 Average life. The estimated useful-life expectancy of a group of assets subject to depreciation.
 

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Section 451.34 - Bad debts

451.34 Bad debts. Amounts considered to be uncollectible from accounts and notes receivable which were created or acquired in providing services to patients.
 

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Section 451.35 - Balance

451.35 Balance. (a) The difference between the total debits and the total credits of an account or the total of an account containing only debits or credits.

(b) The equality of the total debit balances and the total credit balances of the accounts in a ledger.

(c) Agreement of the total of the account balances in a subsidiary ledger with its general ledger control.
 

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Section 451.36 - Balance sheet

451.36 Balance sheet. A statement of financial position of any economic unit, or component thereof, reporting as at a given moment of time its assets (at cost, depreciated cost, or other indicated value), its liabilities, and its ownership equities recorded under an accounting system.
 

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Section 451.37 - Bed turnover rate

451.37 Bed turnover rate. The number of times a health facility bed, on the average, changes occupants during a given period of time.
 

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Section 451.38 - Benefit

451.38 Benefit. The service or satisfaction yielded by an expenditure.
 

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Section 451.39 - Betterment

451.39 Betterment. An expenditure having the effect of extending the useful life of an existing fixed asset, increasing its normal rate of output, lowering its operating cost, increasing rather than merely maintaining efficiency, or otherwise adding to the worth of benefits it can yield.
 

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Section 451.40 - Board-designated funds

451.40 Board-designated funds. Unrestricted funds set aside by the governing board for specific purposes or projects.
 

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Section 451.41 - Bond

451.41 Bond. (a) A certificate of indebtedness, in writing and often under seal.

(b) An obligation in writing, binding one or more parties as surety for another.
 

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Section 451.42 - Book inventory

451.42 Book inventory. (a) An inventory which is not the result of actual stocktaking but of adding the units and the cost of incoming goods to previous inventory figures and deducting the units and cost of outgoing goods.

(b) The balances of materials or products on hand in quantities, dollars, or both, appealing in perpetual-inventory accounts.
 

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Section 451.43 - Book of original entry

451.43 Book of original entry. A record book, recognized by law or custom, in which transactions are successively recorded, and which is the source of posting to ledgers; a journal. Books of original entry include general and special journals, such as cashbooks and registers of sales and purchases.
 

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Section 451.44 - Book value (or cost)

451.44 Book value (or cost). (a) The net amount at which an asset or asset group appears on the books of account, as distinguished from its market value or some intrinsic value.

(b) The face amount of a liability less any unamortized discount and expense.

(c) As applied to capital stock:

(1) the book value of the net assets;

(2) in a corporation, the book value of net assets divided by the number of outstanding shares of capital stock.
 

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Section 451.45 - Calendar year

451.45 Calendar year. A 12-month period beginning January 1st and ending December 31st of the same year.
 

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Section 451.46 - Capital expenditures

451.46 Capital expenditures. An expenditure intended to benefit future periods. in contrast to a revenue expenditure, which benefits a current period; an addition to a capital asset. The term is generally restricted to expenditures that add fixed-asset units or that have the effect of increasing the capacity, efficiency, life span or economy of operation of an existing fixed asset.
 

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Section 451.47 - Capitalization

451.47 Capitalization. The process of setting up expenditures as assets and amortizing or depreciating these assets over time.
 

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Section 451.48 - Cash basis

451.48 Cash basis. Recording cash as received, regardless of when it is earned, and recording expenses when they are paid, regardless of when they are incurred.
 

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Section 451.49 - Certificate of deposit

451.49 Certificate of deposit. (a) A formal instrument, frequently negotiable or transferable, issued by a bank as evidence of indebtedness and arising from a deposit of cash subject to withdrawal under the specific terms of the instrument:

(1) demand certificates, payable upon presentation, seldom bearing interest;

(2) time certificates, payable at a fixed or determinable future date, usually bearing interest at a specified rate.

(b) A formal certificate, usually printed or engraved, ordinarily negotiable or transferable, and issued by a depository or agent against the deposit of bonds or stock of a corporation under the terms of a reorganization plan or other agreement.
 

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Section 451.50 - Chain Organization

451.50 Chain Organization. A health care or other organization consisting of a group of two or more facilities which are owned, leased or, through any other device, controlled by one business entity.
 

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Section 451.51 - Change of ownership

451.51 Change of ownership. A change in the entity which has ultimate legal responsibility for the operation of a provider and thus for decisions and for liabilities arising in the course of its operation.
 

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Section 451.52 - Charity allowances

451.52 Charity allowances. Reductions in charges made by the provider of services because of the indigence or medical indigence of the patient.
 

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Section 451.53 - Chart of accounts

451.53 Chart of accounts. A systematically arranged list of accounts applicable to a specific concern, giving account names and numbers. A chart of accounts, accompanied by descriptions of their use and of the general operation of the books of account, becomes a classification or manual of accounts.
 

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Section 451.54 - Classification of accounts

451.54 Classification of accounts. A list of accounts, systematically grouped (chart of accounts), suitable for a particular organization, with descriptions setting forth the meaning, function and content of each account and the relation of one to another.
 

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Section 451.55 - Clearing account

451.55 Clearing account. (a) A primary account containing costs that are to be transferred or allocated to other accounts.

(b) An intermediate account to which is transferred a group of costs or revenues, or a group of accounts containing costs or revenues, and from which a distribution of the total is made to other accounts.
 

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Section 451.56 - Common ownership

451.56 Common ownership. An individual or individuals with a controlling interest in both the residential health care facility and an organization that does business with the facility.
 

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Section 451.57 - Consistency

451.57 Consistency. Continued uniformity, during a period or from one period to another, in methods of accounting and use of generally accepted accounting principles (mainly in valuation bases and methods of accrual, as reflected in the financial statements of a business enterprise or other accounting or economic unit).
 

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Section 451.58 - Consultant

451.58 Consultant. A firm or person (normally not an employee), with demonstrated expertise in a given field, who provides technical advice in that field in order to improve the necessary day-to-day operation of a facility.
 

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Section 451.59 - Contractor

451.59 Contractor. An entity which contracts with the department to deliver care to medical-recipient patients.
 

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Section 451.60 - Contractual adjustment

451.60 Contractual adjustment. The difference between billings at established charges and amounts received or due from third-party payors under contract agreements--similar to a trade discount.
 

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Section 451.61 - Contributed capital

451.61 Contributed capital. (a) The payments in cash or property made to a corporation by its stockholders:

(1) in exchange for capital stock;

(2) in response to an assessment on the capital stock; or

(3) as a gift.

(b) Paid-In capital.
 

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Section 451.62 - Contributed services

451.62 Contributed services. See donated services.
 

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Section 451.63 - Control

451.63 Control. The process by which the activities of an organization are conformed to a desired plan of action and the plan is conformed to the organization's activities.
 

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Section 451.64 - Control (or controlling) account

451.64 Control (or controlling) account. An account containing primarily totals of one or more types of transactions, the detail of which appears in a subsidiary ledger or its equivalent. Its balance equals the sum of the balances of the detail accounts.
 

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Section 451.65 - Cost

451.65 Cost. An expenditure or outlay of cash, other property, capital stock or services, or the incurring of a liability therefor, identified with goods or services acquired or with any loss incurred, and measured by the amount of cash paid or payable or the market value of other property, capital stock or services given in exchange or, in other situations, any commonly accepted basis of valuation. Implicit in the concept of cost is the accrual basis of accounting.
 

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Section 451.66 - Cost allocation

451.66 Cost allocation. The apportionment or allocation of the costs of nonrevenue-producing cost centers to each other, and to revenue-producing centers on the basis of the statistical data that measure the amount of service rendered by each center to other centers. The purpose of cost allocation is to determine the total of full costs of operating each revenue-producing center of a health facility.
 

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Section 451.67 - Cost centers

451.67 Cost centers. Categories into which related costs are grouped for purposes of cost reimbursement reporting and rate determination.
 

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Section 451.68 - Cost-finding

451.68 Cost-finding. The process of recasting the data derived from the accounts kept by a provider to ascertain the cost of the various types of services rendered.
 

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Section 451.69 - Courtesy allowances

451.69 Courtesy allowances. A reduction in charges in the form of all allowances to physicians, clergy and others for services received from the provider.
 

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Section 451.70 - Current assets

451.70 Current assets. Unrestricted cash, or other assets held for conversion within a relatively short period into cash or other readily convertible asset, or currently useful goods or services. Usually the period is one year or less; however, in some enterprises the period may be extended to the length of the operating cycle, which may be more than a year. The five customary subdivisions of current assets are cash, temporary investments, receivables, inventory, and prepaid expenses.
 

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Section 451.71 - Current liability

451.71 Current liability. A short-term debt, regardless of its source, including any liability accrued and deferred and unearned revenue that is to be paid out of current assets or is to be transferred to income within a relatively short period, usually one year or less, or a period greater than a year but within the business cycle of an enterprise. The currently maturing portion of long-term debt is thus classified.
 

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Section 451.72 - Daily inpatient census

451.72 Daily inpatient census. The number of inpatients present at the census-taking time each day, plus any inpatients who were both admitted and discharged after the census-taking time the previous day. Generally, the inpatient census is taken each midnight. However, a facility may designate and consistently use any other specified hour for census taking.
 

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Section 451.73 - Date of acquisition

451.73 Date of acquisition. The effective purchase date of an asset. Usually, this is the date title is acquired or the burdens of ownership are assumed and the asset is in possession.
 

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Section 451.74 - Deductible

451.74 Deductible. Under the Medicare program, that portion of covered hospital and medical charges which an insured person must pay before his policy benefits begin. Proposed as a mechanism to discourage over-utilization or to avoid processing small claims.
 

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Section 451.75 - Deferral (or deferment)

451.75 Deferral (or deferment). The accounting treatment accorded the receipt or accrual of revenue before it is earned, or the incurrence of an expenditure before the benefits therefrom are received.
 

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Section 451.76 - Deferred charges

451.76 Deferred charges. The portion of an expenditure which has been made which will not be charged against revenue within 12 months following the date of the statement of operations.
 

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Section 451.77 - Definition

451.77 Definition. A statement that sets forth and delimits the meaning of a word, phrase, or other symbolic expression, as used in a given discourse or context.
 

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Section 451.78 - Depreciation

451.78 Depreciation. The systematic distribution of the cost or other basis of depreciable asset over its estimated useful life.
 

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Section 451.79 - Department

451.79 Department. A division within an organizational structure.
 

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Section 451.80 - Development period

451.80 Development period. The period from the inception of an article 28-A residential health care facility to the day preceding the permanent financial occupancy date.
 

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Section 451.81 - Direct cost

451.81 Direct cost. The cost of any good or service that contributes to and is readily ascribable to product or service output.
 

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Section 451.82 - Direct expense

451.82 Direct expense. See direct cost.
 

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Section 451.83 - Discount earned

451.83 Discount earned. A reduction in the purchase price of a good or service because of early payment.
 

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Section 451.84 - Distribution

451.84 Distribution. (a) Any payment to stockholders or owners of cash, property or shares, including any of the various forms of dividend; in noncorporate enterprise, a withdrawal.

(b) A spread of revenue or expenditure or of capital additions to various accounts; an allocation.

(c) Disposal of a product by sale.
 

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Section 451.85 - Donated services

451.85 Donated services. The estimated fair monetary value, based on a facility's compensation policies, of services related to patient care or in administrative positions essential to provisions of patient care performed by individuals who receive no monetary compensation or partial compensation for their services, but in which there is an employer-employee relationship between the individual and the facility. The term is usually applied to services rendered by members of religious orders, societies or similar groups to institutions operated by or affiliated with such groups.
 

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Section 451.86 - Donated supplies

451.86 Donated supplies. The estimated fair monetary value of contributed supplies.
 

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Section 451.87 - Earned

451.87 Earned. Realized or accrued as revenue through sales of goods, services performed, or the lapse of time.
 

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Section 451.88 - Employee benefit

451.88 Employee benefit. A pension provision, retirement allowance, insurance coverage, paid vacation, sick leave or holiday time off, or other cost representing a present or future return to an employee, which is neither deducted on a payroll nor paid or by the employee.
 

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Section 451.89 - Encumbrance (governmental accounting)

451.89 Encumbrance (governmental accounting). (a) An anticipated expenditure, evidenced by a contract or purchase order, or determined by administrative action.

(b) Commitment.

(c) Any lien or other liability attaching to real property.
 

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Section 451.90 - Endowment fund

451.90 Endowment fund. Funds, usually of a nonprofit institution, in which a donor has stipulated, as a condition of gift, that the principal of the fund is to be maintained inviolate and in perpetuity and that only income from investments of the fund may be expended.
 

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Section 451.91 - Enterprise

451.91 Enterprise. Any business undertaking; a business enterprise; without qualification the terms refers to an entire organization rather than a subdivision thereof.
 

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Section 451.92 - Equity

451.92 Equity. (a) Any right or claim to assets.

(b) An interest in property or in a business, subject to claims of creditors.

(c) The difference between assets and liabilities.

(d) Net worth.
 

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Section 451.93 - Equity ownership

451.93 Equity ownership. (a) The interest of an owner in property or in a business or other organization, subject, in case of liquidation, to prior claim of creditors.

(b) The interest (paid-in capital and retained earnings) of a stockholder or of stockholders collectively in a corporation; proprietorship.
 

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Section 451.94 - Examination

451.94 Examination. Audit.
 

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Section 451.95 - Exception

451.95 Exception. A qualification by an auditor in his report, indicating a limitation as to the scope of his audit or disagreement with or doubt concerning an item of a financial statement on which he is reporting.
 

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Section 451.96 - Exhibit

451.96 Exhibit. A financial or other statement of a formal character prepared for the information of others, as in an auditor's report.
 

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Section 451.97 - Expected life

451.97 Expected life. Length of life or years of service of an asset or asset group at a particular moment of time.
 

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Section 451.98 - Expenditure

451.98 Expenditure. (a) The incurring of a liability, the payment of cash or the transfer of property for the purpose of acquiring an asset or service or settling a loss.

(b) The amount of cash or property paid or to be paid for a service rendered, or an asset purchased.

(c) Any cost, the benefits of which may extend beyond the current accounting period.
 

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Section 451.99 - Expense

451.99 Expense. Expired cost; any item or class of cost of (or loss from) carrying on an activity; a present or past experience defraying a present operating cost or representing an irrecoverable cost or loss.
 

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Section 451.100 - Expense center

451.100 Expense center. Any location within an organization at which the coincidence of organization and function has been recognized; an activity.
 

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Section 451.101 - Expired cost

451.101 Expired cost. An expenditure from which no further benefit is anticipated; an expense; a cost absorbed over the period during which benefits were enjoyed or a loss incurred.
 

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Section 451.102 - External audit

451.102 External audit. An audit by a person not an employee; an independent audit.
 

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Section 451.103 - Extraordinary depreciation

451.103 Extraordinary depreciation. Depreciation caused by unusual wear and tear, unexpected disintegration, obsolescence or inadequacy beyond that attributable to ordinary loss of physical or service life.
 

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Section 451.104 - Facility

451.104 Facility. A residential health care facility; may be a distinct part of a hospital.
 

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Section 451.105 - Fair market value

451.105 Fair market value. The price for which an asset would be purchased in an arm's-length transaction as a result of good-faith bargaining between a sophisticated buyer and seller, neither being under any compulsion to buy or sell.
 

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Section 451.106 - Fidelity bond

451.106 Fidelity bond. Insurance against losses arising from dishonest acts of employees involving money, merchandise or other property.
 

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Section 451.107 - Fiduciary

451.107 Fiduciary. Any person responsible for the custody or administration, or both, of property belonging to another; as, a trustee.
 

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Section 451.108 - Financial accounting

451.108 Financial accounting. The accounting for revenues, expenses, assets and liabilities that is commonly carried on in the general offices of a business.
 

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Section 451.109 - Financial Accounting Standards Board (FASB)

451.109 Financial Accounting Standards Board (FASB). A quasi-independent organization established in 1873 by the AICPA-sponsored Financial Accounting Foundation for the purpose of developing principles for financial reporting by business enterprises.
 

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Section 451.110 - Financial statement

451.110 Financial statement. A balance sheet, income statement, funds statement, or any supporting statement or other presentation of financial data derived from accounting records.
 

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Section 451.111 - Fiscal year

451.111 Fiscal year. The facility's uniform period between one annual reporting of financial accounts and the next reporting.
 

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Section 451.112 - Fixed asset

451.112 Fixed asset. (a) A tangible asset held for the services it yields in the production of goods and services; any item of plant.

(b) A balance sheet classification denoting capital assets other than intangibles and investments in affiliated companies or other long-term investments. included in the usual fixed-asset categories are land (from which the flow of services is seemingly permanent), buildings, building equipment, fixtures, machinery, tools (large and small), furniture, office devices, patterns, drawings, dies, and often containers; generally excluded are goodwill, patents and other intangibles. The characteristic fixed asset has a limited life (land is the one important exception), and, in organizations where expenses are accounted for, its cost, less estimated salvage at the end of its useful line, is distributed over the periods it benefits by means of provisions of depreciation.
 

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Section 451.113 - Fixed capital

451.113 Fixed capital. The investment in capital assets.
 

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Section 451.114 - Fixed cost (or expense)

451.114 Fixed cost (or expense). An operating expense, or operating expense as a class, that does not vary with business volume. Examples: interest on bonds; rent; property tax; depreciation (sometimes in part); minimal amounts of general overhead. Fixed costs are not fixed in the sense that they do not fluctuate or vary; they vary, but from causes independent of volume.
 

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Section 451.115 - Fringe benefit

451.115 Fringe benefit. See employee benefit.
 

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Section 451.116 - Functional

451.116 Functional (a) The general end or purpose sought to be accomplished by an organizational unit. Examples: administrative services; skilled nursing; physical therapy; research; plant operation and maintenance; dietary.

(b) A group of related activities serving a common end.
 

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Section 451.117 - Functional

451.117 Functional. Adapted to and capable of performance; a function or service performed by one organizational unit for another.
 

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Section 451.118 - Functional accounting

451.118 Functional accounting. Accounting by functions and activities; activity accounting.
 

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Section 451.119 - Fund

451.119 Fund. A self-contained accounting entity set up to account for a specific activity or project.
 

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Section 451.120 - Fund account

451.120 Fund account. Any account reflecting transactions of a fund.
 

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Section 451.121 - Fund accounting

451.121 Fund accounting. Maintenance of separate and/or group accounts for health facility resources according to spending objectives set by donors, other outside sources or the governing body.
 

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Section 451.122 - Fund asset

451.122 Fund asset. An asset belonging to a particular fund or a group of funds.
 

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Section 451.123 - Fund balance

451.123 Fund balance. The excess of assets over liabilities (net equity). An excess of liabilities over assets is known as a deficit in fund balance.
 

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Section 451.124 - Fund balance sheet

451.124 Fund balance sheet. A balance sheet divided into self-balancing sections, each of which shows the assets and liabilities of a single fund or group of related funds.
 

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Section 451.125 - Funded debt

451.125 Funded debt. Debt evidenced by outstanding bonds or long-term notes.
 

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Section 451.126 - Funded reserve

451.126 Funded reserve. A pension reserve, a reserve for bonuses or for the retirement of preferred stock, or other prospective future liability against which certain assets have been accumulated and set aside or earmarked.
 

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Section 451.127 - Fund group

451.127 Fund group. A group of funds of similar character which are brought together for administrative and reporting purposes. Examples: current funds; loan funds; endowment funds; plant funds; agency funds.
 

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Section 451.128 - Fund liability

451.128 Fund liability. A liability of a fund which is to be met out of its existing resources.
 

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Section 451.129 - Funds held in trust by others

451.129 Funds held in trust by others. Funds held and administered, at the direction of the donor, by an outside trustee for the benefit of an institution or institutions.
 

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Section 451.130 - Generally accepted accounting principles

451.130 Generally accepted accounting principles. Accounting principles currently approved by the American institute of Certified Public Accountants,
 

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Section 451.131 - Generally accepted auditing standards

451.131 Generally accepted auditing standards. Auditing standards currently approved by the American institute of Certified Public Accountants.
 

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Section 451.132 - General journal

451.132 General journal. The journal in which are recorded transactions not provided for in specialized journals.
 

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Section 451.133 - General ledger

451.133 General ledger. A ledger containing accounts in which all the transactions of a business enterprise or other accounting unit are classified, either in detail or in summary form.
 

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Section 451.134 - Generally accepted

451.134 Generally accepted. Given authoritative recognition; said of accounting principles or audit standards, and the pronouncements concerning them, particularly, in recent years, those of the American Institute of Certified Public Accountants and the Financial Accounting Standards Board.
 

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Section 451.135 - Gross

451.135 Gross. Undiminished by related deductions, except corrections; applied to sales, revenues, income, expense and the like.
 

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Section 451.136 - Group I equipment

451.136 Group I equipment. Equipment permanently attached to the structure (fixed equipment).
 

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Section 451.137 - Group II equipment

451.137 Group II equipment. Equipment and furnishings not permanently attached to the structure (movable equipment).
 

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Section 451.138 - Group III equipment

451.138 Group III equipment. Equipment and supplies with a relatively short, useful life (minor equipment).
 

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Section 451.139 - HFMA

451.139 HFMA. Hospital Financial Management Association.
 

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Section 451.140 - Historical cost

451.140 Historical cost. The total actual cost incurred in acquiring and preparing a fixed asset for use. This cost includes items, if any, which would be capitalized under generally accepted accounting principles in addition to purchase price; e.g., installation costs.
 

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Section 451.141 - Home office

451.141 Home office. The office of the controlling organization. This office generally incurs costs and provides services to or on behalf of the individual health facility.
 

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Section 451.142 - Hospital

451.142 Hospital. An establishment with an organized medical staff; with permanent facilities that include inpatient beds; and with medical services, including continuous nursing services, that provide diagnosis and treatment for patients.
 

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Section 451.143 - Imprest cash

451.143 Imprest cash. Imprest fund.
 

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Section 451.144 - Imprest fund

451.144 Imprest fund. (a) A fixed cash fund or petty cash fund in the form of currency, a bank checking account, or both, maintained for expenditures that must be made in cash, and from time to time restored to its original amount by a transfer from general cash of a sum equal to the aggregate of disbursements.

(b) A form of working fund.
 

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Section 451.145 - Imprest system

451.145 Imprest system. The system under which imprest cash in disbursed and from time to time restored to its original amount through reimbursements equal to sums expended. Implicit in the concept is the review by a higher authority of the propriety of the expended amounts before reimbursement is approved.
 

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Section 451.146 - Improvement

451.146 Improvement. (a) Betterment.

(b) The clearing, draining, grading, or other addition to the worth of a tract of land; any cost of developing real estate, whether paid for directly or through special assessment taxes.
 

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Section 451.147 - Imputed value of services rendered

451.147 Imputed value of services rendered. The dollar value of specified services, computed according to formulas established by the department.
 

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Section 451.148 - Income realization

451.148 Income realization. The recognition of income, the usual test being the passage of title to or delivery of goods, or the performance of services.
 

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Section 451.149 - Income statement

451.149 Income statement. A summary of the revenues and expenses of an accounting unit, or group of such units, for a specified period.
 

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Section 451.150 - Increment

451.150 Increment. (a) An increase in value from one point of time to another, without reference to cost or book value.

(b) Unearned increment has reference to an increase in the value of land from causes to which the owner has made no contribution, as from growth of population.
 

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Section 451.151 - Indirect cost

451.151 Indirect cost. A functional cost not attributed to the production of a specified good or service but to an activity associated with production generally.
 

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Section 451.152 - Indirect liability

451.152 Indirect liability. (a) An obligation not yet incurred but for which responsibility may have to be assumed in the future; as, the possible liability from the premature settlement of a long-term contract.

(b) A debt of another, as the result of which an obligation to pay may develop.

(c) A contingent liability.
 

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Section 451.153 - Initial occupancy period

451.153 Initial occupancy period. The period Commencing with the first month prior to the admittance of the first patient and ending with the day preceding the permanent financial occupancy date. The initial occupancy period is part of the development period.
 

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Section 451.154 - Initial occupancy expense

451.154 Initial occupancy expense. All expenses incurred and all income earned related to patient care accounted for on the accrual basis during the initial occupancy period, except for:

(a) interest expense and interest income;

(b) any additional New York State Housing Finance Agency financing expense;

(c) accounting fees of outside independent accountants; and

(d) legal fees.
 

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Section 451.155 - Inpatient

451.155 Inpatient. A person who is provided with room, board and continuous nursing service in a health facility.
 

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Section 451.156 - Inpatient admission

451.156 Inpatient admission. The formal acceptance by a health facility of a patient who is to be provided with room, board and continuous nursing service in an area of the health facility where patients generally stay at least overnight.
 

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Section 451.157 - Inpatient bed count

451.57 Inpatient bed count. The number of available health facility inpatient beds, both occupied and vacant, on any given day.
 

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Section 451.158 - Inpatient bed count day

451.158 Inpatient bed count day. A unit of measure denoting the presence of one inpatient bed (either occupied or vacant) set up and staffed for use in one 24-hour period.
 

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Section 451.159 - Inpatient bed count days (total)

451.159 Inpatient bed count days (total). The sum of inpatient bed count days for each of the days in the period under consideration.
 

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Section 451.160 - Inpatient bed occupancy ratio

451.160 Inpatient bed occupancy ratio. The proportion of inpatient beds occupied, defined as the ratio of inpatient service days to inpatient bed count days in the period under consideration.
 

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Section 451.161 - Inpatient census

451.161 Inpatient census. See daily inpatient census.
 

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Section 451.162 - Inpatient discharge

451.162 Inpatient discharge. The termination of period of inpatient care through the formal release of an inpatient by a health care facility.
 

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Section 451.163 - Intangible assets

451.163 Intangible assets. Nonphysical assets (e.g., goodwill, an agreement not to compete), almost always noncurrent.
 

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Section 451.164 - Interfund transfer

451.164 Interfund transfer. The transfer of money or other asset, or of a liability, from one fund to another.
 

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Section 451.165 - Interest

451.165 Interest. The cost incurred for the use of borrowed funds.
 

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Section 451.166 - Interest on capital indebtedness

451.166 Interest on capital indebtedness. The cost incurred for funds borrowed for capital purposes. Examples: acquisition of facilities, equipment and capital improvements. Generally, loans for capital purposes are long-term loans.
 

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Section 451.167 - Internal control

451.167 Internal control. (a) The general methodology by which management is carried on within an organization; also, any of the numerous devices for supervising and directing an operation or operations generally. Internal control, a management function, is a basic factor operating in one form or another in the administration of every organization, business or otherwise. Although sometimes identified with the administrative organism itself, it is often characterized as the nervous system that activates overall operating policies and keeps them within practicable performance ranges. The principal elements contributing to internal control are usually these:

(1) recognition that within every organizational unit there are one or more functional or action components known as activities, cost or responsibility centers, or management units with appropriate segregation of functional responsibilities;

(2) delegated operating authority in each organizational unit permitting freedom of action within defined limits;

(3) the linking of expenditures--their incurrence and disposition--with specified individual authority;

(4) end-product planning:

(i) by means of a budget fitted to the organizational structure and to its functional components, thus maintaining dual forward operating disciplines; and

(ii) the adoption of standards of comparison and other performance measurements such as standard costs, quality controls and timing goals;

(5) an accounting process and system of record procedures adequate to provide organizational and functional administrators with reasonable accounting control over assets, liabilities, revenues and expenses and also provide administrators with prompt, complete and accurate information on operating performance, and comparisons with predetermined performance standards;

(6) periodic reports, consonant with accounting and related records, by activity heads to supervisory management; reports serving as feedbacks of informative pictures of operations, and as displays of favorable and unfavorable factors that have influenced performance;

(7) internal check, built into operating procedures, and providing maximum protection against fraud and error;

(8) frequent professional appraisals, through internal audit, of management and its policies and operations generally, as a protective and constructive management service, its emphasis varying with the quality of operating policies and their administration.

(b) The construction of the above controls in such a manner as to stimulate and take full advantage of those natural attributes of individual employees. i.e., personnel of a quality commensurate with responsibilities.
 

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Section 451.168 - Inventory

451.168 Inventory. The dollar value (computed in accordance with generally accepted accounting principles) of merchandise, materials and supplies on hand at the close of a facility's accounting period.
 

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Section 451.169 - Inventory control

451.169 Inventory control. The control of merchandise, materials, goods in process, finished goods, and supplies on hand by accounting and physical methods. An accounting control is effected by means of a stock or stores ledger, mechanical storage records, or a ledger account in which the quantities or amounts (or both) of goods received during an accounting period are added to corresponding balances at the beginning of the period and amounts of goods sold or otherwise disposed of are deducted at a calculated cost based on individual identification or any of various methods of averaging. Physical controls consist of various plans of buying, storing. handling, issuing, supervising and stocktaking. Stockledger control is made more effective by physical control in the nature of a continuous check of the goods on hand.
 

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Section 451.170 - Inventory valuation

451.170 Inventory valuation. The determination of the costs or the portion of cost assignable to on-hand raw materials, merchandise held for resale, and supplies based on any generally accepted method consistently applied.
 

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Section 451.171 - Invested capital

451.171 Invested capital. (a) The amount of capital contributed to a business by its owners; capital.

(b) The amount so contributed, plus retained earnings (or less accumulated losses) and appropriated surplus.
 

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Section 451.172 - Ledger control

451.172 Ledger control. The control of a subsidiary record or ledger by the use of a control account. Ledger control is limited to a proof that all items were recorded in the subsidiary record or that they were accurately made, as required, to the debit and credit sides of that record. It does not furnish proof that every item was recorded in its proper account in the subsidiary record.
 

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Section 451.173 - Length of stay (for one patient)

451.173 Length of stay (for one patient). The number of calendar days from admission to discharge, counting the day of admission but not the day of discharge.
 

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Section 451.175 - Leasehold improvements

451.175 Leasehold improvements. Those improvements made by the owners of a facility to leased land, buildings or equipment.
 

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Section 451.176 - Liability

451.176 Liability. (a) An amount owing by one person (a debtor) to another (a creditor), payable in money, or in goods or services; the consequence of an asset or service received or a loss incurred or accrued; particularly, any debt:

(1) due or past due (current liability);

(2) due at a specified time in the future (e.g., funded debt, accrued liability); or

(3) due only to failure to perform a future act (deferred income, contingent liability).

(b) The title of the credit half of a balance sheet, often including net worth as well as obligations to outsiders; when thus used, the inference is that the organization reflected in the balance sheet has a status independent of both its creditors and its owners--to whom it must account in the amounts shown.
 

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Section 451.177 - Licensed bed capacity

451.177 Licensed bed capacity. The maximum number of beds which a provider may keep occupied under the terms of its license.
 

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Section 451.178 - Limited-life asset

451.178 Limited-life asset. Any capital asset, as a building, machine or patent, the usefulness of which to its owner is restricted by its physical life or by the period during which it contributes to operations.
 

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Section 451.179 - Liquid asset

451.179 Liquid asset. Cash in banks and on hand, and other cash assets not set aside for specific purposes other than the payment of a current liability, or a readily marketable investment. The term is somewhat less restrictive than cash asset and much more restrictive than quick asset.
 

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Section 451.180 - Living trust funds

451.180 Living trust funds. Funds acquired by an institution subject to agreement whereby resources are made available to the institution on condition that the institution pay periodically to a designated person, or persons, the income earned on the resources acquired for the lifetime of the designated person, or persons, or for a specified period.
 

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Section 451.181 - Maintenance

431.181 Maintenance. The keeping of property at a standard of operating condition; also, the expense involved. Example: recurring operations of cleaning, oiling, repairing and adjusting. Maintenance cost includes outlays for:

(a) labor and supplies;

(b) the replacement of any parts that constitute less than a retirement unit; and

(c) major overhauls, the item of which may involve elements of the first two classes.
 

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Section 451.182 - Management

451.182 Management. (a) Executive authority; the combined fields of policy and administration.

(b) As applied to individuals:

(1) the head of an organization; or

(2) collectively, the head and his immediate staff and any or all persons possessing supervisory persons' delegated authority; or

(3) broadly, the persons within an organization who originate transactions.
 

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Section 451.183 - Materiality

451.183 Materiality. (a) The relative importance, when measured against a standard of comparison, of any item included in or omitted from books of account or financial statements, or of any procedure or change in procedure that conceivably might affect such statements.

(b) The characteristic attaching to a statement, fact or item whereby its disclosure or the method of giving it expression would be likely to influence the judgment of a reasonable person.
 

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Section 451.184 - Matrix inversion

451.184 Matrix inversion. A process of allocating a department's costs to all other departments by solving simultaneous equations.
 

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Section 451.185 - Medical recipient

451.185 Medical recipient. A recipient of medical assistance under title XIX of the Social Security Act or of State-funded medical care services.
 

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Section 451.186 - Medical services

451.186 Medical services. The services pertaining to medical care that are performed at the direction of a physician on behalf of patients by physicians, dentists, nurses and other professional and technical personnel.
 

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Section 451.187 - Medicare

451.187 Medicare. A third-party reimbursement program administered by the Social Security Administration that underwrites the medical costs of persons 65 and over and some qualified persons under 65. "Part A" covers hospital services and "Part B" covers physicians' services.
 

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Section 451.188 - Multi-facility provider

451.188 Multi-facility provider. A provide delivering two or more types of health care; e.g., a hospital and residential health care facility, or a retirement home and residential health care facility.
 

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Section 451.189 - Net worth

451.189 Net worth. The aggregate appearing on the accounting records of the equities representing proprietary interests; the excess of the going concern's value of assets over liabilities to outsiders; of a corporation, the total of paid-in capital, retained earnings and appropriated surplus; of a sole proprietorship, the proprietor's account; of a partnership, the sum of the partners' accounts.
 

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Section 451.190 - Nominal account

451.190 Nominal account. Any of the accounts the balances of which are transferred to retained earnings at the close of each fiscal year; so-called because such accounts reflect completed transactions or expired costs.
 

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Section 451.191 - Nonallowable cost

451.191 Nonallowable cost. A cost which does not meet every test of an allowable cost as defined in this Part.
 

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Section 451.192 - Nonoperating revenue

451.192 Nonoperating revenue. The revenues of an enterprise derived from sources other than its regular activities; other revenue.
 

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Section 451.193 - Nonprofit corporation

451.193 Nonprofit corporation. An incorporated charity, or any corporation operated under a policy by which no stockholder or trustee shares in the profits or losses, if any, of the enterprise.
 

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Section 451.194 - Nonrestricted funds

451.194 Nonrestricted funds. Unrestricted funds. Funds which are not restricted to a specific use by the donor. Examples of unrestricted funds include operating and board-designated funds.
 

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Section 451.195 - Nonrevenue-producing cost centers

451.195 Nonrevenue-producing cost centers. These are overhead units, such as dietary and plant operations and maintenance, that provide necessary support services to revenue-producing centers.
 

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Section 451.196 - Object classification

451.196 Object classification. A method of classifying expenditures according to their natural classification, such as salaries and wages, employee benefits, supplies, purchased services, etc.
 

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Section 451.197 - Obsolescence

451.197 Obsolescence. The loss in usefulness of an asset, occasioned by the approach to the state of economic uselessness through progress of the arts; economic inutility arising from external causes; disappearing usefulness resulting from invention, change of style, legislation, or other causes having no physical relation to the object affected. It is distinguished from exhaustion, wear and tear, and deterioration, in that these terms refer to a functional loss arising out of a change in physical condition.
 

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Section 451.198 - Occasion of service

451.198 Occasion of service. A specific identifiable instance of an act of service involved in the medical care of health facility patients.
 

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Section 451.199 - Occupancy expense

451.199 Occupancy expense. Expense relating to the use of property. Examples: rent, heat, light, depreciation, upkeep, and general care of premises occupied.
 

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Section 451.200 - Operating budget

451.200 Operating budget. A budget covering recurrent revenue and expense.
 

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Section 451.201 - Operating cost (or expense)

451.201 Operating cost (or expense). An expense incurred in conducting the ordinary major activities of an enterprise, usually excluding nonoperating expense or income deductions.
 

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Section 451.202 - Operating income (or profit)

451.202 Operating income (or profit). The excess of revenues of a business enterprise over the expenses pertaining thereto, excluding income and expense derived from sources other than its regular activities.
 

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Section 451.203 - Operational period

451.203 Operational period. The period commencing with the permanent financial occupancy date.
 

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Section 451.204 - Organizational unit

451.204 Organizational unit. Any administrative subdivision of an enterprise, especially one charged with carrying on one or more functions or activities.
 

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Section 451.205 - Original cost

451.205 Original cost. Outlay for an asset by its owner, not including any adjustments of cost arising from post-acquisition alterations, improvement or depreciation.
 

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Section 451.206 - Outpatient

451.206 Outpatient. A person who receives health care services in a health facility without being admitted as a bed patient.
 

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Section 451.207 - Outstanding

451.207 Outstanding. (a) Uncollected or unpaid; said of an account or note receivable or payable, or of a check sent to the payee but not yet cleared against the drawee bank.

(b) in the hands of others; said of the units of funded debt of a corporation or of the certificates representing issued shares of capital stock in the hands of the public; treasury stock is defined in terms of shares issued but not outstanding.
 

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Section 451.208 - Overhead

451.208 Overhead. (a) Any cost of doing business other than a direct cost of an output of product or service.

(b) A general name for costs of materials and services not directly adding to or readily identifiable with the product or services constituting the main object of an operation.
 

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Section 451.209 - Owner

451.209 Owner. The entity which is legally responsible for the operation of a provider, and thus for decisions and for liabilities arising in the course of its operation.
 

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Section 451.210 - Paid-in capital

451.210 Paid-in capital. The total amount of cash, property and services contributed to a corporation by its stockholders and constituting a major balance sheet item. It may be reflected in a single account or divided between capital stock and additional paid-in capital accounts.
 

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Section 451.211 - Part A and Part B services

451.211 Part A and Part B services. Medicare benefits are payable from two funds. Part A services, which, in general, are those rendered by institutions, are reimbursed from funds derived from payroll tax. Part B services, generally medical and surgical physicians' services, and outpatient treatment and diagnosis, are reimbursed from the fund created by voluntary premium payments and general Federal revenues.
 

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Section 451.212 - Patient day

451.212 Patient day. A calendar day of patient care. In computing calendar days of care, the day of admission is always counted. The day of discharge is counted only when the patient was admitted on the same day. A patient is admitted for purposes of this definition when he or she is physically present, is assigned a bed, and a patient medical record is opened.
 

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Section 451.213 - Payroll distribution

451.213 Payroll distribution. (a) An analysis of the total amount of salaries and wages paid or accrued for a period, showing the component amounts to be charged to the various departments, operations, activities or products affected.

(b) The entry by which the amount of salaries and wages paid or accrued for a period is charged in the required detail to the accounts or records.
 

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Section 451.214 - Permanent financial occupancy date

451.214 Permanent financial occupancy date. The date declared by the Commissioner of Health or his designee after a facility has been occupied for a period of time. This date is a financial concept date; it is not the date a facility admits its first patient.
 

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Section 451.215 - Per patient day costs (PPD)

451.215 Per patient day costs (PPD). Total allowable costs divided by total patient days for the period covered.
 

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Section 451.216 - Petty cash fund

451.216 Petty cash fund. See imprest fund.
 

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Section 451.217 - Plant

451.217 Plant. Physical properties used for institutional purposes; i.e., land, building, improvements, equipment and so forth. The term does not include real estate or properties of restricted or unrestricted funds not used for health facility operations.
 

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Section 451.218 - Plant replacement and expansion funds

451.218 Plant replacement and expansion funds. Funds restricted by donor or granted for renewal, expansion or replacement of plant.
 

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Section 451.219 - Pooled investments

451.219 Pooled investments. Assets of two or more funds consolidated for investment purposes.
 

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Section 451.220 - Pre-operating expenses

451.220 Pre-operating expenses. The one-time expenses of a new provider incurred prior to the admission of any patients.
 

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Section 451.221 - Prepaid expense

451.221 Prepaid expense. The portion of an expenditure which has been made which will be charged against revenue within 12 months following the date of the statement of operations.
 

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Section 451.222 - Principal

451.222 Principal. A sum on which interest accrues; capital, as distinguished from income.
 

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Section 451.223 - Proprietary accounts

451.223 Proprietary accounts. (a) The accounts, including nominal accounts, containing the equities of owners.

(b) Governmental accounting. The accounts reflecting the assets and liabilities, and displaying the results of operations in terms of revenue, expense, surplus or deficit.
 

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Section 451.224 - Prorate

451.224 Prorate. To assign or redistribute a portion of a cost, such as a joint cost, to a department, operation, activity or product according to some formula or other agreed-to, often arbitrary, procedure.
 

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Section 451.225 - Prudent buyer concept

451.225 Prudent buyer concept. The price paid for items by a prudent buyer in the open market under competitive conditions.
 

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Section 451.226 - Purchased services

451.226 Purchased services. Services directly or indirectly related to patient care which a provider contracts for with an outside individual or firm.
 

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Section 451.227 - Quick asset

451.227 Quick asset. A current asset normally convertible into cash within a relatively short period, such as a month. Examples: cash, call loan, marketable security, customer's account, a commodity immediately salable at quoted prices on the open market.
 

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Section 451.228 - Reasonable cost

451.228 Reasonable cost. Those costs which are determined by the Department of Health as reasonable in comparison to like expenses incurred by other similar facilities.
 

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Section 451.229 - Related organization

451.229 Related organization. An entity which, to a significant extent, is under common ownership and/or control with, or has control of or is controlled by, the provider. An entity is deemed to control another entity if it has a significant ownership interest in the other, or if it has the power, whether or not exercised, to influence directly or indirectly the activities or policies of the other.
 

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Section 451.230 - Repair

451.230 Repair. (a) The restoration of a capital asset to its full productive capacity, or a contribution thereto, after damage, accident or prolonged use, without increase in its previously estimated service life or productive capacity.

(b) The charge to operations representing the cost of such restoration.
 

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Section 451.231 - Replacement

451.231 Replacement. The substitution of one fixed asset for another, particularly of a new asset for an old, or of a new part for an old part. On the books of account, the recognition of the cost of the new asset requires the elimination of the cost of the asset it replaces.
 

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Section 451.232 - Replacement cost

451.232 Replacement cost. (a) The cost of an acquired asset or asset part, capitalizable if the cost of its retired counterpart is removed from the asset account.

(b) The cost at current prices, in a particular locality or market area, of replacing an item of property or a group of assets.
 

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Section 451.233 - Residential health care facility

451.233 Residential health care facility. All facilities or organizations covered by the term nursing home as defined in article 28 of the Public Health Law, including hospital-based residential health care facilities, provided that such facility possesses a valid operating certificate issued by the State Commissioner of Health and, where required, has been established by the Public Health Council.
 

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Section 451.234 - Responsibility accounting

451.234 Responsibility accounting. The classification, management, maintenance, review, appraisal of accounts serving the purpose of providing information on the quality, quantity and standards of performance attained by persons to whom authority has been assigned.
 

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Section 451.235 - Restricted funds

451.235 Restricted funds. Funds designated by the donors, governmental units and endowments for special nonoperating purposes.
 

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Section 451.236 - Retained earnings (or income)

451.236 Retained earnings (or income). Accumulated net income, less distributions to stockholders and transfers to paid-in capital accounts.
 

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Section 451.237 - Retirement of indebtedness funds

451.237 Retirement of indebtedness funds. Funds required by external sources to be used to meet debt-service charges and the retirement of indebtedness on plant assets. The term sinking funds is sometimes used to describe these funds.
 

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Section 451.238 - Return on capital investment

451.238 Return on capital investment. A rate of return on owner's net equity.

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Section 451.239 - Revenue

451.239 Revenue. (a) Sales of products, merchandise and services, and earnings from interest, dividends, rent and wages; transactions resulting in increases in assets.

(b) Governmental accounting. The gross receipts and receivables of a governmental unit derived from taxes, customs and other sources, but excluding appropriations and allotments.
 

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Section 451.240 - Revenue-producing cost centers

451.240 Revenue-producing cost centers. Health facility departments providing direct services to patients (such as nursing, physical therapy and laboratory) and thereby generating revenue.
 

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Section 451.241 - Revolving fund

451.241 Revolving fund. A fund from which moneys are continuously expended, replenished, and again expended. Examples: imprest cash; working funds; assets available for loans, the repayments of which are available for other loans.
 

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Section 451.242 - Round off

451.242 Round off. To simplify the presentation of a quantity by omitting its terminal digits, with the express purpose of displaying only significant figures.
 

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Section 451.243 - Schedule

451.243 Schedule. A supporting, explanatory or supplementary analysis accompanying a balance sheet, income statement or other statement prepared from the books of account.
 

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Section 451.244 - Service cost

451.244 Service cost. (a) The cost of any service.

(b) The amortizable cost of a limited-life asset; i.e., the asset cost, less estimated recovery, if any, from resale or scrap. Service cost is the amount to be depreciated over the useful life of a fixed asset.
 

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Section 451.245 - Share of pooled investments

451.245 Share of pooled investments. The proportion of pooled investments, including accumulated gains or losses, owned by a particular fund, usually expressed by a number (units) indicating the fractional ownership of total shares in the pool or by a percentage expressing the portion of the total pool owned by the particular fund.
 

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Section 451.246 - Sinking fund

451.246 Sinking fund. Retirement of indebtedness funds.
 

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Section 451.247 - Special purpose fund

451.247 Special purpose fund. Specific purpose funds.
 

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Section 451.248 - Specific purpose funds

451.248 Specific purpose funds. Funds restricted for a specific purpose or project. Board-designated funds do not constitute specific purpose funds.
 

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Section 451.249 - Stepdown method

451.249 Stepdown method. The allocation of the accumulated costs of the nonrevenue-producing centers to those other nonrevenue-producing centers which utilize their services, as well as to the revenue-producing centers to which they render service. Once the costs of a nonrevenue-producing center have been allocated, that center is considered closed.
 

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Section 451.250 - Straight-line method

451.250 Straight-line method. The assignment of equal segments of the service cost of any item to the benefits to be yielded by the item; a procedure followed in depreciation computations and in the spread of prepaid expenses and bond discount. In practice, a period charge for depreciation is usually substituted for a more exact measurement of benefits yielded because of:

(a) its relative simplicity;

(b) the presence of only minor differences between the two methods;

(c) the impossibility of estimating with any degree of realism the total prospective output of services, as in the case of many types of machinery; or

(d) the absence of any ready determinable unit of service, as in the case of buildings. See amortization; apportionment; deferred charge.
 

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Section 451.251 - Tangible assets

451.251 Tangible assets. Physical assets (e.g., building, equipment inventory).
 

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Section 451.252 - Temporary funds

451.252 Temporary funds. See specific purpose funds.
 

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Section 451.253 - Term endowment funds

451.253 Term endowment funds. Donated funds which, by the terms of the agreement, become available either for any legitimate purpose designated by the board or for a specific purpose designated by the donor upon the happening of an event or upon the passage of a stated period of time.
 

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Section 451.254 - Trial balance

451.254 Trial balance. A list or abstract of the balances or of total debits and total credits of the accounts in a ledger, the purpose being to determine the quality of posted debits and credits and to establish a basic summary for financial statements. The term is also applied to a list of account balances (and their total) abstracted from a customer's ledger or other subsidiary ledger for the purpose of testing their totals with the related control account.
 

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Section 451.255 - Trade discount

451.255 Trade discount. The discount allowed to a class of customers on a list price before consideration of credit terms; as a rule, invoice prices are recorded in the books of account net after deduction of trade and quantity discounts.
 

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Section 451.256 - Total inpatient service days

451.256 Total inpatient service days. The sum of all inpatient service days for each of the days in the period under consideration.
 

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Section 451.257 - Total length of stay (for all inpatients)

451.257 Total length of stay (for all inpatients). The sum-of-the-days' stay of any group of inpatients discharged during a specified period of time.
 

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Section 451.258 - Unit of service

451.258 Unit of service. A unit of measure, often commonly accepted, for determining average cost, time or efficiency, thus making possible:

(a) comparisons of one operation with another, or with the same operation in a preceding period; and

(b) estimates of future operations.
 

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Section 451.259 - Unrestricted funds

451.259 Unrestricted funds. Funds which bear no external restrictions as to use or purpose, i.e., funds which can be used for any legitimate purpose designated by the governing board as distinguished from funds restricted externally for specific operating purposes, for plant replacement and expansion, and for endowment.
 

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Section 451.260 - Useful life

451.260 Useful life. Normal operating life in terms of utility to the owner: said of a fixed asset or a fixed-asset group; the period may be more or less than physical life or any commonly recognized economic life; service life.
 

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Section 451.261 - Valuation account (or reserve)

451.261 Valuation account (or reserve). An account which relates to and partly or wholly offsets one or more other accounts; as, accumulated depreciation or allowance for bad debts; unamortized debt discount.
 

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Section 451.262 - Weighted average

451.262 Weighted average. A simple average of items reduced to a common basis. For example, purchases of certain raw material are made during a given month as follows:

Units Price each Total cost

150 $1.50 $225.00

175 1.40 245.00

50 1.32 66.00

65 1.30 84.50

___ _____ _______

440 $5.52 $620.50

The simple average of prices paid is $5.52 / 4, or $1.38; but the weighted average would be the total cost divided by the number of units purchased: $620.50 / 440, or $1.41.
 

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Part 452 - Basic Concepts, Reporting Principles And Specialized Reporting Areas

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 452.1 - Purpose

Section 452.1 Purpose. The purpose of this Article is to establish a foundation for uniform reporting by residential health care facilities. In making their reports, such facilities will be bound by the basic principles and concepts set forth in this Article. Any reporting principles not specifically discussed herein should be report according to generally accepted accounting principles as interpreted in the opinions of the American Institute of Certified Public Accountants (AICPA) and in the statements by the Financial Accounting Standards Board.
 

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Section 452.2 - Basic concepts

452.2 Basic concepts. (a) Accounting entity. A fundamental accounting concept is that of the accounting entity or unit. For the purposes of this Article, a residential health care facility is presumed to be an accounting entity, the boundaries of which may not be the same as those of the legal entity. The residential health care facility is the primary unit for which the accounting records are maintained.

(b) Going concern. An accounting entity is viewed as continuing in operation in the absence of evidence to the contrary. The results of operation of an accounting entity are recognized and measured based on this concept.

(c) Reporting period. The economic activities of an accounting entity are measured and accounted for in incremental time periods that are shorter than the life of the entity. The basic reporting period for this Article is one year, commencing on January 1st and ending on December 31st of each year.

(d) Substance over form. Financial accounting is concerned with the economic substance of transactions rather than the legal form of such transactions. Generally, economic substance agrees with legal form. However, in those instances where substance and form differ, the financial treatment for such transactions should be accounted for based on their economic substance to provide more meaningful information of the economic activities of the accounting entity.

(e) Consistency. Consistency refers to continued uniformity, during a period and from one period to another, in methods of accounting, mainly in valuation bases and methods of accrual, as reflected in the financial statements of an accounting entity. However, consistency does not require continued adherence to a method or procedure that is incorrect or no longer useful, nor does it preclude a justifiable and desirable change in accounting and reporting methods or procedures.

(f) Materiality. Materiality is an elusive concept, with the dividing line between material and immaterial amounts subject to various interpretations. It is clear, however, that an amount is material if its exclusion from the financial statements would cause misleading or incorrect conclusions to be drawn by users of the statements.

(g) Functional vs. responsibility accounting. (1) Normally, financial data is accumulated for operating departments that are identified with specific managerial responsibility. This information provides management with tools necessary to evaluate the performance of various departments. Recording and reporting financial data in this manner is known as responsibility accounting.

(2) Functional accounting is the process of recording and reporting revenues and expenses on the basis of activities performed without regard to organizational framework. Thus, costs related to a specific activity, normally charged to the organizational unit (department) responsible for that activity, would instead be charged to the cost center whose function is to perform the activity.

(3) Since facilities vary in basic organizational structure and the way responsibilities are organized within departments, this Article mandates reporting on a functional basis in accordance with defined activities of each department to achieve a level of compatibility.

(h) Objective evidence. (1) Information produced by the accounting process should be based, to the extent possible, on objectively determined facts. A record of an addition to inventory, for example, should be supported by properly executed business documents such as the purchase order, the receiving report, the supplier's invoice, and the check issued in payment of the invoice. Such documents serve as objective evidence of the transaction, and permit reliable determination of the cost of the asset, the amount of the liability, and the appropriateness of the resulting cash disbursement. Retention of these documents for a suitable period makes it possible to verify data in the accounting records.

(2) The requirement of objective evidence, however, cannot always be met by financial data in accounting reports. Although various computations and analyses can provide some evidence, it is often necessary to make estimates. Determination of depreciation and anticipated bad debts, for example, are based to a large extent on past experience and expected future conditions. In those instances requiring estimates, the judgment of the accountant and of management must be exercised.
 

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Section 452.3 - Reporting principles

452.3 Reporting principles. (a) Accrual reporting. In order to provide complete, accurate and uniform financial data, all residential health care facilities, including governmental institutions, must report such data on the accrual basis. If differences between the results of accruing an item and reporting that item on a cash basis are immaterial, accrual reporting of that item would be waived. Within these guidelines, therefore, employee vacation, sick time, holidays and personal time must be accrued when there is reasonable assurance that a liability does exist and will be liquidated.

(b) Matching of revenue and expenses. (1) Subject to the limitations of subdivision (a) of this section, revenue must be reported in the period earned, i.e., when the services are rendered and a legal claim arises for the services. Deductions from revenue, including contractual adjustments, are to be given accounting recognition in the same period that the related revenues were recorded.

(2) Revenue derived from services must be matched with the cost of providing those services.

(3) Revenue and expenses should be matched for each cost center within the residential health care facility. Therefore, the cost of functions and activities within each cost center are to be included in accounts designated for that cost center. Revenue relative to such functions and activities must be included in the matching revenue accounts.

(4) For those institutions that record charges on an all-inclusive rate basis (a flat charge regardless of services performed), a center-by-center matching of cost and revenue at the cost center level would be impossible. Therefore, for these institutions, the matching of cost and revenue should be accomplished at the program level. This, however, does not preclude such institutions from recording their costs in the proper cost center. In addition, revenue from patients should be reported at gross (the full established rate charged to a private patient) with a contractual allowance to reflect the difference between the full rate and the amount received from third-party payors. If the institution is on an all-inclusive rate basis (a flat charge for all services), then the gross rate would be the all-inclusive flat charge. If, however, the institution utilized a fee-for-service basis (a separate charge for each service provided), the gross charge for each service and patient must be reflected.

(c) Fund accounting. Many residential health care facilities receive funds from donors which are restricted as to use. These funds must be accounted for separately as restricted funds. This does not preclude the pooling of assets for investment purposes. Restricted funds generally fall into three categories: endowment funds, plant replacement and expansion funds, and specific purpose funds. However, certain facilities may also have agency funds to account for funds held for patients. The accounts within each restricted fund are self-balancing, as each fund requires separate fiduciary accountability. The following paragraphs outline the conditions and events which require separate accountability and the required accounting treatment for transactions within the established funds.

(1) Unrestricted Fund. (i) The Unrestricted Fund is used to account for funds derived from the day-to-day activities of the residential health care facility and unrestricted contributions. Funds which originate from unrestricted gifts or previously accumulated income may be designated by the governing board for special uses. If the governing board designates funds in this manner, it should be recognized that the board also has the authority to rescind its action. For this reason, such funds should be accounted for in the Unrestricted Fund as "board-designated funds". A separate structure of accounts in the Unrestricted Fund has been provided for these assets.

(ii) The term restricted should not be used in connection with board or other internal appropriations or designations of funds.

(2) Endowment funds. (i) Funds classified as endowment include:

(a) pure endowments (principal is to remain intact in perpetuity); and

(b) term endowments (principal is available for use upon the passage of time or the occurrence of an event).

(ii) When term endowments become available to the governing board for unrestricted purposes, they should be reported as nonoperating revenue; if these funds are restricted, they should be transferred to the appropriate restricted fund.

(iii) Income earned on endowment fund investments should be accounted for in accordance with donors' instructions if restricted, or as nonoperating revenue in the Unrestricted Fund if not restricted.

(iv) Under section 513 of the New York State Not-for-Profit Corporation Law, realized gains from the sale of endowment fund assets may be available for the general use of the residential health care facility, provided that the amount of fair value of the principal of such assets as of the end of the fiscal year in which the gains are recorded is not less than the amount of fair value of such assets at the time they were originally received by the home. Realized gains that were treated as additions to principal before the effective date of this section of law, September 1, 1970, may be available to the residential health care facility under the aforementioned conditions in an amount not to exceed 20 percent of such gains in one year. (3) Plant Replacement and Expansion Funds. (i) Resources restricted by donors and other third-parties for the acquisition or construction of plant assets or the reduction of related debt must be accounted for in the Plant Replacement and Expansion Fund.

(ii) When expenditures for plant assets are made by the Unrestricted Fund for the Plant Replacement and Expansion Fund, a transfer must be made from the Plant Replacement and Expansion Fund to match such expenditures if such funds are available.

(iii) Due to/due from accounts are to be used only as an interim measure, and must be reduced within a reasonable period of time by a transfer of physical assets (generally cash or investments) between the respective funds.

(iv) If expenditures for plant assets are made in the Plant Replacement and Expansion Fund, the plant assets must be transferred to the Unrestricted Fund, with the accompanying credit made to the Operating Fund Balance--Transfers from restricted funds for capital outlays. In the Plant Replacement and Expansion Fund, fund balance would be debited, and a cash account credited. No entry would be made to the interfund payable or receivable accounts.

(v) Income earned and any net realized gains on investments should be reflected as an addition to the fund balance if so specified by the donor. If available for general operating purposes, they should be included in nonoperating revenue in the Unrestricted Fund.

(4) Specific Purpose Fund. (i) Funds received which are restricted for a specific purpose should be accounted for in a separate restricted fund (Specific Purpose Fund). These resources must be recorded as other operating revenue in the period in which expenditures are made for the purpose specified by the donor.

(ii) Income earned and any net realized gains on investments should be recorded as an addition to fund balance if required to conform to the donor's instructions or as nonoperating revenue of the Unrestricted Fund if such revenue is available for general purposes.

(d) Investments in marketable securities. Investments in marketable securities are to be valued at cost if purchased or, if acquired by donation, at the fair market value at the date of the gift. If there is evidence of a permanent decline in value, an appropriate reduction in carrying value must be made.

(e) Pooled investments. (1) Investments of various funds may be pooled unless prohibited by law or the terms of a donation or grant. Gains/losses and investment income on pooled investments should be distributed to participating funds on a basis utilizing market value.

(2) The distribution of the income for the first year would be based on each participating fund's percentage of the pool, based on its contribution at market value at the initiation of the pool. For subsequent periods, the distribution percentage for the income and gains on pooled investments for each of the participating funds would be based on the market value of the investment pool as of the date of the last addition. Each time an addition is made to the investment pool, a new distribution basis must be calculated. This is also true for any reductions to the pool. All gains/losses and investment income from the beginning of the accounting period up to the date of the addition must be determined and distributed on the basis prior to the addition. Any gains/losses and investment income subsequent to an addition would be distributed on the new basis until another addition or reduction is made.

(f) Inventories. (1) Inventories reflect the cost of unused residential health care facility supplies and should be carried at cost or market, whichever is lower. Any generally accepted cost method (e.g., FIFO, LIFO, average, etc.) may be used as long as it is consistent with that of the preceding reporting period. Cost of inventories based on the last invoice price is not an acceptable method for determining such cost.

(2) Perpetual inventory record systems are recommended. Physical valuation must be made at least once a year and the accounting records and perpetual records, if applicable, adjusted to such valuations. Physical valuations on a cycle basis are acceptable if perpetual inventory record systems are used by the residential health care facility.

(3) Inventory usage records of some sort should be maintained for all inventories that are distributed and used by more than one department or cost center in the residential health care facility. It is recommended that a formal requisition system be used for this purpose.

(4) Where inventory had not been recorded in the past, the cumulative effect of establishing such amounts will be reflected in accordance with generally accepted accounting principles.

(5) While the taking of a physical inventory is mandated, the independent public accountant shall determine whether or not they should observe the physical evaluation of inventory for the purpose of expressing an opinion on the financial statements. (g) Accounting for property, plant and equipment. (1) Classification of fixed asset expenditures. Property, plant and equipment and related liabilities must be recorded in the Unrestricted Fund, since segregation in a separate fund would imply the existence of restrictions on the use of the asset. Costs of construction in progress and related liabilities should be recorded in or transferred to the Unrestricted Fund as incurred except for assets and liabilities related to the proceeds of debt. For those areas, refer to paragraph (n)(3) of this section.

(2) Basis of valuation. Property, plant and equipment must be recorded on the basis of cost. Cost shall be defined as historical cost or fair market value at the date of gift for donated property, less any applicable salvage value.

(3) Accounting control. To maintain accounting control over capital assets of the residential health care facility, a plant asset ledger should be maintained as part of the general accounting records. Some items of equipment should be treated as individual units within the plant ledger when their individuality and unit cost justify such treatment. Other items of equipment, if they are similar and are used in a single cost center, may be grouped together and treated as a single unit within the ledger. The plant ledger should be segregated by cost center so that the cost of equipment and the related depreciation for each center is available. Those providers who are not able to identify historical costs and depreciation by department for major movable acquisitions prior to January 1, 1978, may use square feet net to allocate depreciation by department. All additions to major movable equipment as of January 1, 1978 and thereafter must be identified by cost center.

(4) Capitalization policy. Each residential health care facility must set a standard policy with respect to the capitalization of its depreciable assets. This policy, excluding minor equipment, must meet the following specifications:

(i) The minimum capitalization policy must follow the guidelines and amounts required in the Medicare regulations.

(ii) Normal repair and maintenance and modernization to maintain depreciable assets should not be capitalized if the life of the asset is not materially extended.

(iii) Significant alterations and renovations should be capitalized and depreciated over the expected useful lives, which should not exceed the lives of the assets to which they are fixed.

(5) Minor equipment. Minor equipment includes such items as wastebaskets, bed pans, syringes, catheters, silverware, mops, buckets, etc. The general characteristics of this equipment are: (i) in general, no fixed location, and subject to use by various departments within a residential health care facility; (ii) comparatively small in size and unit cost; (iii) subject to inventory control; (iv) fairly large quantity in use; and (v) generally, a useful life of approximately three years or less. The cost of minor equipment is to be reported in accordance with Medicare regulations.

(6) Interest expense during period of construction. Frequently, residential health care facilities borrow funds to construct new facilities or to modernize and expand existing facilities. Interest costs incurred during the period of construction must be capitalized as a part of the cost of the construction. The period of construction is considered to extend to the date the constructed asset is put into use. When proceeds from a construction loan are invested and income is derived from such investments during the construction period, the amount of interest expense to be capitalized must be reduced by the amount of such income.

(7) Depreciation policies. (i) Depreciation on plant assets used in the residential health care facility's operations should be recorded as an operating expense in the Unrestricted Fund. The straight-line method of depreciation must be used for uniform reporting.

(ii) The estimated lives used in computing depreciation should be taken from the recommendations made in the Estimated Useful Lives of Depreciable Hospital Assets, published by the American Hospital Association ( copyright 1973), or other acceptable sources. However, with the rapidly changing technology in residential health care facilities, these recommendations may not be all-inclusive; in which case, the exper tise of the manufacturer or other reliable source may be considered subject to approval by the New York State Department of Health.

(iii) Each residential health care facility must establish, and consistently follow, a policy relative to the amount of depreciation to be taken in the year of acquisition on normal annual additions. Examples of acceptable policies are: (a) recording first-year depreciation based upon the number of actual months the asset was in use during the first year;

(b) recording one half of the annual depreciation expense in the years of acquisition and disposal, regardless of the date of acquisition;

(c) recording no depreciation in the year of acquisition and a full year's depreciation in the year of disposal; or

(d) recording a full year's depreciation expense if the asset was acquired in the first half of the year. If the asset was acquired in the last half of the year, no depreciation expense would be recognized in the year of acquisition.

The above alternatives are acceptable for normal annual additions to plant assets. However, when major construction projects are completed and capitalized, first-year depreciation must be computed based upon the actual number of months the asset was in use, if the application of any other method results in a material mismatching of revenue and expense in the initial year.

(8) Disposal of plant assets. Plant assets may be retired voluntarily, or disposed of by sale, trade or abandonment, or involuntarily lost as a result of casualty such as fire or storm. At the date of the retirement or disposal, the cost of the asset and its related accumulated depreciation must be removed from the accounts. Any resulting gain or loss on the retirement or disposal is to be reported as nonoperating revenue/expense.

(h) Investment tax credit. (1) As contained in APB Opinion No. 2, issued by the American Institute of Certified Public Accountants, the investment tax credit may be accounted for in one of the following manners:

(i) the allowable investment credit may be taken as a reduction of Federal income taxes in the year in which the credit arises (flow-through method); or

(ii) the allowable investment credit may be reflected in net income over the productive life of the asset and not in the year in which it is placed in service (deferral method).

(2) Once a residential health care facility has applied one of these methods, that method must be used consistently thereafter.

(i) Leases. Often a facility will obtain the use of land, buildings, or equipment by entering into an agreement to lease them from an outside party. In some cases, a lease is merely obtaining the use of an asset for a specified period; however, under certain conditions a lease is considered to be, in substance, a purchase of property. For determination of the acceptable accounting treatment for leases, reference should be made to Accounting for Leases--Statement of Financial Accounting Standards No. 13.

(j) Timing differences. Timing differences result when accounting policies and practices used in an organization's accounting differ from those used for reporting operations to governmental units collecting taxes or to outside agencies making payments based upon the reported operations. These differences must be recorded on the residential health care facility's records when they arise. The references relative to their acceptable accounting treatment are as follows:

(1) income tax allocation--accounting principles--Board Opinions Nos. 11, 23 and 24;

(2) third-party cost reimbursement--timing differences--Hospital Audit Guide.

(k) Accounting for pledges. All pledges, less a provision for amounts estimated to be uncollectible, should be included in the residential health care facility's records. If unrestricted, they should be recorded as nonoperating revenue. If restricted, they should be recorded as an addition to the appropriate restricted fund balance.

(l) Self-insurance. Self-insurance by a residential health care facility for potential losses due to malpractice claims, asserted or otherwise, places all or part of the risk of such losses on the residential health care facility rather than insuring against all or part of such losses with an independent insurer. Accruing for self-insured losses is governed by the Financial Accounting Standards Board's Statement No. 5, Accounting for Contingencies.

(1) Paragraph 8 of that statement indicates that "an estimated loss from a loss contingency can only be accrued as a charge to income if both of the following conditions are met:

(i) "Information available prior to issuance of the financial statements indicates that it is probable that an asset had been impaired or a liability had been incurred at the date of the financial statements. It is implicit in this condition that it must be probable that one or more future events will occur confirming the fact of the loss.

(ii) "The amount of loss can be reasonably estimated."

(2) Paragraphs 29 and 30 of that statement state:

(i) "An enterprise may choose not to purchase insurance against risk of loss that may result from injury to others, damage to the property of others, or interruption of its business operations. Exposure to risks of those types constitutes an existing condition involving uncertainty about the amount and timing of any losses that may occur, in which case a contingency exists... (ii) "Mere exposure to risks of those types, however, does not mean that an asset has been impaired or a liability has been incurred. The condition for accrual in paragraph 8(a) is not met with respect to loss that may result from injury to others, damage to the property of others, or business interruption that may occur after the date of an enterprise's financial statements. Losses of those types do not relate to the current or a prior period but rather to the future period in which they occur. Thus, for example, an enterprise with a fleet of vehicles should not accrue for injury to others or damage to the property of others that may be caused by those vehicles in the future, even if the amount of those losses may be reasonably estimable. On the other hand, the conditions in paragraph 8 would be met with respect to uninsured losses resulting from injury to others or damage to the property of others that took place prior to the date of the financial statements, even though the enterprise may not become aware of those matters until after that date, if the experience of the enterprise or other information enables it to make a reasonable estimate of the loss that was incurred prior to the date of its financial statements."

(3) For the purposes of this Article, a reasonable estimate of current and prior unasserted self-insurance claims can only be made by an independent professional qualified to make such valuations. If an estimate is obtained, such amount should be recorded on the books of the residential health care facility.

(m) Other related organizations. Auxiliaries, guilds, fund-raising groups and other related organizations frequently assist residential health care facilities. If such organizations are independent and are characterized by their own charter, bylaws, tax-exempt status and governing board, or a sufficient combination of these characteristics, to demonstrate their independent existence from the residential health care facility, the financial reporting of these organizations should be separate from reports of the residential health care facility. If such organizations are under the control of (or common control with) residential health care facilities and handle residential health care facility resources, their financial reports should be combined with those of the residential health care facility.

(n) Debt financing for plant replacement and expansion purposes. Debt financing for plant replacement and expansion programs may take many forms. Under the terms of most debt financing agreements, the debtor is required to perform or is prohibited from performing certain acts. In many instances, such financing gives rise to special accounting treatment because of discounts and premiums on bond issues, financing charges, formal restrictions on debt proceeds, sinking and other required funds.

(1) Discounts and premiums on bond issues. Discounts and premiums arising from the issue of bonds must be amortized over the life of the related issue(s). For reporting purposes, bond discounts must be reported as a reduction of the related debt (Bonds Payable--New of Unamortized Discount). Bond premium must be reported as Other Deferred Credits.

(2) Financing charges. All costs of obtaining debt financing other than discounts (e.g., legal fees, underwriting fees, special accounting costs) should be recorded as deferred costs and amortized over the life of the related debt.

(3) Accounting for debt proceeds. (i) Debt agreements which finance plant replacement and expansion programs may or may not require formal segregation of debt proceeds prior to their use. Proceeds which are not required to be formally segregated prior to their uses should be reported as other noncurrent assets in the unrestricted funds. However, proceeds which require formal segregation have been recorded in several ways, specifically:

(a) as a separate restricted fund which includes all of the attendant liabilities and any required equity contribution, as in the case of financing through New York State Housing Finance Agency; or

(b) as part of the restricted plant replacement and expansion funds, which include all of the attendant liabilities; or

(c) the liabilities are reflected in the unrestricted fund and only the proceeds are reflected in a restricted fund. The proceeds, however, are not considered as an addition to the restricted fund balance but rather as a liability to the unrestricted fund. This liability is reduced as the proceeds are used for their intended purposes.
 

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Section 452.4 - Specialized reporting areas

452.4 Specialized reporting areas. (a) Interdepartmental services. The following represent areas for which costs must be directly assigned to the functional reporting center operating such costs. The term interdepartmental services, for the purposes of this Article, is defined as the direct cost of utility provided by one residential health care facility department to another. The objective of accounting for interdepartmental services is to establish a proper distribution of direct costs prior to any cost allocation process.

(1) For the purposes of this Article, the following are costs which should be so treated:

(i) Plant maintenance. (a) All direct costs incurred in the routine maintenance, repair and service of buildings and equipment are included in the Plant Operation and Maintenance reporting center.

(b) However, the cost of noncapitalizable nonroutine maintenance and repairs directly assignable to a single reporting center (such as a major repair of an X-ray machine) must be transferred to the reporting center receiving the service. These costs include all direct expenses incurred by the Plant Operation and Maintenance cost center in performing such services.

(c) When such nonroutine maintenance and repairs are performed by nonfacility personnel, the cost related to these purchased services must be either transferred from Plant Operation and Maintenance or charged directly to the reporting center receiving the service. In the event that such costs are charged directly to the recipient reporting center, such costs must be segregated under the new natural classification provided, i.e., Repairs and Maintenance-- Purchased Services Directly Assignable.

(d) It is recommended that identification of direct costs be accomplished by developing a work order system. Written work orders identifying the requesting reporting center should be prepared upon receipt of the request for services. Upon completion of the service, the direct cost of labor and materials would be entered on the work order. Completed work orders should be sent to general accounting on a regular basis so that interdepartmental costs can be recorded.

(ii) Employee benefits. Employee benefits must be reported in the functional reporting centers which include the applicable employee's compensation. This can be accomplished by accumulating all fringe benefit costs in one account and assigning the expenses to the appropriate reporting center at year-end as a preliminary adjustment prior to cost finding. This assignment can be performed on an actual basis or upon the following basis:

(a) FICA and tuition refunds--actual expense by department.

(b) Pension and health insurance. (1) Union--gross salaries of participating individuals by department.

(2) Nonunion--gross salaries of participating individuals by department.

(c) All other benefits--the remaining benefits may be allocated to the various departments based upon gross salaries of the departments.

(iii) Major movable depreciation. Major movable depreciation must be reported in the reporting center established entitled, "Depreciation--Major Movable Equipment". Such depreciation must be assigned to the department (as a cost allocation basis later explained) where the equipment is located and utilized. However, those providers who are not able to allocate historical costs and depreciation for major movable equipment acquired prior to January 1, 1978 may use square feet, net, to allocate depreciation by department. All additions to major movable equipment as of January 1, 1978 and thereafter will be functionalized.

(b) Residential health care facility research and education costs. All direct costs incurred in conducting residential health care facility research and formal educational activities (as opposed to inservice education) must be reported in the appropriate unrestricted or restricted fund reporting center.

(c) Grant accountability. When separate accounting is required by law, grant, contract, or donation restricted for research and educational activities, such grants should be reported separately. Transfers from restricted funds to match the expenditures for these activities must also be segregated. Thus, accountability is maintained for all restricted research and educational activities. Grants that represent deficit financing should be reported as a reduction of the appropriate contractual allowances when used rather than, in the case of other grants, as other operating revenue.

(d) Grant overhead allocation. (1) No allocation of overhead should be made prior to cost finding unless such allocation is required by grant agreement. When a grant contract calls for the payment of direct costs plus an overhead factor, the overhead factor should be used in billing only. (2) If indirect overhead must, by grant contract, be recorded in the unrestricted fund cost centers used for the recording of the direct costs of the grant activity, the natural expense classification (other direct expenses) must be used. Such overhead allocations should be accumulated separately in the unrestricted fund. For reporting to the New York State Department of Health, this amount must be offset against grant activity costs, so such remaining costs are direct costs only.

(e) Overhead allocation between facilities. An allocation of overhead should be made prior to cost finding for facilities which share services or receive services from a service corporation. Statistical bases utilized for such allocation must be approved by the New York State Department of Health.

(f) Affiliated school contracts. Education costs incurred relative to affiliated school contracts, including salaries, wages and stipends paid to students on approved programs and fees paid to physicians involved primarily in approved education programs, must be reflected in the appropriate education reporting center in the Unrestricted Fund.

(g) In service education--nursing. (1) Nursing inservice education activities are defined as educational activities conducted within the residential health care facility for residential health care facility nursing personnel. The cost of time spent by nursing personnel as students in such classes and activities must remain in the reporting center in which their normal salary and wage costs are charged (i.e., the reporting center in which they work). However, the cost (defined as salary, wages and payroll-related fringe benefits) of time spent in such classes and activities by those instructing and administering the programs must be included in the Nursing Administration reporting center.

(2) If instructors do not work full-time in the inservice education program, the cost (as defined above) of the portion of time they spend working in the inservice education program must be included in the "Nursing Administration" reporting center. This may be accomplished by direct distribution of these costs (by natural classification of expense category) each payroll period, or by reclassification (based upon time spent) at year end.

(3) The costs of nursing inservice education supplies (such as cassettes, books, medical supplies, etc.) and outside lecturers must also be reflected in the Nursing Administration reporting center.

(h) Inservice education--other. All costs relative to nonnursing inservice education activities should be included in the reporting center to which they apply (e.g., Physical Therapy, Radiology, etc.), as such inservice education activities will rarely apply to more than one functional activity.

(i) Physician remuneration. Due to the numerous types of financial and work arrangements between residential health care facilities and physicians, comparability of costs between residential health care facilities may be significantly impaired. This section deals with the methods to be used in reporting costs and revenues related to the services of physicians.

(1) Financial arrangements. Although the variations in financial arrangements between residential health care facilities and physicians are endless, there are five general types of such arrangements:

(i) Attending physician. Under this arrangement, the physician bills both Medicare, part B, and patients in his name for professional services provided. The residential health care facility reflects no operating revenue or expense relative to the professional component.

(ii) House physician. The residential health care facility bills Medicare, part B, in its name and receives payment, or bills in the physician's name and receives payment from the physician. The physician is paid a salary by the residential health care facility which is included in the facility's expense. Amounts received by the residential health care facility from Medicare may be operating revenue to the facility or may be a liability to Medicaid or the patient, depending upon the extent of the reimbursement ceiling in effect.

(iii) Normal arrangement. The residential health care facility bills patients for the physician's contractual professional services, including this amount as facility revenue. All department expenses are paid by the residential health care facility. The residential health care facility remits a fee to the physician which is included in facility expense.

(iv) Rental department. The physician bills the patients for certain of the part A and part B component (as defined by Medicare) and incurs all substantial direct expenses. The physician remits a fee to recover certain residential heath care facility expenses. This fee is recorded an nonoperating revenue in the appropriate department. (v) Independent/separate department. The department functions are provided by an independent physician or group of physicians. Neither revenues nor expenses are incurred by the residential health care facility. The residential health care facility refers patients and/or specimens to the physician or group, which is usually located on separate premises. No costs are incurred and no revenue is received under this arrangement.

(2) Work arrangement. (i) The services provided by residential health care facility-based physicians may be categorized into five general types:

(a) professional component--providing direct patient care;

(b) education--teaching and supervising student activity in educational programs;

(c) research--working in research projects;

(d) administration--administering overall activities; and

(e) department supervision--supervising activities of the department.

(ii) When physicians are involved in more than one of the above functional activities, their remuneration, if any, should be recorded in the reporting center for which services they are paid. Prior to cost finding, their remunerations are to be reclassified to the appropriate reporting center on the residential health care facility's records.

(j) Periodic Interim Payments (PIP). Periodic interim payments are made biweekly to a residential health care facility on the PIP program and are based on the facility's estimate of applicable Medicare reimbursement for the current cost report period. When such payments are received, a cash account in the Unrestricted Fund is debited and a PIP clearing account is credited for the amount of the payment. When applicable, Medicare charges are billed to the intermediary, the PIP clearing account is debited and patient accounts receivable is credited. At year end, adjustments must be made to eliminate any remaining balance in the PIP clearing account and to reflect the amount receivable from, or due to, the Medicare intermediary.

(k) Patient trust funds. Patient trust funds consist of amounts deposited on behalf of the patient which are to be used for the personal care and expenditure of that patient. In most cases, these funds consist of social security funds which are received by the patient or by the residential health care facility on behalf of the patient. In most instances, the facility must give the patient an allowance each month out of these funds. Since patient trust funds are administered by a facility, these funds should be accounted for as agency funds by governmental and voluntary facilities. For proprietary facilities, these funds should be accounted for as noncurrent assets and noncurrent liabilities.
 

Doc Status: 
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Part 453 - Mandatory Reporting Levels

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 453.1 - General

Section 453.1 General. (a) The listing of mandatory reporting levels that follows is a system of aggregating accounting information for the purposes of uniform reporting mandated in this Article. Definitions for the mandatory reporting levels are contained within the listing for all items other than the functional reporting centers which are specifically addressed in Part 455 of this Article. The names of all such functional reporting centers are included in the listing and are designated with an asterisk(*).

(b) The listing of mandatory reporting levels is not required to be formally adopted as a residential health care facility's chart of accounts. However, such levels are mandated nonetheless, and the crosswalk between a facility's chart of accounts and the mandated levels must be considered a permanent part of the facility's records and must contain sufficient audit trails to demonstrate the reliability of the information.
 

Doc Status: 
Complete

Section 453.2 - Mandatory sublevels

453.2 Mandatory sublevels. In addition to the basic listing, the following additional sublevels of detail are mandated in certain areas. The circumstances under which such additional sublevels are required are outlined in subdivision (f) of this section.

(a) Financial Classification.

(1) Self-Pay.

(2) Medicare Part A.

(3) Medicare Part B.

(4) Medicaid.

(5) Other.

(b) Patient Service Category.

(1) Residential Health Care Facility.

(2) Domiciliary Care Facility.

(3) Adult Day Health Care.

(4) Outpatient Clinic.

(5) Home Health Services.

(6) Homemaker.

(7) Meals on Wheels.

(8) Intermediate Care Facility--Mental Retardation.

(9) Independent Living.

(10) Specialty Pediatric.

(11) Head Injury.

(12) Acquired Immune Deficiency Syndrome.

(13) Respite Care.

(14) Long Term Ventilator Dependent.

(c) Natural Classification of Expenses.

(1) Salaries and Wages.

(i) Management and Supervision.

(ii) Technicians, Specialists, and Non-Physician Medical Practitioners.

(iii) Registered Nurses.

(iv) Licensed Practical Nurses.

(v) Aides, Orderlies and Assistants.

(vi) Clerical and Other Administrative Employees.

(vii) Environment, Hotel and Food Service Employees.

(viii) Physicians.

(ix) Interns, Residents and Fellows.

(2) Employee Benefits.

(i) Employee Uniform Allowance.

(ii) FICA.

(iii) State Unemployment and Federal Unemployment Insurance.

(iv) Group Health Insurance.

(v) Pension and Retirement--Union.

(vi) Workers' Compensation Insurance.

(vii) Pension and Retirement--Nonunion.

(viii) Disability.

(ix) Other Employee Benefits.

(x) Union Health and Welfare.

(xi) Employee Meal Allowance.

(3) Fees.

(i) Administrative Fees--Long-Term Debt.

(ii) Physicians Fees.

(iii) Therapists and Other (Non-Physicians).

(iv) Consulting and Management Services.

(v) Legal Services.

(vi) Auditing Services.

(vii) Registered Nurses.

(viii) Licensed Practical Nurses.

(ix) Private Duty Nurses Fees.

(x) Other Fees.

(4) Supplies and Materials.

(i) Disposable Linen.

(ii) Prescription Drugs.

(iii) Medicine Cabinet Drugs.

(iv) Other Medical Care Materials and Supplies.

(v) Dietary--Food.

(vi) Dietary--Other.

(vii) Linen and Bedding.

(viii) Cleaning Supplies.

(ix) Office and Administrative Supplies.

(x) Employee Wearing Apparel.

(xi) Instruments and Minor Medical Equipment.

(xii) Minor Nonmedical Equipment.

(xiii) Other Supplies and Materials.

(5) Purchased and Contracted Services.

(i) Repairs and Maintenance--Purchased Services--Nonassignable.

(ii) Medical--Purchased Services.

(iii) Repairs & Maintenance--Purchased Services--Directly Assignable.

(iv) Management Services.

(v) Collection Services.

(vi) Other Purchased Services.

(vii) Contracted Services.

(6) Depreciation, Rentals and Leases.

(i) Depreciation and Amortization.

(ii) Rental or Lease--Land.

(iii) Rental or Lease--Buildings.

(iv) Rental or Lease--Fixed Equipment.

(v) Rental or Lease--Movable Equipment.

(7) Other Direct Expenses.

(i) Electricity.

(ii) Gas.

(iii) Water and Sewer.

(iv) Fuel Oil #2.

(v) Fuel Oil #4.

(vi) Fuel Oil #6.

(vii) Other Utilities.

(viii) Insurance.

(ix) Interest.

(x) Licenses and Taxes (Other than Income Taxes).

(xi) Telephone and Telegraph.

(xii) Dues to Nursing Home Association.

(xiii) Printing, Duplicating, Microfilming.

(xiv) Travel, Conferences, Workshops.

(xv) Books, Periodicals, etc.

(xvi) Other Direct Expenses.

(8) Assessments.

(i) Assessments from Municipalities or Religious, Educational, Foundations or Other Associations.

(d) Charges by type.

(1) Routine, representing room and board charges.

(2) Ancillary, by type.

(i) Laboratory.

(ii) Electrocardiology.

(iii) Electroencephalogy.

(iv) Radiology.

(v) Inhalation Therapy.

(vi) Podiatry.

(vii) Dental.

(viii) Psychiatric.

(ix) Physical Therapy.

(x) Occupational Therapy.

(xi) Speech and Hearing Therapy.

(xii) Pharmacy.

(xiii) Central Service Supply.

(xiv) Medical Staff Services.

(xv) Other.

(e) Fund Classification.

(1) Unrestricted Operating Fund.

(2) Unrestricted Board-Designated Fund.

(3) Plant Replacement and Expansion Fund.

(4) Specific Purpose Fund.

(5) Endowment Fund.

(6) Other.

(f) Application of preceding sublevels of detail.

(1) For Patient Service Revenues, the following sublevels are mandated:

(i) Where a facility records patient charges on a fee-for-service basis, such charges must be reported by type (subdivision (d) of this section) in accordance with the functional reporting center descriptions in Part 455 of this Article. (ii) Where a facility records patient charges on an all-inclusive or flat-rate basis, such charges would all be reported as Routine Patient Service Revenue.

(iii) Regardless of a facility's charge structure, charges must also be reported by Patient Service Category, subdivision (b) of this section.

(2) For Deductions From Revenue, the following sublevels are mandated:

(i) Financial Classification, subdivision (a) of this section.

(ii) Patient Service Category, subdivision (b) of this section.

(3) For Expenses, the sublevel of natural classification of expense, subdivision (c) of this section, is mandated. Such Natural Classification of Expenses is described in detail in Part 458 of this Article.

(4) For Assets, Liability and Fund Balances/Equity Accounts, the sublevel of Fund Classification, subdivision (e) of this section, is mandated.
 

Effective Date: 
Tuesday, January 1, 1991
Doc Status: 
Complete

Section 453.3 - Listing and definitions

453.3 Listing and definitions. (a) Current assets.

(1) Cash.

(2) Savings accounts.

(3) Certificates of Deposit. These assets, paragraphs (1)-(3), represent the amount of cash on deposit in banks that is immediately available for use in financing various fund activities, amounts of cash that are on hand for minor disbursements, and amounts of cash that are held in savings accounts and certificates of deposits.

(4) Investments. Current securities, including U.S. government securities, other current investments, share of pooled investments, cash and investments held in escrow, evidenced by certificates of ownership or indebtedness, should be included in these reporting levels.

(5) Accounts and Notes Receivable. These assets should reflect the amounts due from residential health care facility patients and their third-party sponsors.

(6) Allowance for Uncollectible Receivables and Third-Party Contractuals. These are valuation type (or contra-asset) reporting levels. Credit balances represent the estimated amount of uncollectible receivables from patients and third-party payors.

(7) Receivables from Third-Party Payors. These assets reflect the estimated amount due from third-party reimbursement programs based on cost reports which will be submitted or have already been submitted and/or audited. Other levels should be maintained for each year's settlement if more than one year's settlement is included in an estimated amount, and by program if separately reimbursed.

(8) Pledges and Other Receivables (Pledges).

(9) Due from Parent/Subsidiary/Affiliate. These assets, paragraphs (8) and (9), reflect pledges, grants and legacies due the facility as well as miscellaneous receivables due from staff, employees, affiliates, and interest receivable. An allowance for the estimated amount of uncollectible pledges should also be reported.

(10) Due from Other Funds. These assets reflect the amounts due between funds. These balances should not be construed as receivables because they do not represent external claims. Instead, these balances should be viewed as representing assets of the general funds that are currently accounted for as restricted funds.

(11) Inventory. These assets reflect the cost of unused supplies. Perpetual inventory records should be maintained and adjusted periodically to show actual amounts of supplies on hand. These adjustments should be applied to the inventory and distributed to the requisitioning cost centers. The extent of inventory control and detailed record-keeping will depend on the size and organizational complexity of the residential health care facility.

(12) Prepaid Expenses. These prepaid asset and other asset levels represent costs incurred that are properly chargeable to a future accounting period. Other current assets not included elsewhere can be included here.

(b) Assets whose use is limited.

(1) Depreciation funds.

(2) Operating escrow funds.

(3) Mortgage repayment escrow. These assets, paragraphs (1) - (3) are provided to account for board-designated assets, or assets whose use is restricted as to withdrawal or use.

(c) Property, Plant and Equipment--Historical Cost.

(1) Land. The balance of this asset reflects the cost of land used in residential health care facility operations. Included here are the costs of offsite sewer and water lines, public utility charges for servicing the land, government assessments for street paving and sewers, curbs and sidewalks whose replacement is not the responsibility of the facility, and other land expenditures of a nondepreciable nature. Unlike buildings and equipment, land does not deteriorate with use or with the passage of time; therefore, no depreciation is accumulated.

(2) Land Improvements. All depreciable land expenditures for residential health care facility operations are charged to this asset. This includes the costs of onsite sewer and water lines; paving of roadways, parking lots, curbs and sidewalks (if replacement is the responsibility of the facility); and the cost of shrubbery, fences, and walls.

(3) Buildings. The original costs of all buildings and any subsequent additions used in residential health care facility operations are included here. Included are architectural, consulting and legal fees related to the acquisition or construction of buildings, and interest paid on construction loans during the period of construction.

(4) Leasehold Improvements. All expenditures for the depreciable improvement of leased land and buildings used in residential health care facility operations are to be included here.

(5) Fixed Equipment. Expenditures for fixed equipment are included in this amount. The equipment should fulfill the following requirements:

(i) It should be affixed to the building and not be subject to transfer or removal. (ii) It should be a depreciable asset with a life less than or equal to that of the building to which it is affixed.

(iii) It should be used in residential health care facility operations. Fixed equipment includes such items as boiler, generators, incinerators, elevators, engines, pumps, air conditioning systems and refrigeration machinery.

(6) Major Movable Equipment. Depreciable equipment included in this amount fulfills the following requirements:

(i) It should be movable, as distinguished from fixed equipment.

(ii) It should have sufficient individuality and size to make control by means of identification tags feasible.

(iii) It should usually have a minimum life of three years or more.

(iv) It should be used in residential health care facility operations. Major movable equipment includes such items as automobiles and trucks, desks, beds, chairs, accounting machines, oxygen tents and X-ray apparatus.

(7) Minor Equipment. Equipment included here generally fulfills the following requirements:

(i) Its location is usually not fixed and it is subject to requisition or use by various departments of the residential health care facility.

(ii) It should be of relatively small size.

(iii) It should be subject to storeroom control.

(iv) There should be a fairly large number of pieces in use.

(v) It should usually have a useful life of three years or less.

(vi) It should be used in residential health care facility operations. Minor equipment includes such items as wastebaskets, bedpans, syringes, catheters, basins, glassware, silverware, pots and pans, mattresses and surgical instruments. Each facility should develop capitalization parameters, in accordance with Medicare regulations and in consultation with its independent public accountants.

(8) Construction in Progress. This must include the construction costs of uncompleted facilities that will be used for residential health care facility operations. Upon completion of the construction program, these amounts would be transferred and the appropriate asset debited. In the case of projects that are financed through debt agreements that require formal segregation of project assets and/or separate accountability, the construction in progress should be accounted for in the Plant Replacement and Expansion Fund. Upon completion of the construction program, these amounts should be transferred to appropriate operating fund assets.

(d) Accumulated Depreciation--Historical Cost.

(1) Land Improvements.

(2) Buildings.

(3) Leasehold Improvements.

(4) Fixed Equipment.

(5) Major Movable Equipment.

(6) Minor Equipment. These amounts reflect the depreciation accumulated on the listed assets used in residential health care facility operations.

(e) Deferred Charges and Other Assets.

(1) Cash.

(2) Time deposits and equivalents.

(3) Patient fund held in trust (proprietary facilities only).

(4) Other assets.

(5) Investments.

(6) Investment in nonoperating property, plant and equipment.

(7) Accumulated depreciation--investments in nonoperating plant and equipment. Included in these levels, paragraphs (1)-(7), are the costs (or fair market value at date of donation) of property, plant and equipment not used in residential health care facility operations, and the accumulated depreciation on these assets. Other assets not included elsewhere are also included here.

(8) Other intangible assets. This level is required to record intangible assets such as goodwill and organization costs.

(9) Due from plant replacement and expansion funds (noncurrent). This level reflects the receivables of the operating fund from the plant replacement and expansion funds relative to special restricted funds required by debt agreement. These amounts would increase as the operating fund transfers assets to these restricted funds. These transfers are considered to give rise to receivables/payables between the funds, rather than reductions or increases to their fund balances, since the source of the assets are provided either from operations or from a portion of the proceeds from the debt financing. These operating funds receivables and the corresponding Plant Replacement and Expansion Fund liabilities will be reduced as the assets are used in these restricted funds to reduce debt, replace assets or pay specified operating expenses.

(f) Current Liabilities.

(1) Notes and Loans Payable.

(2) Current Portion of Long-Term Debt. These required levels, paragraphs (1) and (2) reflect liabilities of the residential health care facility to vendors, banks, and other creditors, evidenced by promissory notes due and payable within one year.

(3) Accounts Payable. This required level reflects the amounts due to trade and other creditors for supplies and services purchased. (4) Accrued Compensation and Related Liabilities. This required level reflects the actual or estimated liabilities of the residential health care facility for salaries and wages payable and liability amounts related to payroll.

(5) Other Accrued Expenses. This required level represents current liabilities that have accumulated at the end of the month or accounting period for those expenses.

(6) Advances from Third-Party Payors. Included here are liabilities to third-party payors for current financing and other types of advances due and payable within one year. Liabilities to third-party payors arising from reimbursement settlements are not to be included. Such liabilities must be included in Payable to Third-Party and Private Payors, paragraph (7) of this subdivision.

(7) Payable to Third-Party and Private Payors. These amounts reflect reimbursement settlements due to third-party and private payors.

(8) Due to Other Funds. Liabilities to other funds are to be recorded here. These liabilities should not be construed as payables because no external obligation exists.

(9) Income Taxes Payable. The amount of income taxes currently payable should be included here.

(10) Other Current Liabilities.

(11) Deferred Revenue--Patient Deposits.

(12) Deferred Revenue--Other.

(13) Due to Parent/Subsidiary/Affiliate.

(i) Deferred revenue is defined as revenue received or accrued that is applicable to services to be rendered within the next fiscal or calendar accounting period. Deferred revenue applicable to accounting periods extending beyond the next accounting period should be included under Deferred Credits and Other Liabilities, subdivision (f) of this section. Any deferred revenue items, previously classified as noncurrent liabilities, that have become current should be included here.

(ii) Also included are unrestricted fund current liabilities which have not been provided for elsewhere.

(iii) In addition, certain construction project liabilities would be included here, in the Plant Replacement and Expansion Fund, for those projects that are financed through debt agreements that require final accountability of project activities. These liabilities should be reduced as paid or transferred to the operating fund when the project is completed and the assets are transferred to the appropriate operating fund assets.

(g) Deferred Credits and Other Liabilities.

(1) Deferred Income Taxes.

(2) Deferred Third-Party Revenue. These required levels, paragraphs (1) and (2), reflect the effects of any timing differences between book and tax or third-party reimbursement accounting.

(3) Due to Operating Fund--Long-Term. This level reflects the liabilities of the plant replacement and expansion funds to the operating fund relative to special restricted funds required by debt agreements. These amounts would increase as the operating fund transfers assets into these funds. The source of such funds could either be provided from operations or a portion of the proceeds from the debt financing. The liabilities in the Plant Replacement and Expansion Fund and the corresponding receivables in the operating fund would be reduced as the assets are used to reduce debt, replace assets or pay specified operating expenses.

(4) Other Liabilities.*

(5) Patient Funds Held in Trust* (proprietary facilities only).

_________________________________________________________________________

*FOOTNOTE: See section 453.1(a) of this Part.

_________________________________________________________________________

(h) Long-Term Debt.

(1) Long-Term Debt. Included here are amounts which reflect those liabilities that have maturity dates extending more than one year beyond the current year-end.

(2) Long-term debt liabilities would also be included in the plant replacement and expansion funds for those projects that are financed through debt agreements that require separate accountability of project activities.

(3) These liabilities should be transferred to the operating fund when the project is completed and the assets are transferred to the appropriate operating fund assets.

(i) Fund Balances (Not-for-Profit Residential Health Care Facilities).

(1) (i) Fund Balances--Each Major Fund Group.

(ii) Restricted Project Fund Balance.

(iii) Depreciation Fund Balance.

(iv) Retirement of Indebtedness Fund Balance.

(v) Operating Escrow Fund Balance.

(vi) Donor-Restricted Fund Balance.

(vii) Transfers from Restricted Funds for Capital Outlays.

(viii) Value of Donated Property, Plant and Equipment.

(ix) Transfers to Operating Fund for Operating Purposes.

(x) Transfers of Amounts Equivalent to Depreciation.

(2) (i) General fund balances represent the difference between total general fund assets and total general fund liabilities; that is, the net assets of the general fund. (ii) The Transfers from Restricted Funds for Capital Outlays reporting level should be credited for the cost of capital i tems purchased with money from the restricted funds. The fair market value at the date of donation of donated property, plant and equipment should be credited to value of donated property, plant and equipment. At the end of the year these amounts should be closed out to the fund balance.

(iii) The credit balances of the restricted fund balances represent the net amount of each restricted fund's assets that is available for its designated purpose. These fund balances must be credited for all income earned on restricted fund assets and for gains from the disposal of such assets, and must be debited for all losses from disposal of such assets.

(iv) If, however, such items are treated as operating fund income (considering legal requirements and donor intent), the restricted fund balance should be charged for such income and due to operating funds should be credited.

(j) Equity.

(1) Investor-Owned Corporation. The level of detail required to report equity amounts reflects the difference between the total assets and the total liabilities of the investor-owned corporation.

(i) Stockholders' Equity.

(ii) Preferred Stock.

(iii) Common Stock.

(iv) Retained Earnings.

(v) Treasury Stock.

(vi) Additional Paid-In Capital.

(2) Investor-Owned Partnership. These amounts represent the net assets of the partnership.

(i) Capital.

(ii) Partner's Draw.

(3) Sole Proprietorship or Governmentally Operated Facilities.

(i) Capital.

(ii) Retained Earnings.

(iii) Contributions from Other Funds. This reporting level is to be used to record the value of assets contributed to an enterprise fund for its unrestricted use and without any liability attached to them. It corresponds, in a general sense, to capital invested by stockholders of a private corporation. The most common source is from the general revenues of a governmental unit, usually through the general fund, to provide initial resources for acquisition of the enterprise.

(k) Revenue. The following represent mandated reporting levels of revenue. To reiterate, where a reporting level coincides with a functional reporting center, such level is listed only, designated with an asterisk(*) and not defined. All functional reporting centers are described in detail in Part 455 of this Article.

(1) Nursing and Professional Services.

(i) Residential Health Care Facility.

(ii) Domiciliary Care Facility.*

(iii) Adult Day Health Care.*

(iv) Home Health Care.*

(v) Homemaker.*

(vi) Outpatient Clinics.*

(vii) Meals on Wheels.*

(viii) Intermediate Care Facility--Mental Retardation.*

(ix) Independent Living.*

(x) Speciality Pediatric.*

(xi) Head Injury.*

(xii) Acquired Immune Deficiency Syndrome.*

(xiii) Respite Care.

(xiv) Long Term Ventilatory Dependent.*

(xv) Central Medical Supplies and Equipment.*

(xvi) Laboratory Services.*

(xvii) Electrocardiology.*

(xviii) Electroencephalogy.*

(xix) Radiology.*

(xx) Inhalation Therapy.*

(xxi) Pharmacy.*

(xxii) Podiatry.*

(xxiii) Dental.*

(xxiv) Psychiatric.*

(xxv) Physical Therapy.*

(xxvi) Occupational Therapy.*

(xxvii) Speech and Hearing Therapy.*

(xxviii) Medical Staff Service.*

(2) Other Operating Revenues.

(i) Transfers from Restricted Funds for Research. This required level of detail reflects the amount of money transferred from restricted funds to the unrestricted fund to match expenses incurred by the unrestricted fund in the current period for restricted fund research activities only. Amounts should be segregated for each specific restricted fund activity or group of activities for which separate accounting is required by law, grant or donation agreement.

(ii) Transfers from Restricted Funds for Education. Included here is the amount of money transferred from restricted funds to the unrestricted fund to match expenses incurred by the unrestricted fund in the current period for restricted fund education activities only. Amounts should be segregated for each specific restricted fund activity or group of activities for which separate accounting is required by law, grant or donation agreement.

(iii) Transfers from Restricted Funds for Specific Operating Purposes. This level reflects the amount of money transferred from restricted funds to the unrestricted fund to match expenses incurred by the unrestricted fund in the current period for restricted fund activities other than research and education.

(iv) Supplies Sold to Other than Patients. This level reflects the income earned by the institution in the sale of medical supplies sold to other than patients. (v) Private Duty Nurses' Fees. This level is used to report revenues earned on services of private duty nurses.

(vi) Barber and Beauty Shops.*

(vii) Cafeteria.*

(viii) Gift Shop.*

(ix) Public Restaurant.*

(x) Laundry and/or Linen Services. This level should include revenues earned by providing laundry services to employees and students. See also subparagraph (j)(2)(xxiii) of this section.

(xi) Telephone and Telegraph Services. Money received from patients, employees and others in payment for residential health care facility telephone and telegraph services should be reported here.

(xii) Parking. Money received from visitors, employees and others in payment for parking privileges should be reported here.

(xiii) Television and Radio Rentals. This level should be used to report the revenue from television and radio rentals.

(xiv) Medical Record and Abstract Fees. This level should be used to report medical record transcript and abstract fees.

(xv) Sale of Scrap and Waste. This level should be used to report the revenue from sale of miscellaneous scrap and waste.

(xvi) Vending Machine Commissions (net). Commissions earned by the residential health care facility from coin-operated vending machines and telephones should be reported here.

(xvii) Housing.*

(xviii) Physicians' Offices and Other Rentals.*

(xix) Cash Discounts on Purchases. The amounts of cash discounts taken by the residential health care facility on purchases should be reported here. Trade discounts, however, should be treated as reductions in the costs of items purchased.

(xx) Rebates and Refunds from Vendors. This level should be used to report the revenue from rebates and refunds of expenses.

(xxi) Donated Commodities. This level should be used to report the fair market value of donated commodities.

(xxii) Interest, Finance and Penalty Charges on Accounts Receivable. This level should be used to report interest, finance and penalty charges billed (net of an estimate for uncollectibles).

(xxiii) Services to Other Organizations. This level should include revenues earned from the provision of services to other organizations or individuals.

(3) Nonoperating Revenue.

(i) General Contributions.

(ii) Donated Services.

(iii) Gain (Loss) on Sale of Property.

(iv) Income and Gains from Unrestricted Fund Investments.

(v) Unrestricted Income from Endowment Funds.

(vi) Unrestricted Income from Other Restricted Funds.

(vii) Term Endowment Funds Becoming Unrestricted.

(viii) Transfers from Restricted Funds for Nonoperating Purposes.

(ix) Contributions from Other Funds (governmentally operated facilities only). This reporting level reflects periodic transfers, from the general fund or special revenue fund to an enterprise fund, that serve as a subsidy for the operation of the enterprise. This level is not to be confused with the reporting level Deficit Financing Grants, paragraph (k)(5) of this section, which relates to contractual arrangements.

(x) Extraordinary Gain (Loss).

(l) Deductions from Revenue.

(1) Bad Debts. (i) This level should contain periodic estimates of the amounts of accounts and notes receivable that are likely to be credit losses. The estimated amounts of bad debts can be based on an experience percentage applied to the balances of accounts receivable or the amount of charges made to patients' accounts during the period, or it can be based on a detailed aging and analysis of patients' accounts.

(ii) Because residential health care facilities experience bad debt patterns that vary with classes or types of patients, the computation of the estimate or provision should take these differences into consideration.

(2) Contractual Adjustments. (i) These levels of detail must be used to report the differential (if any) between the amount (based on the residential health care facility's full established rates) of contractual charges to patients for services rendered during the period covered by the contract, and the amounts received and due from third-party agencies in payment of such charges, including adjustments estimated at year end.

(ii) Should the facility receive more than its established rates from a contractor, the differential will reduce these amounts.

(iii) In any instance in which the difference between the amount of a patient's bill and the payment received by the residential health care facility from a third-party agency is recoverable from the patient, the differential is retained in Accounts and Notes Receivable until it is paid or deemed to be a bad debt and is written off.

(iv) Specific required sublevels of reporting detail were outlined in section 453.2 of this Part. (3) Charity Services. (i) This level of detail should be used to report the difference between the amount (based on the residential health care facility's full established rates) of bills for services to charity patients and the amount (if any) to be received from patients in payment for such services. This difference should be credited directly to Accounts and Notes Receivable, rather than to an allowance, because charity discounts are readily determinable.

(ii) In order to properly distinguish between patients whose uncollectible bills should be considered charity write-offs and patients whose uncollectible bills should be considered bad debts, all patients should be classified at the time of admission or as soon after as possible as charity (full or partial) or paying patients. There may be some instances in which charges to a patient are considerably greater than was anticipated because of complications unforeseen at the time of admission, and the patient then is unable to pay the full amount. In such cases the patient should be reclassified as a charity patient, and the charges attributable to the unforeseen complications should be considered charity service. Uncollectible charges to patients classified as paying patients should be treated as credit losses--that is, bad debts--except for contractual adjustments, policy discounts and administrative adjustments.

(4) Other Deductions. Adjustments in charges for services rendered, in the form of courtesy allowances and employee discounts from the residential health care facility's full established rates, should be reported here and credited to Accounts and Notes Receivable.

(5) Deficit Financing Grants. This level is used to report voluntary and governmental grants received for the purpose of funding deficits at the residential health care facilities in accordance with contracted arrangements. Reference: subparagraph (j)(3)(ix) of this section.

(m) Expenses. The following represents mandatory reporting levels of expense. To reiterate, in addition to the following, the sublevel of natural classification of expense is also mandated.

(1) All Functional Reporting Centers, described in Part 455 of this Article, subject to the significance of criteria outlined therein.

(2) Nonoperating Expenses.

(i) Federal, State and Local Income Tax--Current.

(ii) Federal, State and Local Income Tax--Deferred.

(n) The following represent mandatory reporting levels for statistical information:

(1) Standard Units of Measure, as detailed and defined under each Functional Reporting Center in Part 455 of this Article.

(2) Cost Allocation Basis, as detailed and defined for each Functional Reporting Center in section 456.3 of this Article.
 

Effective Date: 
Tuesday, January 1, 1991
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Part 454 - Functional Reporting

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 454.1 - Introduction and concepts

Section 454.1 Introduction and concepts. (a) This Part discusses the overall concepts, principles, and other factors involved in the preparation and submission of financial and statistical information for the uniform financial reporting program for residential health care facilities in New York State. Uniform reporting is defined as the identification and reporting of all financial and related statistical data in a uniform manner consistent with the definitions set forth in this Article. All residential health care facilities in New York State will be required to adopt the policies, methodologies and practices presented in this section in preparing and submitting their uniform reports to the State.

(b) The revenue and expense portion of uniform reporting includes:

(1) alignment and classification of revenue and expense on a functional (activity) basis, rather than by organizational unit;

(2) application of a uniform standard unit of measure to the functional reporting center for an expression of revenue or expense per unit of activity; and

(3) cost finding, involving the systematic allocation of expenses on a statistical basis between centers which serve or are directly related to the activity performed in another center.

(c) This Part presents overall concepts, definitions of the functional revenue and expense reporting centers and standard units of measurement for the identified centers.

(d) The cost-finding methods, including segregation of costs and statistical bases for allocation, are discussed in Part 456 of this Article.
 

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Section 454.2 - Concepts for functional reporting

454.2 Concepts for functional reporting. (a) In order to comply with the reporting requirements of the New York State Department of Health, residential health care facilities must adhere to the following basic concepts.

(1) Residential health care facilities must follow the uniform accounting policies and practices as specified in Part 452 of this Article. Items such as methods of capitalization and depreciation of assets and direct charging of maintenance repairs, and payroll-related benefits to using centers are examples of important policies which must be adhered to for the annual uniform financial report.

(2) The principles and concepts utilized in the preparation of the annual uniform financial report will be based upon a portrayal of the activities on a functional basis regardless of third-party reimbursement practices.

(3) Another concept affecting the preparation of the annual uniform financial report is the requirement that costs will be measured at a level where uniformity can be obtained and a standard statistical measurement applied. For purposes of reporting, it was determined that standard units of measure would not be applied to certain nonrevenue or general support services; however, their total cost would be identifiable. The application of standard units of measure for some support services and ancillary revenue centers and all program centers would occur at the direct cost level. Standard units of measure may also be applied to support services, ancillary revenue and program service centers after cost allocation.

(4) Uniform financial reporting for revenue and expense categories is divided into three categories, as follows:

(i) nonrevenue support services centers--includes those reporting centers which do not normally produce patient service revenue and which tend to support the activities and services provided by the patient care services or special education, research or auxiliary programs. Reporting centers representing functions not necessarily associated with services would also be included in this category, such as insurance, etc;

(ii) ancillary service centers--includes those reporting centers which provide diagnostic and treatment services for inpatient and outpatient care; and

(iii) program and auxiliary service centers--includes those patient care, education, research and auxiliary programs for which the residential health care facility is ultimately organized to provide. All effort within the facility is ultimately related to these final program centers.

(b) Conversion from responsibility to functional reporting. (1) A fundamental aspect of the uniform financial reporting program is the portrayal of revenue and expenses on a functional basis rather than following the organizational pattern of the specific residential health care facility.

(2) The need for uniform functional reporting practices occurs from the fact that facilities will identify costs and revenue according to responsibility centers; that is, the reporting of costs according to the operating units such as departments. Because of the significant variation of the size and scope of residential health care facilities, there may be variation in the assignment of costs within each chart of accounts. Therefore, for uniform functional reporting of revenue and expenses, there may be a need for reclassifications to convert costs from the responsibility reporting format to a functional reporting format. Functional reporting may be defined as the reporting of costs according to the type of activities.

(3) Certain facilities will be required to reclassify certain revenue and expenses to meet the specifications for uniform reporting. Without this conversion from responsibility to functional reporting, residential health care facilities would not be reporting costs in a uniform manner, thus defeating the purposes of the uniform financial reporting requirements within the State.

(4) To achieve uniform functional reporting, all facilities will be required to reclassify revenue, expenses and statistics according to the definition of the functional centers discussed in Part 455 of this Article.

(i) Reclassifications, as discussed in this Part are of two types:

(a) To obtain the required level of reporting. This type of reclassification may be necessary to reach the required level of reporting because the facility has combined several departments. For instance, smaller facilities may be combining the costs of housekeeping and maintenance in one reporting center. In such cases, it is necessary to reclassify the total direct costs into the reporting centers relating to these two types of services.

(b) To correct accumulation of costs. This type of reclassification would be necessary when the expense associated with a particular function is recorded in a reporting center different from the functional description specified in this section. For instance, a reclassification would be required if the Patient Food Services Department recorded the costs associated with hand-feeding of patients, because these costs should have been recorded in the nursing reporting center relating to that patient program. (ii) These reclassifications may be computed on any one of the following bases:

(a) analysis of direct expense, including time and cost studies;

(b) ratio of total charges to charges of a specific cost center; or

(c) ratio of total units of service to units of service reclassified in a specific reporting center.

(iii) (a) Reclassifications must be made for significant amounts of misplaced costs. Significant is defined, for the purposes of this section, as an amount in excess of:

(1) one full-time equivalent employee within the functional center transferred to or from for salary costs; or

(2) 10 percent of the direct costs or $1,000, whichever is greater of the functional center transferred to or from, for other than salary costs.

(b) For the purposes of this Part, an estimate may be utilized to determine the limitation for salary costs. This estimate should be based on an approximation of one employee's total paid working hours during the year; e.g., 2,000 hours representing one full-time employee.

(c) Pursuant to the above criteria, the determination of the necessity for reclassification of salary costs may be made based on time studies. A time study must be made of employees who are performing activities related to more than one function. Time studies would be performed for such employees for a two-week period per quarter, for all four quarters in a year. The time study would result in a percentage of employees' hours worked, by function, to total hours worked. These percentages would, for each quarter, be applied to total hours paid for the same employees to arrive at hours paid by function. The results would be totaled for all four quarters and then compared to the estimate of one full-time equivalent of 2,000 hours to determine whether or not a reclassification is required.

(d) When reclassifying full-time equivalent employees between cost centers, non-work hours, i.e., vacation, sick pay, etc., will also be reclassified.

(e) The tests of significance indicated above do not apply to the areas described in section 453.4 of this Article. These allocations must be classified as described in that section. Also, in determining the segregation of costs between the Cafeteria and Patient Food Service Reporting Centers, where joint kitchen facilities are used, the criteria described in those functional reporting centers is to be utilized.
 

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Section 454.3 - Standard units of measure

454.3 Standard units of measure. (a) The purpose of the standard unit of measure is to provide a uniform statistic for measuring costs. The unit of measure for revenue-producing centers has been developed to reflect man effort, where possible, and the volume of services rendered to patients.

(b) With regard to the standard unit of measure, the following terms are defined as follows:

(1) A clinic outpatient is one who is admitted to the clinical service of the residential health care facility for diagnosis or treatment on an ambulatory basis in a formally organized unit of a medical specialty or subspecialty clinic or service.

(2) A day-care outpatient is one who is participating in a psychiatric or medical day or night care program and is not included in the daily inpatient census.

(3) A home health outpatient is one who receives medical services at his residence from representatives of an organized home health program of the residential health care facility.

(4) Meals on wheels is a program whereby a patient receives dietary services at his residence from representatives of the residential health care facility.

(5) A homemaker outpatient is one who receives domestic services at his residence from representatives of the residential health care facility. Examples of services are housekeeping, maintenance, laundry, etc.
 

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Section 454.4 - Listing of functional reporting centers and standard units of measure

454.4 Listing of functional reporting centers and standard units of measure.

(a) The listing which follows shows each functional center and related standard unit of measure that are mandated levels of reporting for this Article. The standard units of measure are required to be reported for all functional reporting centers in which direct costs are reported. The specific definitions of each reporting center and related standard unit of measure, and the data source for its collection, are indicated in Part 455 of this Article.

(1) Non-Revenue Support Services.

Functional Reporting Centers Standard Unit of Measure

(i) Depreciation, Leases and Rentals Square feet, gross

(ii) Depreciation on Major Movable Equipment None

(iii) Interest on Capital Debt Total operating expenses

(iv) Fiscal Services Total operating expenses

(v) Administrative Services Total operating expenses

(vi) Plant Operations and Maintenance Square feet, net

(vii) Grounds Square feet serviced

(viii) Security None

(ix) Laundry and Linen Dry and clean pounds processed

(x) Housekeeping Square feet serviced

(xi) Patient Food Services Dietary meals served

(xii) Cafeteria Equivalent cafeteria meals served

(xiii) Nursing Administration Average number of nursing department employees

(xiv) Activities Program Total number of participants program

(xv) Non-Physician Education Number of students

(xvi) Medical Education Number of students

(xvii) Medical Director's Office None

(xviii) Housing Average number of persons housed

(xix) Medical Records None

(xx) Utilization Review Number of cases reviewed

(xxi) Social Services None

(xxii) Transportation Number of trips

(2) Ancillary Service Revenue Centers.

Functional Reporting Center Standard Unit of Measure

(i) Laboratory Services CAP workload measurement unit

(ii) Electrocardiology CAP workload measurement unit

(iii) Electroencephalogy CAP workload measurement unit

(iv) Radiology Relative value units

(v) Inhalation Therapy Number of treatments

(vi) Podiatry Number of visits

(vii) Dental Number of visits

(viii) Psychiatric Number of visits

(ix) Physical Therapy Number of treatments

(x) Occupational Therapy Number of treatments

(xi) Speech and Hearing Therapy Number of treatments

(xii) Pharmacy None

(xiii) Central Service Supply None

(xiv) Medical Staff Services None

(3) Program Service Revenue Centers.

(i) Inpatient.

(a) Residential Health Care Facility Patient days

(b) Adult Care Facility Patient days

(c) Intermediate Care Facility--

Mental Retardation Patient days

(d) Independent Living Patient days

(e) Specialty Pediatric Patient days

(f) Head Injury Patient days

(g) Acquired Immune Deficiency

Syndrome Patient days

(h) Long Term Ventilator Dependent Patient days

(ii) Ambulatory and Other Care.

(a) Outpatient Clinics Visits

(b) Adult Day Health Care Visits

(c) Home Health Number of home health visits

(d) Homemaker Number of homemaker visits

(e) Meals on Wheels Number of meals

(iii) Research and Auxiliary Services.

(a) Research None

(b) Physicians' Offices and Other Rentals None

(c) Gift Shop None

(d) Public Restaurant None

(e) Fund Raising None

(f) Barber and Beauty Shop None

(g) Sold Services None
 

Effective Date: 
Tuesday, January 1, 1991
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Part 455 - Functional Reporting Centers

Effective Date: 
Tuesday, January 1, 1991
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e 2808

Section 455.0 - Introduction

Section 455.0 Introduction. The following sections contain the mandatory reporting levels of functional reporting centers, standard units of measure, appropriate definitions for each center and the source for collection of data.
 

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Section 455.1 - Depreciation, leases and rentals

455.1 Depreciation, Leases and Rentals. This functional reporting center must contain all depreciation and amortization expenses on buildings, fixed equipment and leasehold improvements recorded at their historical cost. In addition, the center must also contain all lease and rented expenses for land, buildings, fixed equipment and leasehold improvements.

(a) Standard unit of measure: gross square feet. Gross square feet shall be determined using the outer dimensions of the facility. Measurement should be taken by floor, to account for structural irregularities that may exist on various floors. When changes have been made during the year as a result of new construction or expansion or curtailment of service, statistical data should be maintained to allow for the development of "weighted" areas for the fractional part of the year.

(b) Data source. Gross square feet shall be determined from the blueprints of the residential health care facility, or actual measurement if blueprints are not available.
 

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Section 455.2 - Depreciation on major movable equipment

455.2 Depreciation on major movable equipment. This functional reporting center must contain all depreciation on major movable equipment of the residential health care facility. Note the special rules shown in section 452.4(a)(1)(iii) of this Article for assignment of major movable depreciation to departments.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.3 - Interest on capital debt

455.3 Interest on capital debt. This functional reporting center must contain all interest on capital, mortgage rates and other loans for the acquisition of equipment.

(a) Standard unit of measure: total operating expenses. The total operating expenses of the facility, less depreciation and lease costs for land, buildings and fixed equipment, and interest on capital debt.

(b) Data source. The costs shall be determined from the general accounting records.
 

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Section 455.4 - Fiscal services

455.4 Fiscal services. This functional reporting center must contain all expenses related to managing the residential health care facility's fiscal affairs, including general ledger accounting, budgeting, accounts payable, plant asset records, payroll, inventory accounting and data processing. Additional activities include but are not restricted to the following: entering abstracted data on insurance forms; accounting for sales to other institutions; patient accounting, including the processing of patient charges, preparing claims for patient-related billings, receiving and processing payments from or on behalf of patients for services rendered, extending credit, collecting outstanding accounts, and recording and accounting for patient trust funds.

(a) Standard unit of measure: total operating expenses. The total operating expenses of the residential health care facility, less depreciation and lease costs for land, buildings and fixed equipment, and interest on capital debt.

(b) Data source. The costs shall be determined from the general accounting records.
 

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Section 455.5 - Administrative services

455.5 Administrative services. This functional reporting center must contain all the expenses associated with the overall management of the facility, including the office of the administrative director, management fees, public relations, auxiliaries or volunteer groups, messenger services, purchasing, governing board, information and paging activities, maintaining all insurance policies (except employee benefit insurance), licenses and taxes, and working capital interest. Additional activities include but are not limited to the following: provision of staff support to the board; charting the flow of patients through residential health care facility services; projecting daily census for budgets; pickup and delivery of mail within the residential health care facility; printing and duplication of forms and reports; operation of the communications system within the facility, including the telephone switchboard and related telephone services; receipt and processing of requisitions; monitoring perpetual supply items; obtaining quotes from selected vendors and monitoring receipt of supplies; receiving, storing and delivering materials, equipment and supplies to various departments; recruitment, employee selection, salary and wage administration; fringe benefit program administration; procurement of temporary help; scheduling and recordkeeping relative to employee visits and pre-employment and post-illness employee physicals.

(a) Standard unit of measure: total operating expenses. The total operating expenses of the facility less depreciation and lease costs for land, buildings and fixed equipment, and interest on capital debt.

(b) Data source. The costs shall be determined for the general accounting records.
 

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Section 455.6 - Plant operation and maintenance

455.6 Plant operation and maintenance. This functional reporting center must contain all the expenses associated with the maintenance, repair and service of buildings, fixed and movable equipment, and operating and utility systems, including minor renovation of buildings (including services of the building trades, i.e., carpentry, plumbing, electricity, painting, masonry, plastering and mechanical repairs); maintenance and repair of the following systems: domestic water supply, sewage treatment facility, domestic hot water storage and distribution; bulk oxygen distribution from entry into the buildings; biomedical equipment inspection, testing, maintenance and repair; electrical distribution; operation and maintenance of the boiler plant to include steam distribution piping up to and including PRV stations and the condensate return system from the receiving tanks to the boiler plant; emergency power system; air conditioning systems to include air handling equipment; incinerators and waste removal equipment; elevators and dumbwaiters. This center should include all similar services performed under contract. Additional activities include but are not limited to the following: technical assistance on equipment purchases and installations; coordinating construction; establishing priorities for repairs and utility systems and projects; service and maintenance of water and sewage treatment facilities; and maintenance of utilities such as heat, light, water, air conditioning and air treatment.

(a) Standard unit of measure: net square feet. The number of net square feet shall be determined using the center of the exterior walls of the facility, by floor. Measurement should be taken by floor to account for structural irregularities that may exist on various floors. When changes have been made during the year as a result of new construction, expansion, or curtailment of service, statistical data should be maintained to allow for the development of weighted areas for the fractional part of the year.

(b) Data source. Net square feet shall be determined from the blueprints of the residential health care facility, or actual measurement if blueprints are not available.
 

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Section 455.7 - Grounds

455.7 Grounds. This functional reporting center must contain all the expenses associated with the maintenance of grounds of the facility, including landscaped and paved areas, streets on the property, sidewalks, fenced areas and fencing, external recreation areas and parking facilities (e.g., lawn care, repairs and snow removal).

(a) Standard unit of measure: square feet serviced. Measurement should be of the outer dimensions of the residential health care facility property and should only include grounds which are maintained. Wooded grounds which are not maintained would not be included. When changes occur during the year as a result of purchase, sale or receipt of donated property, data should be maintained to allow for the development of weighted areas for the fractional part of the year.

(b) Data source. Square feet of grounds shall be determined from the deeds held by the residential health care facility or actual measurement. Square feet serviced should then be determined by the grounds department.
 

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Section 455.8 - Security

455.8 Security. This functional reporting center must contain all the expenses associated with maintaining the safety and well-being of residential health care facility patients, personnel and visitors, and protecting the facility by patrolling and guarding designated areas.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.9 - Laundry and linen services

455.9 Laundry and linen services. This functional reporting center must contain all the expenses associated with picking up, sorting, issuing, distributing, mending, washing, and processing in-service linens, including uniforms and special linens. Also included in this reporting center are linen purchases, purchased laundry services and the cost of disposable linen.

(a) Standard unit of measure: dry and clean pounds processed. The total weight of linen processed for the residential health care facility's use (including patients' personal linen and linen applicable to employee housing). If the facility is presently weighing soiled linen, a conversion to dry and clean pounds must be made by dividing the soiled weight by 110 percent. If the facility is accumulating pieces of linen as a statistic, a conversion by weight of piece must be made. In those instances where disposable linen substitutes are utilized, an equivalent weight statistic in terms of actual linen must be included.

(b) Data source. The weight should be determined from an actual measurement maintained by the laundry and linen department.
 

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Section 455.10 - Housekeeping service

455.10 Housekeeping service. This functional reporting center must contain all the expenses associated with care and cleaning of the interior physical plant, including care of floors (washing, waxing and stripping), walls, ceilings, partitions, windows (inside and outside), furniture stripping, disinfecting beds, fixtures (excluding equipment), and furnishings, and emptying of room trash containers. Routine housekeeping services performed by dietary personnel in dietary (kitchen) should be reported in the Patient Food Service functional center. This includes the costs of purchasing similar services from outside organizations. Additional activities include but are not limited to the following: providing pest and rodent control; gathering bacteriological surface samplings and carrying out pertinent infection control procedures; providing technical assistance in selection of furniture and furnishings; moving and relocating furniture; and arranging for refinishing, repairing and upholstering or replacement of furniture.

(a) Standard unit of measure: square feet serviced. The number of square feet in the residential health care facility should be determined either by a physical measurement of the facility or by a measurement from blueprints. Floor area measurements should be taken from the center of walls to the center of adjoining corridors if a hallway services more than one department. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. When changes in assigned areas have been made during the year as a result of new construction, departmental relocation, expansion, or curtailment of service, statistical data should be maintained to allow for the development of weighted areas for the fractional part of the year.

(b) Data source. Square feet shall be determined from the blueprints of the residential health care facility, or actual measurement if blueprints are not available. Square feet serviced should then be determined by reference to housekeeping assignments as maintained by the director of housekeeping.
 

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Section 455.11 - Patient food service

455.11 Patient food service. (a) This functional reporting center must contain all the expenses associated with the procurement, storage, processing and delivery of food and nourishments to the floors and dining facilities in compliance with public health regulations and physicians' orders. This would include the material costs relative to tube feeding of a high protein diet. Additional activities include but are not limited to the following: teaching patients and their families about nutrition and modified diet requirements; determining patient food preferences in terms of type of food and method of preparation; preparing selective menus for various specific diet requirements; preparing or recommending a diet manual, approved by the medical staff, for use by physicians and nurses; and delivering and collecting food trays to the floors and dining facilities for meals and nourishments.

(b) Where this center and the Cafeteria functional reporting center share kitchen facilities with corresponding common salaries of cooks, food costs, minor equipment costs, administrative costs, etc., such common costs must be entirely distributed (preferably on a monthly basis) to the Patient Food Service and Cafeteria functional reporting centers, based on the ratio of number of meals served in each area. Note that such distribution must be performed and is not subject to the reclassification criteria detailed in section 454.2(b) of this Article. The patient meal count should be made by counting one meal for each tray sent to a patient at mealtime. Nourishments should be excluded. For a meal count, tube feedings will be counted as three meals for each day so fed. An equivalent meal count should be made in the cafeteria by use of the following procedures: count a free meal served as a full meal. A full meal consists of meat, potato, vegetable, salad, beverage and dessert. When there is a selection of entrees, desserts, etc., at different prices, use an average in calculating the selling price of a full meal. An equivalent meal in a pay cafeteria is determined by dividing total sales by the average selling price of a full meal served at noon.

(c) Standard unit of measure: dietary meals served. Number of meals served shall include only regularly scheduled meals and exclude snacks and fruit juices served between regularly scheduled meals. For a meal count, tube feedings will be counted as three meals for each day as fed.

(d) Data source. The number of meals served shall be determined from an actual count maintained by the dietary and nursing departments.
 

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Section 455.12 - Cafeteria

455.12 Cafeteria. This functional reporting center must contain all the expenses associated with procurement, storage, processing and delivery of food and nourishment to personnel and visitors in compliance with public health regulations, including vending machine operation. Additional activities include but are not limited to the following: preparation of food, food service, maintenance of vending machines, and operation of the cafeteria to serve employees and visitors. Note that when distributing shared (common) kitchen costs between this center and the Patient Food Service functional center, the reclassification criteria do not apply. See the special rules which are detailed in section 455.11(b) of this Part.

(a) Standard unit of measure: equivalent cafeteria meals served. An equivalent meal count is determined by total cafeteria dollar sales divided by the average sales price of a full meal served at noon. The average sales price of a full meal should include meat, potato, vegetable, salad, beverage and dessert. Count a free meal to an employee (or other nonpatient) as a full meal.

(b) Data source. The average sales price of a full meal shall be determined by an estimate based upon cafeteria prices and appropriately weighted for price changes during the year. Dollar sales in the cafeteria are maintained in general accounting. Free meals are to be determined by an actual count maintained by cafeteria personnel.
 

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Section 455.13 - Nursing administration

455.13 Nursing administration. This functional reporting center must contain all the expenses associated with the overall administration and supervision of all nursing services, including all nursing in-service training, scheduling and transferring of nurses between services and units, nursing staff supervision, evaluation and discipline. It includes the work of the director, assistants and/or associates, secretaries, clerks, and all nursing personnel who are responsible for conducting in-service education of nursing personnel, and the following specific job titles: RN Supervisor (supervising two or more units and/or areas), Health Services Supervisor, Director of Nursing Services, and Assistant Director of Nursing Services. Note that nursing in-service education is subject to special rules rather than the reclassification criteria (section 452.4(g)). Additional activities include but are not limited to the following: recommendation of appointments to the nursing staff; definition and execution of the philosophy, objectives, policies and standards for nursing care of patients; participation in community education health programs; participation in patient care review committees; inspection of patient areas to verify that patient needs are met; and coordination of all nursing activities and functions with other residential health care facility functions.

(a) Standard unit of measure: average number of nursing department employees. The sum of the average number of nursing service personnel working in the various departments throughout the residential health care facility under the direction of nursing administration.

(b) Data source. The average shall be determined by adding the number of nursing service personnel who worked for at least four pay periods during the year and dividing the total by the number of pay periods used. Payroll records should be used to obtain this information.
 

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Section 455.14 - Activities program

455.14 Activities program. This functional reporting center must contain all the expenses associated with providing recreational and leisure-time facilities, activities and services to patients both at the facility and on special group activities including trips for recreational purposes, excluding transportation costs. This department is supervised by personnel trained for administration of an activities program. Additional activities encompassed by this functional reporting center include but are not limited to the following: coordinating and scheduling activity programs; arranging for special group activities and trips; arranging for transportation to activities; supervising activity programs; participating in discharge coordination as required by code.

(a) Standard unit of measure: total number of participants in program. Count one participant for each person participating in each activity.

(b) Data source. The total number of participants in the program shall be determined from the activities logs.
 

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Section 455.15 - Nonphysician education

455.15 Nonphysician education. This functional reporting center must contain all the direct expenses associated with State-approved schools for educating professional people other than physicians. Additional activities include but are not limited to the following: student assistance; selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining an education library and student personnel records; counseling students regarding their professional, personal and educational problems; selecting faculty personnel; assigning and supervising students in on-the-job training; and administering aptitude tests and other tests for counseling and selection purposes.

(a) Standard unit of measure: number of students. Number of students enrolled in the program(s). This number should be appropriately weighted for students who do not attend for the entire school year, and for those who do not undertake a full education workload as defined by the program.

(b) Data source. The number of students shall be determined from the education department's records.
 

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Section 455.16 - Medical education

455.16 Medical education. This functional reporting center must contain all expenses associated with organized medical education programs approved by the American Medical Association that provide medical clinical education to interns and residents. Additional activities include but are not limited to the following: providing services of interns and residents; selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling students regarding professional, personal and educational problems.

(a) Standard unit of measure: number of students. Number of students in the program(s). This number should be appropriately weighted for students who are not in the program for the entire year, and for those who do not undertake a full workload as defined by the program.

(b) Data source. The number of students shall be determined from the education department's records.
 

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Section 455.17 - Medical director's office

455.17 Medical director's office. This functional reporting center must contain all the expenses, both professional and clerical, associated with the medical director's office and providing overall medical administration at the facility. Additional activities include but are not limited to the following: providing administrative guidance to physicians at the facility; monitoring the quality of physician care; conducting medical staff meetings; providing clerical assistance to physicians. Note that the time spent by the medical director on direct patient care, as well as in this function, must be specifically assigned to the appropriate reporting center and is not subject to the reclassification criteria. Reference: section 452.4(i) and section 454.2(b) of this Article.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.18 - Housing

455.18 Housing. This functional reporting center must contain all the expenses associated with the provision of living quarters to residential health care facility employees.

(a) Standard unit of measure: average number of persons housed. Average number of employees housed in residential health care facility residences. This number should be appropriately weighted for employees housed for periods less than the full year.

(b) Data source. This average should be calculated from records maintained in the housing office.
 

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Section 455.19 - Medical records

455.19 Medical records. This functional reporting center must contain all the expenses associated with maintaining a record system for the use, transcription, retrieval, storage and disposal of patient medical records and production of indexes, abstracts and statistics for residential health care facility management and medical staff use. Additional activities include but are not limited to: operating microfilm equipment (or equivalent).

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.20 - Utilization review

455.20 Utilization review. This functional reporting center must contain all the expenses associated with providing utilization review. Reference: section 416.9 of this Subchapter. Additional activities include but are not limited to the following: conducting ongoing evaluation of the quality of care provided. This includes periodic review of utilization of bed facilities and of the diagnostic, nursing and therapeutic resources of the residential health care facility with respect to availability of these resources to all patients according to their medical needs, and recognition of the medical practitioner's responsibility for the costs of health care. This review should cover necessity of admission (including concurrent review of admission), length of stay, level of care, quality of care, utilization of ancillary services, professional services furnished, and availability and alternative use of facilities and services. The review committee should include two or more physicians with participation of other professional personnel, or a group outside the facility which is similarly composed and which is established by the local medical society and some or all of the residential health care facilities in the locality, or a group established and organized in a manner approved by the Department of Health that is capable of performing such function.

(a) Standard unit of measure: number of cases reviewed. The total number of patient cases reviewed by the Utilization Review Committee. If a case is reviewed more than once, it should be counted as a case reviewed, each time reviewed.

(b) Data source. The number shall be determined from an actual count maintained in the Utilization Review Committee.
 

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Section 455.21 - Social services

455.21 Social Services. (a) This functional reporting center must contain all the expenses associated with obtaining, analyzing and interpreting social and economic information to assist in diagnosis, treatment and rehabilitation of patients, including counseling of staff and patients in case units and group units, participating in the development of community social and health education programs, coordinating the admission and transfer of patients, coordinating discharges, and providing religious counseling and services. Additional activities include but are not limited to the following: filling out admission forms; scheduling admission times; accompanying patients to rooms or service areas after admission and arrangement of admission details; interviewing patients and relatives in order to obtain social history relevant to medical problems and planning; interpreting problems of social situations as they relate to the medical condition and/or hospitalization of the patient; arranging for post-discharge care of chronically ill patients; and collecting and revising information on community health and welfare resources.

(b) Standard unit of measure. None.
 

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Section 455.22 - Transportation

455.22 Transportation. This functional reporting center must contain all the expenses associated with the transporting of patients and supplies to and from the facility on behalf of patient-related activities. Additional activities include but are not limited to the following: transporting patients to and from scheduled outside activities; transporting patients to and from department and other stores; transporting supplies to be used in patient-related activities.

(a) Standard unit of measure: number of trips. The total number of trips made for the purpose of transporting patients and supplies to and from the facility.

(b) Data source. The number of trips shall be determined from departmental logs.
 

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Section 455.23 - Laboratory services

455.23 Laboratory Services. This functional reporting center must contain all the expenses associated with performance of diagnostic and routine laboratory tests on tissues and cultures necessary for the diagnosis and treatment of residential health care facility patients. This functional reporting center should also include maintenance of a blood bank within the residential health care facility. Additional activities include but are not limited to the following: transportation of specimens from nursing floors; care of laboratory equipment; preparation of samples for testing; drawing or otherwise procuring, processing, storing and issuing whole blood and blood derivatives.

(a) Standard unit of measure: CAP workload measurement units. A Workload Recording Method for Clinical Laboratories, published by the College of American Pathologists (use the latest edition). In recording workload measurement units, workload units related to quality control studies, calibration standards and specimen collection, and repeats for which a patient is not charged, are not to be counted. Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel. Workload measurement units shall be maintained and reported for laboratory services obtained from outside laboratories.

(b) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory. Copies of the Workload Recording Method can be obtained by writing to:

College of American Pathologists

7400 North Skokie Boulevard

Skokie, IL 60076
 

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Section 455.24 - Electrocardiology

455.24 Electrocardiology. This functional reporting center must contain all the expenses associated with the operation of specialized equipment to record electromotive variations in actions of the heart muscle on an electrocardiograph for diagnosis of heart ailments. Additional activities include but are not limited to the following: wheeling portable equipment to patients' bedsides; explaining test procedures to patients; operating electrocardiograph equipment; inspecting, testing and maintaining special equipment; and attaching and removing electrodes to and from patients.

(a) Standard unit of measure: CAP workload measurement units. Reference: section 455.23(a) of this Part.

(b) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory.
 

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Section 455.25 - Electroencephalogy

455.25 Electroencephalogy. This functional reporting center must contain all the expenses associated with the operation of specialized equipment to record electromotive variations in brain waves on an electroencephalograph for diagnosis. Additional activities include but are not limited to the following: wheeling portable equipment to patients' bedside; explaining test procedures to patient; operating electroencephalograph equipment; inspecting, testing and maintaining special equipment.

(a) Standard unit of measure: CAP workload measurement units. Reference: section 455.23(a) of this Part.

(b) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory.
 

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Section 455.26 - Radiology

455.26 Radiology. This functional reporting center must contain all the expenses associated with the provision of diagnostic radiology services under the direction of a radiologist as required for the examination and care of patients. Additional activities include but are not limited to the following: taking and processing fluorographs and radiographs; examining and interpreting results; consulting with patients and attending physicians; disposing of radioactive waste; and storing and retrieving film and radioactive materials.

(a) Standard unit of measure: relative value units. Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies, pages 142-155, California Medical Association, 44 Gough Street, San Francisco, CA 94103. Copies of this publication are available from the Office of Health Systems Management, Department of Health, Empire State Plaza, Corning Tower, Albany, NY 12237, and a copy is available for inspection and copying at the offices of the records access officer of the Department of Health, Empire State Plaza, Corning Tower, Albany, NY 12237. Relative value units for unlisted and "BR" (By Report) procedures should be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. Count "Total Unit Value," not "PC Unit Value."

(b) Data source. The number of relative value units shall be the actual count maintained by the radiology department. Copies of the California Relative Value Scales can be obtained from the Office of Health Systems Management by requesting a copy of Health Facilities Memorandum No. 78-72, dated August 7, 1978.
 

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Section 455.27 - Inhalation therapy

455.27 Inhalation therapy. This functional reporting center must contain all the expenses associated with the administration of oxygen and certain potent drugs through inhalation or positive pressure and other forms of rehabilitative therapy as prescribed by physicians. This function is performed by specially trained personnel who initiate, monitor and evaluate patient performance, cooperation and ability during testing procedures. Additional activities include but are not limited to the following: assisting physician in performance of emergency care; maintaining open airways, breathing and blood circulation; maintaining aseptic conditions; transporting equipment to patients' bedsides; observing and instructing patients during therapy; visiting all assigned patients to ensure that physicians' orders are being carried out; inspecting and testing equipment; enforcing safety rules; and calculating test results.

(a) Standard unit of measure: number of treatments. Count each procedure as one treatment. Administering of oxygen should be reported as one procedure, regardless of service time, except in those instances where oxygen is continuously administered. In such instances, one treatment would be counted for each 24-hour period.

(b) Data source. The number of treatments shall be obtained from an actual count maintained by the inhalation therapy department.
 

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Section 455.28 - Podiatry

455.28 Podiatry. This functional reporting center must contain all the expenses associated with the provision of specialized diagnostic and therapeutic procedures in treatment of a patient by a podiatrist and/or podiatry staff. Additional activities include but are not limited to the following: examination of patients; consulting with patients and attending physicians.

(a) Standard unit of measure: number of visits. A visit is defined as medical attention provided by the podiatry department regardless of whether the patient visits the podiatry department or is visited in his room by the podiatrist and/or podiatry staff.

(b) Data source. The number of visits shall be an actual count maintained by the podiatry department.
 

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Section 455.29 - Dental

455.29 Dental. This functional reporting center must contain all the expenses associated with the provision of preventive and emergency dental care under the supervision of a dentist or other licensed dental personnel. Additional activities include but are not limited to the following: examination and treatment of patients; consulting with patients and attending physician.

(a) Standard unit of measure: number of visits. A visit is defined as dental attention provided by the dentist and/or dental staff, regardless of whether the patient visits the dental department or the patient is visited by the dentist and/or dental staff.

(b) Data source. The number of visits shall be an actual count maintained by the dental office.
 

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Section 455.30 - Psychiatric

455.30 Psychiatric. This functional reporting center must contain all the expenses associated with providing specialized diagnostic and therapeutic procedures by a licensed psychiatrist or psychologist. Additional activities include but are not limited to the following: consultation with patients, patient relatives and attending physician; establishing goal-directed relationship with patient; participating in group and milieu therapy.

(a) Standard unit of measure: number of visits. A visit is defined as psychiatric care provided by the psychiatrist and/or psychiatric staff, regardless of whether the patient visits the psychiatric office or is visited by the psychiatrist and/or psychiatric staff.

(b) Data Source. The number of visits shall be an actual count maintained by the psychiatric office.
 

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Section 455.31 - Physical therapy

455.31 Physical therapy. This functional reporting center must contain all the expenses associated with employing therapeutic exercises and massage and utilizing effective properties of heat, light, cold water and electricity for diagnosis and rehabilitation of patients with neuromuscular, orthopedic and other impairments. Such services are provided in a coordinated and integrated program under the direction and prescription of a physician or a registered physical therapist. Additional activities include but are not limited to the following: the provision of clinical and consultative services; the direction of patients in the use, function and care of braces, artificial limbs and other devices; prescribing therapeutic exercises; counseling patients and their relatives; organizing and conducting medically prescribed physical therapy programs; applying diagnostic muscle tests; administering whirlpool and compact baths; changing linen on physical therapy department beds and treatment tables; assisting patients in changing clothes and other personal needs and participating in discharge coordination as required by the code.

(a) Standard unit of measure: number of treatments. (1) A treatment should be synonymous with a visit. The treatment would consist of one or more modalities and/or procedures rendered during one patient visit. If a patient received two such visits in one day, that would constitute two treatments. The main difference between a skilled (or rehabilitative) treatment and a maintenance visit lies in the purpose and method of provision. A skilled treatment is rendered with the expectation of improving the patient's condition and is given by the licensed therapist or under the therapist's direct supervision. A maintenance procedure is designed to help keep the patient at his/her present level of function and is most often performed by ancillary personnel and does not require direct supervision. Maintenance procedures, for the most part, do not require the therapist's skills and do not utilize the more refined modalities or procedures.

(2) For purposes of reporting under this Article, a count of the total number of treatments, both skilled and maintenance, will be required. However, facilities must also maintain statistics which segregate skilled treatments from maintenance procedures as they will be required for reporting to the Department of Health for other purposes, i.e., management assessment, PMR/IPR's and surveys.

(b) Data source. The number of treatments shall be an actual count maintained by the physical therapy department.
 

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Section 455.32 - Occupational therapy

455.32 Occupational therapy. This functional reporting center must contain all the expenses associated with teaching manual skills and independence in personal care to stimulate mental and emotional activity on the part of patients. This would include the utilization of modalities and tests of occupational therapy and rehabilitative nursing in a coordinated and integrated program of services under the direction of a physician. This would consist of instructing patients in prescribed academic subjects to prevent mental deconditioning, improving patients' mental and physical conditions and aiding in the attainment of knowledge and skills that will further patients' progress toward vocational objectives. Additional activities include but are not limited to the following: evaluation by conducting diagnostic tests; consultations; prescriptions and carrying out prescriptions; assisting patients with personal needs; counseling patients' relatives and employees on both individual case and group bases; administering accreditation and other academic tests; instructing patients in technical aspects of work participation and in discharge coordination as required by the code.

(a) Standard unit of measure: number of treatments. Count each procedure as one treatment. In group sessions, the number of treatments would be equal to the number of patients in the group.

(b) Data source. The number of treatments shall be an actual count maintained by the occupational therapy department.
 

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Section 455.33 - Speech and hearing therapy

455.33 Speech and hearing therapy. This functional reporting center must contain all expenses associated with the utilization of modalities and tests of speech and hearing therapy and rehabilitation nursing in a coordinated and integrated program of services under the direction and prescription of a physician. Additional activities include but are not limited to the following: evaluation by conducting diagnostic tests; consultations, prescriptions, and carrying out prescriptions; assisting patients with personal needs; and participation in discharge coordination as required by code.

(a) Standard unit of measure: number of treatments. Count the number of treatments for each modality or procedure provided to a patient. When a combination of modalities and procedures is provided, the count shall include the individual modality(ies) and procedure(s).

(b) Data source. The number of treatments shall be obtained by an actual count maintained by the speech and hearing therapy department.
 

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Section 455.34 - Pharmacy

455.34 Pharmacy. This functional reporting center must contain all the expenses associated with the procurement, preservation, storage, compounding, manufacturing, packaging, controlling, assaying and dispensing of medications (including intravenous solutions) for in-and out-patients carried out under the jurisdiction of a licensed pharmacist. This functional reporting center should include the cost of drugs charged to patients and the cost of non-billable floor stock distributed to the various departments. Additional activities include but are not limited to the following: developing and maintaining formularies established by the medical staff; consulting and advising medical staff and nursing staff on drug therapy overdoses; adding drugs to I.V. solutions; analyzing incompatibility of drug combinations; and stocking of floor drugs and dispensing machines.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.35 - Central services supply

455.35 Central services supply. This functional reporting center must contain all the expenses associated with the preparation and issuance of medical and surgical supplies and equipment to patients and other functional reporting centers, and the cost of medical/surgical supplies and equipment charged to patients and the cost of non-billable medical supplies distributed to the various floors as stock. Additional activities include but are not limited to the following: requisitioning and issuing appropriate supply items required for patient care; preparing sterile irrigating solutions; collecting, assembling, cleaning, sterilizing and redistributing reusable items; and cleaning, assembling, maintaining and issuing of portable apparatus.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.36 - Medical staff service

455.36 Medical staff service. This functional reporting center must contain all the expenses associated with services to patients provided by physicians who are not assigned to specific professional service departments. All remuneration for physicians' services should be reported under this functional classification for payment to chiefs of service, house officers, and all other physicians not assigned to a specific professional service department. Note that the assignment of physicians' costs are not subject to the reclassification criteria and must be directly assigned in accordance with section 452.4(i) of this Article.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.37 - Skilled nursing facility

455.37 Skilled nursing facility. This functional reporting center must contain all the expenses associated with providing skilled nursing care to patients on the basis of physicians' orders and approved nursing care plans, when patients require convalescent rehabilitative and/or restorative services at a level less intensive than that of the usual medical acute care. Additional activities include but are not limited to the following: monitoring vital life signs; operating specialized equipment; preparing equipment and assisting physicians during patient examinations and treatments; changing dressings and cleansing wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping them in and out of bed; observing patients for reaction to drugs; administering specified medication; serving food to patients in their rooms, and feeding patients regardless of location; assisting patients with daily hygiene; answering patient calls; stripping and making beds; and keeping patients' rooms in order.

(a) Standard unit of measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

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Section 455.38 Reserved

Section 455.39 - Adult care facility

455.39 Adult care facility. This functional reporting center must contain all the expenses associated with the provision of supportive, restorative and preventive health care for ambulatory patients who are capable of caring for themselves under supervision.

(a) Standard unit of measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

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Section 455.40 - Intermediate care facility--mental retardation

455.40 Intermediate care facility--mental retardation. This functional reporting center must contain all the expenses associated with the provision of safe, hygienic, sheltered living for mentally retarded patients not capable of fully independent living. Regular and frequent medical nursing services are provided.

(a) Standard unit of measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

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Section 455.41 - Independent living

455.41 Independent living. This functional reporting center must contain all the expenses associated with the provision of a safe and sheltered place of living for those capable of fully independent living. Quarters are usually provided in the form of apartment complexes. Note that any housekeeping, dietary or other services provided should be reported in their respective functional cost center.

(a) Standard unit of measure: number of occupant days. Report occupant days for all occupants assigned to this unit. Include the initial day of occupancy but not the day of vacancy.

(b) Data source. The number of occupant days shall be taken from daily census counts.
 

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Section 455.42 - Specialty pediatric

455.42 Specialty pediatric. This functional reporting center must contain all the expenses associated with the provision of extensive nursing, medical, psychological and counseling support services to children with diverse and complex medical, emotional and social problems in a program recognized and approved by the department to provide specialty pediatric services.

(a) Standard unit of measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

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Section 455.43 - Head injury

455.43 Head injury. This functional reporting center must contain all the expense associated with a planned combination of services provided in a residential health care facility unit as a provider of specialized services for head injured patients.

(a) Standard unit of measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

Effective Date: 
Tuesday, January 1, 1991
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Section 455.44 - Acquired Immune Deficiency Syndrome

455.44 Acquired Immune Deficiency Syndrome. This functional reporting center must contain all the expenses associated with the care of individuals with AIDS, AIDS related complex, and those diagnosed with other human immunodeficiency virus related illnesses in a discrete AIDS unit within a residential health care facility or in a free standing designated AIDS center. Costs associated with AIDS patients in designated or undesignated AIDS beds in an existing non-AIDS unit will remain a part of that unit's costs.

(a) Standard unit of measure: number of patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same say, the day is considered a day of admission and counts as one patient day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

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Tuesday, January 1, 1991
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Section 455.45 - Long term ventilator dependent

455.45 Long term ventilator dependent. This functional reporting center must contain all the expenses associated with the provision of nursing services to long term ventilator dependent patients in a discrete unit established and approved to provide care to such patients.

(a) Standard unit of measure: number of patient days of care for all patients admitted to this unit. Include the day of admission but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(b) Data source. The number of patient days shall be taken from daily census counts.
 

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Section 455.46 - Outpatient clinics

455.46 Outpatient clinics. This functional reporting center must contain all the expenses associated with an organized service providing diagnostic, preventive, curative, rehabilitative and educational services on a scheduled basis to ambulatory patients. Additional activities include but are not limited to the following: participating in activities designed to promote health education; assisting in administration of physical examinations and diagnosis and treatment of ambulatory patients; referring patients who require prolonged or specialized care to appropriate services; assigning patients to physicians in accordance with clinic rules; and making patients' appointments through required professional service functions.

(a) Standard unit of measure: number of visits. Enter all visits to medical clinics. Each visit is counted as one.

(b) Data source. The number of visits shall be the actual count maintained by the clinics.
 

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Section 455.47 - Adult day health care

455.47 Adult day health care. This functional reporting center must contain all the expenses associated with the provision of organized treatment on a scheduled basis for ambulatory patients. This unit is used to provide medical supervision and evaluation to patients who require a minimal amount of nursing supervision.

(a) Standard unit of measure: number of visits. Enter all visits to the day care center. Each visit is counted as one.

(b) Data source. The number of visits shall be the actual count maintained by day care.
 

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Tuesday, January 1, 1991
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Section 455.48 - Home health care

455.48 Home health care. This functional reporting center must contain all the expenses associated with the provision of nursing care and professional and nonprofessional services to patients at their place of residence. Activities include but are not limited to the following functions which can be performed to patients outside the residential health care facility: nursing care; intravenous therapy; inhalation therapy; electrocardiology; physical therapy; occupational and recreational therapy; speech and hearing therapy; social services; dietary services; and housekeeping services.

(a) Standard unit of measure: number of home health patient visits. The number of home health patient visits shall be the number of home health patients visited at their place of residence by representatives of the home health program.

(b) Data source. The number of home health patient visits shall be the actual count obtained from home health services.
 

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Section 455.49 - Homemaker

455.49 Homemaker. This functional reporting center must contain all the expenses associated with the provisions of domestic services to patients at their place of residence. Additional activities include but are not limited to the following functions which can be performed under this program at the patient's residence: housekeeping, dietary, maintenance, laundry and linen, and patient education.

(a) Standard unit of measure: number of homemaker visits. The number of homemaker visits shall be the number of homemaker patients visited at their place of residence by representatives of the homemaker program.

(b) Data source. The number of homemaker visits shall be the actual count obtained from homemaker services.
 

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Section 455.50 - Meals on wheels

455.50 Meals on wheels. This functional reporting center must contain all the expenses associated with the provision of dietary services to patients at their place of residence.

(a) Standard unit of measure: number of meals. The number of meals provided by the residential health care facility to participants in the meals on wheels program.

(b) Data source. The number of meals shall be determined from an actual count maintained by the dietary department at the facility.
 

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Section 455.51 - Research

455.51 Research. This functional reporting center must contain all the expenses associated with the overall administrative management of all research projects carried on by the facility. This would include all expenses associated with all research activities that are specifically funded by internal or external sources.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.52 - Physicians' offices and other rentals

455.52 Physicians' offices and other rentals. This functional reporting center must contain all the expenses associated with the provision of rental space to physicians and other professional persons, and with other rental activities engaged in by the residential health care facility, such as the rental of movable equipment.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.53 - Gift shop

455.53 Gift shop. This functional reporting center must contain all the expenses associated with the operation of a gift shop maintained on the premises of the residential health care facility. This would include the provision of space for the maintenance of a gift shop, as well as direct salaries and incurred expenses in gift shop operations.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.54 - Public restaurant

455.54 Public restaurant. This functional reporting center must contain all the expenses associated with the operation of a restaurant open to the general public on the premises of the residential health care facility.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.55 - Fundraising

455.55 Fundraising. This functional reporting center must include all the expenses associated with fundraising efforts by the residential health care facility.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.56 - Barber and beauty shop

455.56 Barber and beauty shop. This functional reporting center must contain all the expenses associated with providing barber and beautician services to the patients at the residential health care facility.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Section 455.57 - Sold services

455.57 Sold services. This functional reporting center must contain all the expenses related to the sale of services to individuals or enterprises outside of and unrelated to the ordinary functions of the residential health care facility. Activities would include but are not limited to the following: housekeeping services; laundry and linen services; data processing; management services; education services; janitorial services; purchasing; laboratory, etc.

(a) Standard unit of measure. None.

(b) Data source. Not applicable.
 

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Part 456 - Cost-Finding Practices And Procedures

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 456.1 - Introduction

Section 456.1 Introduction. (a) Cost finding is the apportionment or allocation of the costs of the nonrevenue-producing centers to each other and to the revenue-producing centers and final program centers on the basis of statistical data reflective of the amount of service rendered by each center to the other centers.

(b) In general, each nonrevenue, ancillary revenue or program revenue center has a total expense of operation which can be described in an algebraic equation comprised of its own direct expense plus some fraction of the total expense of the operation of each of the other centers.

(c) Also, each center has a relationship to each of the other centers that can be described by a statistical allocation basis which is reflective of the relative amount of service rendered.

(d) Cost finding is a mathematical process used to solve the problem of allocating expenses to each center and subtotal expense in each ancillary or program center after the allocation of nonrevenue centers has been accomplished.

(e) While there are a number of methods that can be and have been used (direct allocation, single step down, multiple step down, matrix inversion, etc.), the matrix inversion process which solves equations simultaneously is the most accurate. This process recognizes all the services provided by one reporting center to all other centers. The complete recognition of services is not possible to the same degree in the other cost-finding processes. Although it is anticipated that the matrix inversion process will be used, the uniform system of statistical allocation is applicable to any process.

(f) This Part discusses the segregation of costs, the source for the compilation of data and other information pertinent to the cost allocation process.

(g) When the single step-down method of cost allocation is employed, the cost centers involved in the step down shall be arrayed in the following sequence:

Depreciation, Leases and Rentals

Depreciation on Major Movable Equipment

Interest on Capital Debt

Fiscal Services

Administrative Services

Plant Operation and Maintenance

Grounds

Security

Laundry and Linen

Housekeeping

Patient Food Service

Cafeteria

Nursing Administration

Activities Program

Non-Physician Education

Medical Education

Medical Director's Office

Medical Records

Utilization Review

Social Service

Transportation

Laboratory Service

Electrocardiology

Electroencephalogy

Radiology

Inhalation Therapy

Podiatry

Dental

Psychiatric

Physical Therapy

Occupational Therapy

Speech and Hearing Therapy

Pharmacy

Central Service Supply

Medical Staff Service

Ancillary--Other--A

Ancillary--Other--B

Ancillary--Other--C
 

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Section 456.2 - Statistics and sampling

456.2 Statistics and sampling. (a) A standard statistical allocation has been set forth for each functional reporting center. This prescribed minimum statistic must be reported based on residential health care facility records for functional reporting centers which have their own direct costs as well as centers which may receive only indirect costs as a result of cost finding.

(b) Alternative statistics may be developed and utilized for cost allocation of a functional center if such alternative basis had been used in the past and approved through audit by the third-party reimbursement agency auditor.

(c) However, a residential health care facility utilizing an alternative statistical basis must also report the minimal acceptable statistics set forth in this Part. A residential health care facility wishing to change its statistical allocation basis at any time in the future must collect the data and submit same to the New York State Department of Health, or other body if established, for approval as an exception to the approved cost allocation basis before it can be used. See procedure for same in Part 457 of this Article. Once an alternative statistic is used, it must remain in use until approval is given to alter the approved statistical basis.

(d) It is understood that in some instances a residential health care facility may not be able to accumulate the statistics for a full year. Under these circumstances, the residential health care facility may use a sample for accumulation of the data. A discussion of the sampling technique is presented in section 456.4 of this Part. The minimum mandated statistical basis for cost allocation is presented in section 456.3. A more precise definition for the compilation of the data is provided in section 456.5.
 

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Section 456.3 - Mandated statistical bases for cost allocation

456.3 Mandated statistical bases for cost allocation. The following represent the minimum mandated statistical bases for cost allocation.
(a) Nonrevenue support services.

Functional reporting center Allocation basis

(1) Depreciation, Leases and Depreciation by building,
Rentals by Department

(2) Depreciation on Major Movable For assets acquired prior to
Equipment 1/1/78, depreciation may be
allocated to departments
based on square feet, net.
For major movable equipment
acquisitions subsequent to
1/1/78, depreciation on such
assets must be assigned based
on the physical location of
the equipment.

(3) Interest on Capital Debt Square feet of building for
incurred which debt incurred and
actual depreciation ofmajor
movable equipment.

(4) Fiscal Services Accumulated costs

(5) Administrative Services Accumulated costs

(6) Plant Operation and Maintenance Square feet, net

(7) Grounds Square feet, net

(8) Security Square feet, net

(9) Laundry and Linen Dry and Clean pounds
distributed, includes
the equivalent weight of
disposable linens
distributed

(10) Housekeeping Assigned time

(11) Patient Food Service Dietary meals served

(12) Cafeteria Average number of employees

(13) Nursing Administration* Total hours of direct nursing
service

(14) Activities Program Number of participants, by
program

(15) Non-Physician Education Assigned time of students

(16) Medical Education Assigned time--interns and
residents

(17) Medical Director's Office* Time spent

(18) Housing Number of rooms occupied by
department assigned

(19) Medical Records* Hours of service

(20) Utilization Review Number of cases reviewed, by
program area

(21) Social Services* Hours of service

(22) Transportation* Number of users, by program

(b) Ancillary service revenue centers.

Functional Reporting Center Allocation Basis

(1) Laboratory Services CAP workload measurement units

(2) Electrocardiology CAP workload measurement units

(3) Electroencephalogy CAP workload measurement units

(4) Radiology Relative value units

(5) Inhalation Therapy Number of treatments

(6) Podiatry Number of visits

(7) Dental Number of visits

(8) Psychiatric Number of visits

(9) Physical Therapy Number of treatments

(10) Occupational Therapy Number of treatments

(11) Speech and Hearing Therapy Number of treatments

(12) Medical Staff Services* Hours of service by physician

(13) Pharmacy** Costed requisitions

(14) Central Service Supply** Costed requisitions
(c) Exceptions.
*(1) For facilities with a single program service classification the cost allocation bases indicated in subdivisions (a) and (b) of this section by an asterisk (*) are waived.
**(2) In Pharmacy and Central Services Supply cost centers, indicated by (**) in subdivision (b) of this section, for facilities with a single program service classification, the cost allocation bases are waived. However, requisitions for these cost centers for the sample periods must be retained as an audit trail showing that such supplies were not utilized in areas other than the program area. Also, for Pharmacy costs in multicare facilities, see section 456.5(p) of this Part for alternate pricing out of requisitions allowable.

 

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Section 456.4 - Sampling technique

456.4 Sampling technique. (a) The following allocation bases may be sampled for the functional reporting centers indicated, rather than having actual cost allocation statistics accumulated for a full year:

(1) dry and clean pounds distributed (Laundry and Linen);

(2) hours of service (Medical Records) (Medical Staff Services) (Social Services);

(3) time spent (Medical Director's Office);

(4) total hours of nursing service (Nursing Administration);

(5) costed requisitions (Pharmacy) (Central Service Supply);

(6) assigned time (Housekeeping); and

(7) the allocation basis for any cost center not having direct costs, but which receives indirect costs as a result of the cost-finding process.

(b) The sampling plan used by the residential health care facility need not conform to the strict mathematical concepts inherent to statistical sampling. The recommended approach to be used to sample statistics used as an allocation basis is as follows:

(1) A minimum of eight calendar weeks will be selected each year for the accumulation of data.

(2) These eight weeks will be representative of the full year. In order to achieve this, the facility will select a two-week block (14 consecutive days) within each fiscal quarter for the collection of data.

(3) The same two-week block need not be used for all statistics.

(4) During the testing period, actual counting, weighing, etc. will be done for all shifts involved in the particular area.

(c) Periods of unusual circumstances should be avoided as test weeks. The principle of representative samples is the ultimate goal.

(d) It should be noted that sampling techniques may only be utilized for those statistical bases indicated above and only with respect to cost allocation. Statistics utilized for the standard unit of measure may not be sampled.
 

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Section 456.5 - Compilation of statistical data

456.5 Compilation of statistical data. The cost allocation process utilizes statistics in distributing costs among the various residential health care facilities services. In order to facilitate the development of appropriate statistical data, set forth below is a definition and source of the required statistic for each nonrevenue-producing department. The statistical bases for cost allocation for ancillary services are the same as the standard units of measure except that such statistics must be segregated by program level of patients served.

Statistic Definition or method of computation Source

(a) Square The number of net square feet in each Blueprints of the feet, net department should be determined either residential health by a physical measurement of the facility care facility or or by a measurement from blueprints. actual measurement Floor area measurements should be taken if blueprints are from the center of walls to the center of not available. adjoining corridors if a hallway services more than one department. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc., serving only one department should be included in that department. When changes in assigned areas have been made during the year as a result of new construction, departmental relocation, expansion or curtailment of service, statistical data should be maintained to allow for the development of weighted areas for the fractional part of the year. Where the same area serves more than one function, this area must be apportioned between functions. Where costs applicable to a particular building are identifiable, e.g., depreciation, the costs should be distributed by the square feet in that building alone, and to the corresponding department.

(b) Square The number of gross square feet in each Blueprints of the feet, gross department should be determined by a residential health physical measurement of the residential care facility or health care facility or by a measurement actual measurement from blueprints. Measurement should be if blueprints are taken from the exterior wall or railing to not available. the center of adjoining interior corridors if a hallway services more than one department. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc., serving only one department should be included in that department. When changes in assigned areas have been made during the year as a result of new construction, departmental relocation, expansion or curtailment of service, statistical data should be maintained to allow for the development of weighted areas for the fractional part of the year. Where the same area serves more than one function, this area must be apportioned between or among the appropriate functions. Where costs applicable to a particular building are identifiable, e.g., depreciation, the costs should be distributed by the square feet of that building alone, and to the corresponding department.

(c) Major Depreciation on major movable equipment General accounting movable allocated to departments, based on the records and equipment department where the equipment is physically blueprints of the depreciation located and utilized. For acquisitions prior residential health by to 1/1/78, allocation may be based on square care facility or department feet, net. actual measurement.

(d) Square The interest expense related to the building General accounting feet of and fixed equipment must be allocated to records and building for departments in the building based upon gross blueprints of the which debt square feet. The interest expense related to residential health incurred and the major movable equipment will be care facility or actual allocated based upon actual department actual measurement. depreciation depreciation of major movable equipment. of major movable equipment

(e) Depre- The depreciation expense for each building General accounting ciation by distributed through gross square feet to records and building, by departments in that building. blueprints of the department. residential health care facility or actual measurement.

(f) Accumu- The direct costs of each reporting center Stepdown report lated costs and indirect costs previously allocated. (For) other than inversion process. matrix

(g) Hours of Accumulated hours of service to departments Departmental service or by program. records.

(h) Dietary Number of meals served shall include only Actual count meals served regularly scheduled meals and exclude maintained by snacks and fruit juices served between dietary regularly scheduled meals. Also includes department. tube feeding at the rate of three meals for each day so fed.

(i) Average The average number of employees in each Payroll records. number of department. This average should be computed employees computed by using at least one pay period per quarter. (j) Total Hours of nurses providing direct patient Payroll records. hours of care for which administration is provided. direct nursing service

(k) Assigned Hours of students enrolled in programs Education records. time of by assigned department. students

(l) Assigned Number of full-time equivalent interns and Education records. time--interns residents in approved teaching programs, and residents by assigned departments.

(m) Time Number of minutes/hours utilized by a Departmental log. spent department.

(n) Dry and Statistic shall include the weight of linen Actual count clean pounds distributed for the residential health care maintained inthe distributed facility's use (including linen of laundry and linen personnel quarters and employee housing). department. Also shall include equivalent weight of disposable linens distributed.

(o) Number of Where housing is provided, a count of the Personnel records rooms number of rooms occupied by physicians and and general occupied by employees, totaled by the departments they accounting records. department are assigned to, regardless of whether or assigned not the facility receives income.

(p) Costed The aggregate cost of goods supplied to General requisitions departments. For the Pharmacy cost center, accounting the prices shown in the Red Book or Blue records. Book reference manuals may be utilized rather than actual invoice price. Such reference manuals are published annually (the Red Book one half of the year; the Blue Book the other half).

(q) Number Number of patient cases reviewed by Department of cases Utilization Review personnel, by program records. reviewed, by area. program area

(r) Number of Number of patients using transportation, Department log. users, by by program area. program area

(s) Assigned The hours (or other unit of time) assigned Department log. time to service each department. Exclude common or unused areas. Time assigned to shared areas is to be allocated to the reporting centers sharing those areas on an equitable basis.
 

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Part 457 - Interpretations

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 457.1 - Interpretations

Section 457.1 Interpretations. This Part contains the procedures for requesting interpretations and special waivers relating to this Article.

(a) Residential health care facilities may have significant questions relative to the meaning and interpretation of various aspects of this Article. Correspondence requesting interpretations should include suggestions on how the issue in question should be handled and considered by any advisory group to the Department of Health. Correspondence requesting interpretations and/or waivers with supporting documentation should be sent to:

New York State Office of Health Systems Management Division of Health Care Financing Empire State Plaza Albany, N.Y. 12237

(b) Major instances or items for which approval or interpretation may be sought include:

(1) interpretation of statements, as applied to a specific residential health care facility;

(2) approval to change allocation statistics;

(3) approval to establish new functional centers; and

(4) approval to waive specific procedures based on unique situations of the facility.
 

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Part 458 - Natural Classification of Expense

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Sections 2803(2), 2803-b, 2805-e, 2808

Section 458.1 - Introduction

458.1 Introduction. This Part contains the definitions (where necessary) of the natural classifications of expense which, as indicated in section 453.2(c) of this Article are a mandated reporting level for expenses. Also contained in this Part are two indexes: one for salaries and wages, by job title; the other, a supplies and materials classification index. The indexes present guidelines for classifying wages and salaries by specific job titles and for proper classification of supplies and services expense.
 

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Section 458.2 - Salaries and wages

458.2 Salaries and wages. (a) General.

(1) If management is to have maximum control over labor costs, close control of the number of man-hours paid is essential. Man-hours are a more stable measure of labor utilization than dollars, because man-hours are not affected by inflation. Also, when man-hours are compared to units of service, they can provide management with information that is useful both for internal control and external comparisons.

(2) A record of man-hours paid that exactly parallels the record of salaries and wages paid by department must be maintained. This requires that the residential health care facility establish a record of paid man-hours by department for all personnel whose compensation is included on the payroll, including exempt personnel. These man-hours must include separate records of worked man-hours and nonworked man-hours. Worked man-hours should include regular hours worked, overtime hours worked, hours worked when on call or on standby, hours spent in in-service education, orientation, breaks, paid social functions (such as Christmas parties), and so forth. Nonworked man-hours should include paid vacations, holidays, sick pay, military leave, educational leave, (including continuing education) bereavement or funeral leave, jury duty, benefit hours paid for but not taken as leave, and so forth.

(3) Overtime hours are hours for which an overtime pay rate is used. The actual overtime hours are not treated differently from regular worked hours; it is the rate that changes. This is preferable to the common but undesirable practice of adding additional hours to the records when calculating the payroll so that the regular pay rate can be used instead of the overtime rate.

(4) On-call and/or standby pay is compensation to an employee for being available to work. During the period when the employee is on call or on standby, he might or might not actually perform work. The Fair Labor Standards Act differentiates between restricted and unrestricted on-call situations. All restricted on-call hours are compensable and contribute to the total hours used for determining overtime pay. Unrestricted on-call hours do not contribute to total hours, but unrestricted on-call compensation does contribute to the salary base used for calculating overtime premiums only. Thus all restricted on-call hours must be accounted for, but only those hours worked need be accounted for when employees are on unrestricted on-call duty.

(5) Salaries and wages are defined as all remuneration, payable in cash, for services performed by an employee for the residential health care facility, and the fair market value of services donated to the facility by persons performing in an employee relationship. Reimbursement of independent contractors, such as private duty nurses, should be excluded.

(b) Specific classifications of salaries and wages follow:

(1) Management and supervision. Employees included in this classification are primarily involved in the direction, supervision and coordination of residential health care facility activities. Salaries and wages for this classification would usually include, but are not limited to, the following job titles: president, chief executive officer; administrator; manager; department head; supervisor; director; and foreman. These employees may be exempt from Federal wage and hour laws. Lead positions of chief, head, and so forth must be classified as Management and Supervision if they provide direct supervision to five or more other employees, except for Registered Nurses and Licensed Practical Nurses which must be classified as detailed in paragraphs (b)(3) and (b)(4) of this section. Positions supervising fewer than five employees may be classified as Management and Supervision if the activities performed otherwise meet the Management and Supervision criteria.

(2) Technicians, specialists and non-physician medical practitioners. Employees included in this classification usually perform activities of a creative or complex nature. Also included are those employed to consult, diagnose and prescribe and provide treatment to patients under the direction of a physician. Salaries and wages for this classification would usually include, but are not limited to, the following job titles: coordinator; chef; programmer; technologist; technician; therapist; instructor; nurse practitioner; physician assistant; clinical specialist and accountant. These employees are often licensed or registered. Some of these positions are exempt from Federal wage and hour laws because they are administrative or professional in nature. Lead positions of chief, head, and so forth must be classified as Management and Supervision if they provide direct supervision to five or more other employees. Positions supervising fewer than five employees may be classified as Management and Supervision if the activities performed otherwise meet the Management and Supervision criteria. (3) Registered nurses. This classification includes all registered nurses employed to provide direct nursing care to patients except the following specific job titles: RN - Supervisor (supervising two or more units), Health Services Supervisor, Director of Nursing Services and Assistant Director of Nursing Services. These specific job titles are to be reported under the classification Management and Supervision in accordance with paragraph (b)(1) of this section.

(4) Licensed practical nurses. This classification includes all licensed practical nurses employed to provide direct nursing care to patients except the following specific job titles: RN - Supervisor (supervising two or more units), Health Services Supervisor, Director of Nursing Services and Assistant Director of Nursing Services. These specific job titles are to be reported under the classification Management and Supervision in accordance with paragraph (b)(1) of this section. Employees in this classification are subject to Federal wage and hour laws.

(5) Aides, orderlies and assistants. Included in this classification are nontechnical personnel employed to provide direct nursing care to patients. Salaries and wages for this classification would usually include, but are not limited to, the following job titles; aide; orderly; and nurse assistant. These employees are subject to Federal wage and hour laws.

(6) Clerical and other administrative employees. Included in this classification are nontechnical personnel employed in the performance of recordkeeping, communication and other administrative functions, who are subject to Federal wage and hour laws. Salaries and wages for this classification would usually include, but are not limited to the following job titles: accounting clerk; admitting clerk; messenger; keypunch operator; secretary; telephone operator; clerk-typist; cashier; and receptionist.

(7) Environment, hotel and food service employees. This classification includes personnel employed to provide basic services related to food and accommodations. They perform routine work of a nontechnical nature and are subject to Federal wage and hour laws. Salaries and wages for this classification would usually include, but are not limited to, the following job titles: maintenance man; housekeeping aide; cook's helper; flatwork finisher; guard; food service worker; wall washer; washperson; carpenter and plumber.

(8) Physicians salaries. Employees included in this classification are employed to consult, diagnose, and prescribe and provide treatment for patients. Physicians are also employed to provide education. These employees must possess Doctor of Medicine or Doctor of Osteopathy degrees and be licensed to practice medicine.

(9) Interns, residents and fellows. Employees included in this classification are employed to consult, diagnose, and prescribe and provide treatment for patients. Salaries and wages for this classification would usually include, but are not limited to, the following job titles: intern; resident and fellow.
 

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Section 458.3 - Other than salaries and wages

458.3 Other than salaries and wages. (a) Employee benefits. The costs of employee benefits are charged directly to the appropriate functional reporting center. If such benefits are charged initially to an employee benefits account, they must be assigned to appropriate functional reporting centers at year-end prior to cost finding. Reference: section 452.4(a)(1)(ii). Specific classifications for employee benefits follow:

(1) Employee Uniform Allowance;

(2) FICA;

(3) State Unemployment and Federal Unemployment Insurance;

(4) Group Health Insurance;

(5) Pension and Retirement--Union;

(6) Workers' Compensation Insurance;

(7) Pension and Retirement--Nonunion;

(8) Disability;

(9) Other Employee Benefits;

(10) Union Health and Welfare; and

(11) Employee Meal Allowance.

(b) Fees. The fees and other amounts paid for professional services of people who are not on the facility's payroll are included in the following classifications:

(1) Administrative Fees--Long-Term Debt;

(2) Physicians' Fees. Included in this classification are all fees paid to nonsalaried physicians for patient care and supervisory activities, and other professional fees for service;

(3) Therapists and Other (Nonphysicians) ;

(4) Consulting and Management Services;

(5) Legal Services;

(6) Auditing Services;

(7) Registered Nurses;

(8) Licensed Practical Nurses;

(9) Private Duty Nurses' Fees; and

(10) Other Fees.

(c) Supplies and materials. The following classifications are used to report the costs of the various supplies used by a residential health care facility. The fair market value of donated supplies is included in these classifications if the commodity would otherwise be purchased by the facility. An offsetting amount would be included in the reporting level Other Operating Revenue, Donated Commodities, section 453.3(i)(2)(xxi) of this Article.

(1) Disposable Linen;

(2) Prescription Drugs. Include in this classification the cost of all drugs for which a prescription would be required if purchased at an outside pharmacy;

(3) Medicine Cabinet Drugs. Include in this classification the cost of all drugs that could be purchased without a prescription;

(4) Other Medical Care Materials and Supplies. Include in this classification the cost of all medical materials and supplies used in direct patient care;

(5) Dietary--Food. Include in this classification all food purchased by the facility;

(6) Dietary--Other. Include in this classification all dietary supplies other than food;

(7) Linen and Bedding;

(8) Cleaning Supplies;

(9) Office and Administrative Supplies;

(10) Employee Wearing Apparel;

(11) Instruments and Minor Medical Equipment;

(12) Minor Nonmedical Equipment; and

(13) Other Supplies and Materials. Include in this classification the cost of nonmedical supplies not included elsewhere. Include the cost of miscellaneous supplies used for the personal care of patients.

(d) Purchased and contracted services. These classifications are provided to report the costs of purchased or contracted services. For instance, if the laboratory function is contracted outside the residential health care facility, the expense would be classified Contracted Services, in the laboratory functional reporting center. If, however, a minor service such as exterior painting were purchased outside the residential health care facility, the expense would be classified Repairs and Maintenance--Purchased Services-Nonassignable. The difference between the purchased and contracted classification lies in the magnitude of the service provided by outsiders. Note that because the service rendered (exterior painting) benefited the entire facility and, therefore, is not directly assignable to a specific functional reporting center (other than the Plant Operation and Maintenance functional reporting center), the cost of the service is classified Repairs and Maintenance--Purchased Services--Nonassignable. In those instances where outside repairs and maintenance can be directly assigned to a specific functional reporting center, e.g., the repair of a piece of laundry equipment, the cost must be classified Repairs and Maintenance--Purchased Services--Directly Assignable.

(1) Repairs and Maintenance--Purchased Services--Nonassignable. Include in this classification purchased repair and maintenance services not directly assignable to a specific functional reporting center other than the Plant Operation and Maintenance functional reporting center;

(2) Repairs and Maintenance--Purchased Services--Directly Assignable. Include in this classification purchased repair and maintenance services that are directly assignable to a functional reporting center other than the Plant Operation and Maintenance functional reporting center;

(3) Medical--Purchased Services;

(4) Management Services; (5) Collection Services;

(6) Other Purchased Services; and

(7) Contracted Services.

(e) Depreciation, leases and rentals.

(1) Depreciation and Amortization;

(2) Rental or Lease--Land;

(3) Rental or Lease--Buildings;

(4) Rental or Lease--Fixed equipment; and

(5) Rental or Lease--Movable equipment.

(f) Other direct expenses.

(1) Electricity;

(2) Gas;

(3) Water and Sewer;

(4) Fuel Oil #2;

(5) Fuel Oil #4;

(6) Fuel Oil #6;

(7) Other Utilities. Include in this classification steam, coal and all other utilities;

(8) Insurance;

(9) Interest. Include in this classification all interest expense of the facility;

(10) Licenses and Taxes (other than Income Taxes);

(11) Telephone and Telegraph;

(12) Dues to Nursing Home Associations;

(13) Printing, Duplicating, Microfilming;

(14) Travel, Conferences, Workshops;

(15) Books, Periodicals, Etc.; and

(16) Other Direct Expenses.

(g) Assessments from municipalities, religious or educational foundations, or other associations. These accounts are used to report costs assessed by parent/subsidiary organizations, such as municipalities, religious or educational organizations.
 

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Section 458.4 - Index for salaries by job title

458.4 Index for salaries by job title. This index presents guidelines for classifying specific job titles by the proper natural classification.

(The chart, Index for salaries by job title, is available from the Bureau of Management Analysis, New York State Department of Health).
 

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Tuesday, January 1, 1991
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Section 458.5 - Supplies and materials classification index

458.5 Supplies and materials classification index. This section presents guidelines for reporting supplies and services expenses by the proper functional reporting center and natural classification. Items whose use is common to more than one functional reporting center are not referenced to a single center but to the "appropriate" reporting center. Some items are too general in nature to be referenced to a specific natural classification. Therefore, the reference is to the "appropriate" natural classification.

(The chart, Supplies and materials classification index, is available from the Bureau of Management Analysis, New York State Department of Health).
 

Effective Date: 
Tuesday, January 1, 1991
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SubChapter B - Hospital Establishment

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Part 600 - General Provisions

Effective Date: 
Wednesday, March 25, 2015
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Statutory Authority: 
Public Health Law, Section 2801-a

Section 600.1 - Applications for establishment

Section 600.1 Applications for establishment. (a) An application to the Public Health Council for its approval, as required by law, shall be in writing on application forms provided by the State Department of Health; and subscribed by the chief executive officer or other officer duly authorized by the board of a corporate applicant, a general partner or proprietor of the proposed medical facility, or, where an application is to be submitted by a local governmental applicant, the president or chairman of the board of the proposed facility or the chief executive officer if there is no board; and accompanied by a certified copy of a resolution of the board of a corporate applicant authorizing the undertaking which is the subject of the application, and the subscribing and submission thereof by an appropriate designated individual. In the event that an application is to be submitted by an entity which necessarily remains to be legally incorporated, it shall be subscribed and submitted by one of the proposed stockholders or directors. If a local governmental applicant submitting an application has not designated a president, chairman or chief executive officer for the proposed facility, the application shall be subscribed by the chairman or president of the local legislature or board of supervisors having jurisdiction, or other appropriate executive officer. An original application and eight copies thereof shall be prepared. The original and eight copies shall be filed with the council through the project management unit in the department's central office in Albany which shall transmit one copy to the health systems agency having geographic jurisdiction.

(b) Applications to the council shall contain information and data with reference to:

(1) the public need for the existence of the facility or the proposed facility at the time and place and under the circumstances proposed;

(2) the character, experience, competency and standing in the community of the proposed incorporators, directors, stockholders, sponsors, individual operators or partners;

(3) the financial resources and sources of future revenue of the facility to be operated by the applicant;

(4) the fitness and adequacy of the premises and equipment to be used by the applicant for the proposed facility;

(5) the following documents shall be filed:

(i) a certified copy of the applicant's certificate of doing business;

(ii) where the applicant is a partnership, full and true copies of all partnership agreements, which shall include the following language:

"By signing this agreement, each member of the partnership created by the terms of this agreement acknowledges that the partnership and each member thereof has a duty to report to the New York State Department of Health any proposed change in the membership of the partnership. The partners also acknowledge that the prior written approval of the Public Health Council is necessary for such change before such change is made, except that a change resulting from an emergency caused by the severe illness, incompetency or death of a member of the partnership shall require immediate notification to The New York State Department of Health of such fact and application shall be made for the approval by both the Public Health Council and the New York State Department of Health of such change within 30 days of the commencement of such emergency. The partners also acknowledge that they shall be individually and severally liable for failure to make the aforementioned reports and/or applications";

(iii) such additional pertinent information or documents necessary for the council's consideration, as requested.

(c) Any person filing a proposed certificate of incorporation or an application for establishment of a hospital as defined in article 28 of the Public Health Law shall file with the commissioner information on the ownership of the property interests in such facility, including the following:

(1) the name and address and a description of the interest held, or proposed to be held, by each of the following persons:

(i) any person who, directly or indirectly, beneficially owns any interest in the land on which the facility is located;

(ii) any person who, directly or indirectly, beneficially owns any interest in the building in which the facility is located;

(iii) any person who, directly or indirectly, beneficially owns any interest in any mortgage, note, deed of trust or other obligation secured in whole or in part by the equipment used in the facility, or by the land on which or the building in which the facility is located;

(iv) any person who, directly or indirectly, has any interest as lessor or lessee in any lease or sublease of the land on which or the building in which the facility is located; and

(v) any person who, directly or indirectly has any interest as a lessor or lessee in any lease or sublease of the equipment used in the building in which the facility is located; (2) if any person named in response to paragraph (1) of this subdivision is a partnership, then the name and address of each partner;

(3) if any person named in response to paragraph (1) of this subdivision is a corporation, other than a corporation whose shares are traded on a national securities exchange or are regularly quoted in an over-the-counter market or which is a commercial bank, savings bank or savings and loan association, then the name and address of each officer, director, stockholder and, if known, each principal stockholder and controlling person of such corporation;

(4) if any corporation named in response to paragraph (1) of this subdivision is a corporation, whose shares are traded on a national securities exchange or are regularly quoted in an over-the-counter market or which is a commercial bank, savings bank or savings and loan association, then the name and address of the principal executive officers and each director and, if known, each principal stockholder of such corporation;

(5) such additional pertinent information and documents necessary for the council's consideration, as requested.
 

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Section 600.2 - Requirements for approval

600.2 Requirements for approval. (a) The application must be complete and in proper form. It shall provide all the information essential for the Public Health Council's consideration.

(b) The applicant must satisfactorily demonstrate to the council:

(1) that there is a public need for the facility or the proposed new facility;

(2) (i) If a nonprofit corporation, that the members of the board of directors and the officers of the corporation are of such character, experience, competence and standing as to give reasonable assurance of their ability to conduct the affairs of the corporation in its best interests and in the public interest and so as to provide proper care for the patients or residents to be served by the facility or the proposed facility;

(ii) if a proprietary business, that the owner, or all the partners, if a partnership, are persons of good moral character who are competent to operate the business so as to provide proper care for the patients or residents to be served by the proposed facility;

(iii) if a business corporation, that the members of the board of directors, the officers and the stockholders of the corporation are of such character, experience, competence and standing as to give reasonable assurance of their ability to conduct the affairs of the corporation so as to provide proper care for the patients or residents to be served by the proposed facility;

(3) that there are adequate finances to properly establish and conduct the proposed facility;

(4) that, with respect to an applicant who is already or within the past 10 years has been an incorporator, director, sponsor, principal stockholder, or operator of any facility as specified in paragraph (b) of subdivision (3) of section 2801-a of the Public Health Law, a substantially consistent high level of care has been rendered in each such facility with which the applicant is or has been affiliated during the past 10 years or during the period of affiliation, as appropriate. In reaching this determination, the Public Health Council shall consider findings of facility inspections, including but not limited to the title XVIII and XIX (of the Social Security Act) and article 28 survey findings, as such pertain to violations of this Chapter, periodic medical review/independent professional review (PMR/IPR) findings, routine and patient abuse complaint investigation results, and other available information. The Public Health Council's determination that a substantially consistent high level of care has been rendered shall be made after reviewing the following criteria: the gravity of any violation, the manner in which the applicant/operator exercised supervisory responsibility over the facility operation, and the remedial action, if any, taken after the violation was discovered.

(i) (a) In reviewing the gravity of the violation, the Public Health Council shall consider whether the violation threatened, or resulted in direct, significant harm to the health, safety or welfare of patients/residents.

(b) In reviewing the manner in which the applicant/operator exercised supervisory responsibility over the facility operation, the Public Health Council shall consider whether a reasonably prudent applicant/operator should have been aware of the conditions which resulted in the violation.

(c) In reviewing any remedial action taken, the Public Health Council shall consider whether the applicant/operator investigated the circumstances surrounding the violation, and took steps which a reasonably prudent applicant/operator would take to prevent the reoccurrence of the violation.

(ii) When violations were found which either threatened to directly affect patient/resident health, safety or welfare, or resulted in direct, significant harm to the health, safety or welfare of patients/residents, there shall not be a determination of a substantially consistent high level of care if the violations reoccurred or were not promptly corrected.

(c)(1) The applicant must supply any additional documentation or information requested by the department acting on behalf of the Public Health Council within 30 days, or any other stated time frame, of such request, or must obtain from the department acting on behalf of the council an extension of the time in which to provide such documentation or information which is requested during the review of the application. Any request for an extension of time shall set forth reasons why such documentation or information could not be obtained within the prescribed time. The granting of a request for an extension shall be at the discretion of the department acting on behalf of the council. Failure to provide such documentation or information within the time prescribed or as extended by the department acting on behalf of the council shall constitute an abandonment or withdrawal of the application without any further action by the council or department. (2) The applicant must supply any authorization the council or the department requests in order to verify any documentation or information contained in the application or to obtain any additional documentation or information which the council or department finds is pertinent to the application. Failure to provide such authorization shall constitute an abandonment or withdrawal of the application without any further action by the council or department.

(d) Whenever any applicant proposes to lease premises in which the operation of a hospital as defined in article 28 of the Public Health law is to be conducted, the lease agreement shall include the following language:

"The landlord acknowledges that his rights of reentry into the premises set forth in this lease do not confer on him the authority to operate a hospital as defined in article 28 of the Public Health law on the premises and agrees that he will give the New York State Department of Health, Tower Building, Empire State Plaza, Albany, N.Y. 12237, notification by certified mall of his intent to reenter the premises or to initiate dispossess proceedings or that the lease is due to expire, at least 30 days prior to the date on which the landlord intends to exercise a right of reentry or to initiate such proceedings or at least 60 days before expiration of the lease.

"Upon receipt of notice from the landlord of his intent to exercise his right of reentry or upon the service of process in dispossess proceedings and 60 days prior to the expiration of the lease, the tenant shall immediately notify by certified mail the New York State Department of Health, Tower Building, Empire State Plaza, Albany, NY 12237, of the receipt of such notice or service of such process or that the lease is about to expire."

(e) No lease covering the premises in which the operation of a hospital as defined in article 28 of the Public Health Law is to be conducted may contain any provision whereby rent, or any increase therein, is based upon the Consumer Price Index, or any other cost-of-living index, except:

(1) leases for outpatient facilities and premises leased solely for administrative purposes may contain cost-of-living index rent determination or adjustment provisions, provided the following conditions are met:

(i) the lease is reviewed and approved by the department;

(ii) the space rented is in a multi-purpose, multi-use building not constructed specifically for the purpose of housing an outpatient facility;

(iii) the rental, if the lease is a sublease, is the same or less than the rental in the overlease;

(iv) the applicant has no interest, direct or indirect, beneficial or of record, in the ownership of the building or any overlease; and

(v) the rental per square foot, in the judgement of the department, is the same as or is comparable to other rentals in the building in which the outpatient service or administrative space is to be located, and the rental per square foot is comparable to the rental of similar space in other comparable buildings in the area when such comparisons can be made.

(2) in addition to the exception set forth in paragraph (1) of this subdivision, in the event the lease covering hospital premises contains provisions whereby it is the lessor's responsibility to pay necessary expenses associated with such premises, such as real estate taxes, utilities, heat, insurance, maintenance and operating supplies, such lease may contain provisions which allow adjustments to the rent only to the extent necessary to compensate for changes in such expenses.
 

Effective Date: 
Sunday, July 1, 1990
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Section 600.3 - Amendments and modifications to applications

600.3 Amendments and modifications to applications. (a) A change to an application before the Public Health and Health Planning Council has approved or contingently approved the application is hereafter referred to as a revision; a change to an application which has been approved or contingently approved by the council but for which an operating certificate has not yet been issued shall be referred to as an amendment if it meets the criteria contained in subdivision (c) of this section, and shall be referred to as a modification approvable pursuant to subdivision (f) if it does not meet the criteria contained in subdivision (c) or does meet the criteria in subdivision (e).

(b) An application made to the Public Health and Health Planning Council, pursuant to this Part, may be modified before the council has approved or contingently approved the application. Such modifications shall be made on appropriate forms supplied by the department and submitted to the council through the central office of the department in Albany and shall be governed by the following:

(1) any modification in the information contained in the original application must be accompanied by a satisfactory written explanation as to the reason such information was not contained in the original application;

(2) the department, when reviewing a competitive batch of applications, may establish deadlines pursuant to written notification for the submission of any modification to an application; and

(3) if a modification is submitted after any such deadline(s), the application shall be removed from consideration within the competitive batch being reviewed.

(c) After the Public Health and Health Planning Council has approved or contingently approved an application but prior to the issuance of an operating certificate, any change as set forth in paragraphs (1) through (3) of this subdivision shall constitute an amendment to the application, and the applicant shall submit the proposed amendment to the department's central office together with appropriate documentation explaining the reason(s) for the amendment and such additional documentation as may be required in support of such amendment. The amended application shall be referred to the health systems agency having geographic jurisdiction and the Public Health and Health Planning Council for their reevaluation and recommendations. The approval of the Public Health and Health Planning Council must be obtained for any such amendment. Each of the following shall constitute an amendment:

(1) a change in the number and/or type of beds and/or services, other than a reduction of service which would be subject to administrative review;

(2) a change in the location of the site of the construction if outside the facility's service area or adjacent service area; and

(3) any change in the applicant.
(d) For purposes of this section, the following terms shall have the following meanings:

(1) Total project cost means total costs for construction, including but not limited to costs for demolition work, site preparation, design and construction contingencies, total costs for real property, for fixed and movable equipment, architectural and/or engineering fees, legal fees, construction manager and/or cost consultant fees, construction loan interest costs, and other financing, professional and ancillary fees and charges. If any asset is to be acquired through a leasing arrangement, the relevant cost shall be the cost of the asset as if purchased for cash, not the lease amount. (2) Total basic cost of construction means total project costs less the capitalized amount of construction loan interest and financing fees.

(e)(1) If the commissioner, acting on behalf of the Public Health and Health Planning Council, determines that increases in total project costs or total basic costs of construction are due to factors of an emergency nature such as labor strikes, fires, floods or other natural disasters or factors beyond the control of the applicant, or modifications to the architectural aspects of the application which are made on the recommendation of the department, the applicant may proceed without the need for the application to be referred back to the health systems agency and the Public Health and Health Planning Council.

(2) If the applicant can document by evidence acceptable to the commissioner, acting on behalf of the Public Health and Health Planning Council, that increases in total project cost or total basic cost of construction were caused by delays in obtaining zoning or planning approvals which were beyond its control, the commissioner may permit review of the application to proceed without the need for the application to be referred back to the health systems agency and the Public Health and Health Planning Council pursuant to this Part. The evidence shall demonstrate clearly that the applicant had timely pursued the zoning or planning permits, has now obtained all such required permits and approvals, and is prepared to proceed with the project.

(3) If the applicant can document by evidence acceptable to the commissioner, acting on behalf of the Public Health and Health Planning Council, that increases in the total basic cost of construction were caused by inflation in excess of that estimated and approved in the application and that such inflation has affected the total basic cost of construction as a result of delays which were beyond the applicant's control, the commissioner may permit review of the application to proceed without the need for the application to be referred back to the health systems agency and the Public Health and Health Planning Council pursuant to this Part. The evidence shall demonstrate clearly that the increase in inflation exceeds that estimated and approved in the application, and that any delays resulting in such inflationary cost increases were beyond the applicant's control.

(f) Any modification submitted subsequent to the issuance of any approval by the Council which does not constitute an amendment pursuant to the provisions of this section shall require only the prior approval of the commissioner.

(g) Failure to disclose an amendment prior to the issuance of an operating certificate shall constitute sufficient grounds for the revocation, limitation or annulment of the approval of establishment.
 

Effective Date: 
Wednesday, March 25, 2015
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Section 600.4 - Withdrawals or abandonment of applications and failure to satisfy contingencies

600.4 Withdrawals or abandonment of applications and failure to satisfy contingencies.

(a) An application made to the Public Health Council in accordance with this Part may, on written request of the applicant, be withdrawn prior to decision by the council at any time without prejudice to resubmission. Such resubmission shall be subject to the provisions relating to amendments.

(b) The failure, neglect or refusal of an applicant to submit documentation or information, within the stated time frame, to satisfy a contingency imposed by the Public Health Council in conjunction with the council's proposal to approve an application shall constitute and be deemed an abandonment or withdrawal of the application by the applicant without the need for further action by the council.

(c) When an applicant submits documentation or information, within the stated time frame, in an attempt to satisfy a contingency imposed by the Public Health Council but the department, on behalf of the council, does not consider the documentation or information sufficient to satisfy the contingency, the application shall be returned to the council for whatever action the council deems appropriate.
 

Effective Date: 
Wednesday, November 29, 1989
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Section 600.5 - Revocation, limitation or annulment of approvals of establishment

600.5 Revocation, limitation, or annulment of approvals of establishment. (a) An approval of establishment may be revoked, limited, or annulled by the Public Health Council if the council finds:

(1) that the established operator has been guilty of fraud or deceit in procuring such approval of establishment or has made statements or furnished information in support of the application which were not true, accurate, or complete in any material respect;

(2) that the operating certificate of a hospital has been revoked, limited or annulled pursuant to the applicable provisions of law;

(3) that a hospital caused or allowed a patient to be subjected to violence or abuse by an employee, consultant, volunteer or other person serving in any capacity in the hospital or that a hospital has failed to comply with the provisions of article 28 of the Public Health Law or the rules and regulations promulgated thereunder;

(4) that the established operator has had such a change in his financial condition or in the fiscal aspects of the proposed institution since the approval of establishment as to render the project economically unfeasible or render unsatisfactory the financial resources of the proposed institution and its sources of future revenue;

(5) that the established operator has been convicted in a court of competent jurisdiction, either within or without the State, of a crime;

(6) that the established operator is an habitual drunkard or is addicted to the use of morphine, cocaine or other drugs having similar effect; or has become mentally disabled;

(7) that the established operator has transferred his ownership interest in the operation of the facility without Public Health Council approval, and that such person has terminated his participation in the operation of the facility;

(8) that there has been a violation of subdivision (a) of section 610.4 of this Title;

(9) that the established operator has granted any person convicted of a crime relating to hospital activities the authority to direct or cause the direction of the operations, management or policies of the facility;

(10) that the established operator has failed to comply fully with any condition, limitation or other requirement imposed as part of, or in conjunction with, the approval of establishment; or

(11) that the applicant has failed to commence and complete construction within the time period determined under Part 710 of this Title.

(b) For purposes of this section, established operator shall include any person, partnership or partner thereof, and any corporation or stockholder, officer or director thereof, actual or proposed, whose application for establishment has been approved, regardless of whether an operating certificate has been issued.
 

Effective Date: 
Wednesday, November 29, 1989
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Section 600.6 - Hearings

600.6 Hearings. (a) Necessary hearings shall be conducted by the Public Health Council, a committee of the council, or a person designated by the council.

(b) Requests for hearings by applicants shall be made within 20 days after notification that such request may be made. If such request is made by the State Hospital Review and Planning Council or by a Regional Hospital Review and Planning Council, it must be made within 10 days subsequent to the meeting of such council which took place after notification that such request may be made.
 

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Section 600.7 - Decisions

600.7 Decisions. (a) Copies of the resolution of the Public Health Council approving or disapproving an application shall be transmitted to the applicant, the State Hospital Review and Planning Council, the appropriate Regional Hospital Review and Planning Council and the Commissioner of Health.

(b) Copies of a notice that the council is considering the disapproval of an application or action contrary to the recommendation of the State Hospital Review and Planning Council or a regional council and affording an opportunity to request a public hearing shall be transmitted to the applicant, to the State Hospital Review and Planning Council, the appropriate Regional Hospital Review and Planning Council and the Commissioner of Health.
 

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Section 600.8 - Criteria for determining the operation of a diagnostic or treatment center under article 28 of the Public Health Law

600.8 Criteria for determining the operation of a diagnostic or treatment center under article 28 of Public Health Law.

(a) Any provision of medical or health services by a provider of medical or health services organized as a not-for-profit or business corporation other than a professional service corporation shall constitute the operation of a diagnostic or treatment center.

(b) It shall be prima facie evidence that a diagnostic or treatment center is being operated when any provider of medical or health services describes itself to the public as a "center, "clinic" or by any name other than the name of one or more of the practitioners providing these services.

(c) A provider of medical or health services that does not come within subdivision (a) or (b) of this section shall be reviewed by the Commissioner of Health to determine whether medical or health services are being provided by practitioners of medicine engaged in private practice or by a facility within article 28 of the Public Health Law. The following criteria shall be used in conducting such reviews:

(1) Patient contact. Patient contact is made directly with the facility rather than the individual physician; or referral is made to the facility by the physician; or provision is made for services by the physician, not in his offices but at another location.

(2) Admission. The decisions as to admissions are made by the facility rather than by the individual practitioner, or by referral agreement or by arrangements with physicians.

(3) Choice of physician. When the physician is not chosen by the patient, the physician is assigned by the facility, or the patient is given a choice among several practitioners associated with or employed by the facility.

(4) Care of patients. Care that is provided patients is the responsibility of the facility and is provided under the following conditions, among others:

(i) the facility, rather than the physician assumes responsibility for all services rendered within the facility;

(ii) central services, including but not limited to laboratory, pharmacy, X-ray and narcotics are available with no free choice of the provider of such services by the patient;

(iii) the facility insures adherence to standards;

(iv) the facility is organized into departments or has a multi-disciplined approach;

(v) the facility supplies ancillary services; or

(vi) the responsibility of the facility terminates on discharge of the patient, as distinguished from the continuing responsibility of the physician; follow-up care is not provided by or at the facility.

(5) Organization and management. (i) Bills and charges are determined by the facility;

(ii) medical charts and patient records are maintained by the faculty;

(iii) patient care space is provided by the facility;

(iv) income distribution is determined by the facility;

(v) employees are selected as supervised by the facility;

(vi) vital records such as fetal death certificates, etc. are maintained by the facility;

(vii) bills are payable to the facility, rather than to the individual practitioner;

(viii) the scope of the services to be provided is determined by the facility, subject to regulatory limitations;

(ix) the structure is so physically extensive that it exceeds the usual space requirements of the private medical practitioner;

(x) the departmental organization is large enough to require delegation of authority to nonmedical personnel;

(xi) there is employment of other health professions such as registered nurse, physical therapist, pharmacist; or

(xii) the patient registry is more extensive than that found in the usual individual practice. Many more persons are processed than are ordinarily diagnosed or treated by physicians in the private practice of medicine.

(d) The criteria set forth in subdivision (c) of this section shall not be the sole determining factors, but indicators to be considered with such other factors that may be pertinent in particular instances. Professional expertise is to be exercised in the utilization of the criteria. Establishment shall be required where a determination is made that medical services are being provided by a facility within article 28 of the Public Health Law rather than by a private practitioner of medicine. All of the listed indicia of a facility within article 28 of the Public Health Law need not be present in a given instance. The criteria are intended to assist in determining the dominant features of the services offered.

(e) In addition to the foregoing, any facility which qualifies for an agreement to participate in the Medicare program as an ambulatory surgical center shall constitute a diagnostic and treatment center. The conditions of participation in the Medicare program as an ambulatory surgical center are contained in volume 42 of the Code of Federal Regulations, Public Health, at part 416 (42 CFR part 416), 1984 edition, published by the Office of the Federal Register National Archives and Records Service, General Services Administration. Copies may be obtained from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402. 42 CFR part 416 is available for public inspection and copying at the Records Access Office, New York State Department of Health, 10th Floor, Corning Tower Building, Empire State Plaza, Albany, NY 12237. (f) The Department of Health may conduct such hearings as may be necessary to gather sufficient facts to make a determination under this section.
 

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Section 600.9 - Governing authority or operator

600.9 Governing authority or operator. (a) The governing authority or operator is the party responsible for the operation of a medical facility.

(b) The governing authority or operator shall mean:

(1) the policy making body of a government agency;

(2) the board of directors or trustees of a not-for-profit corporation;

(3) the officers, directors and stockholders of a business corporation; and

(4) the proprietor or proprietors of a proprietary medical facility.

(c) An individual, partnership or corporation which has not received establishment approval may not participate in the total gross income or net revenue of a medical facility.

(d)(1)Except as provided in section 405.3 of this Title, the governing authority or operator may not contract for management services with a party which has not received establishment approval.

(2) The criteria set forth in this paragraph shall be used in determining whether there has been an improper delegation to the management consultant by the governing authority or operator of its responsibilities:

(i) authority to hire or fire the administrator or other key management employees;

(ii) maintenance and control of the books and records;

(iii) authority over the disposition of assets and the incurring of liabilities on behalf of the facility;

(iv) the adoption and enforcement of policies regarding the operation of the facility.

(3) The criteria set forth in paragraph (2) of this subdivision shall not be the sole determining factors, but indicators to be considered with such other factors that may be pertinent in particular instances. Professional expertise shall be exercised in the utilization of the criteria. All of the listed indicia need not be present in a given instance for there to be an improper delegation of authority.
 

Effective Date: 
Wednesday, January 25, 1989
Doc Status: 
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Section 600.10 - Agents, nominees and fiduciaries

600.10 Agents, nominees and fiduciaries. Agents, nominees and fiduciaries whether testamentary or inter vivos shall not be considered proper applicants for establishment, transfer of interest or transfer of stock of a facility except that the following persons may apply for establishment approval in accordance with and subject to the requirements and conditions set forth in article twenty-eight of the public health law:

(a) a natural person appointed as trustee of an express testamentary trust created by a deceased sole proprietor, partner or shareholder in the operation of a hospital for the benefit of a person less than twenty-five years of age; or

(b) a natural person appointed conservator pursuant to article seventy-seven of the mental hygiene law or a natural person appointed committee of the property of an incompetent pursuant to article seventy-eight of the mental hygiene law or a sole proprietor, partner or shareholder of a hospital, with respect to a hospital owned by a conservatee or incompetent.
 

Effective Date: 
Wednesday, November 21, 1990
Doc Status: 
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Section 600.11 - Name changes of operators and medical facilities

600.11 Name changes of operators and medical facilities. (a) Any change in the following shall require the prior approval of the Public Health Council in accordance with the requirements of this section and any other applicable requirements of law:

(1) the name of a not-for-profit corporation operating a medical facility under article 28 of the Public Health Law;

(2) the name of a not-for-profit corporation authorized to solicit contributions for the establishment or maintenance of any hospital pursuant to article 28 of the Public Health Law;

(3) the assumed name of a sole proprietor or a not-for-profit corporation operating a medical facility under article 28 of the Public Health Law or of a not-for-profit corporation authorized to solicit contributions for the establishment or maintenance of any hospital pursuant to article 28 of the Public Health Law, whenever the prior assumed name was approved by the Public Health Council or its predecessor; and

(4) the name or assumed name of a business corporation, partnership or governmental subdivision operating a medical facility under article 28 of the Public Health Law whenever the prior name or prior assumed name was approved by the Public Health Council or its predecessor.

(b) Applicants requesting Public Health Council approval of a change of name or assumed name shall submit a written request to the executive secretary of the council at the department's central office in Albany, which shall include the following information and documentation as appropriate:

(1) a letter specifying the current and proposed names and explaining the nature of and the reasons for the requested name change;

(2) a photocopy of the executed proposed certificate of amendment of the certificate of incorporation, certificate of authority to conduct business in the State of New York, or certificate of conducting business under an assumed name; and

(3) such other pertinent information and documents necessary for the council's consideration, as requested.

(c) Whenever the name of a business corporation, partnership or governmental subdivision, or the assumed name of a business corporation, not-for-profit corporation, partnership, governmental subdivision or sole proprietor operating a medical facility or fund raiser under article 28 of the Public Health Law was not specifically approved by the Public Health Council or its predecessor, any proposed change in said name or assumed name or initial use of an assumed name shall not require the approval of the Public Health Council but shall require the approval of the department in accordance with section 401.3 of this Title.

(d) The approval of the Public Health Council of a proposed name or assumed name may be withheld if the proposed name or assumed name indicates or implies that the corporation, partnership, governmental subdivision or individual is authorized to engage in activities for which it is not authorized, provide a level of care it is not authorized to provide, is misleading, causes confusion with the identity of another facility, or violates any provision of the law.

(e) Nothing contained within this section shall limit the authority of the Public Health Council to approve or disapprove the initial use of a name or assumed name for a not-for-profit corporation, business corporation, partnership, governmental subdivision or sole proprietor when such name or assumed name is before the Public Health Council as part of an application for the establishment of a facility or fund raiser.
 

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Part 610 - Special Requirements for Nonprofit Corporations

Effective Date: 
Friday, September 4, 1970
Doc Status: 
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Statutory Authority: 
Public Health Law, Section 2801-a

Section 610.1 - Application of nonprofit corporation

Section 610.1 Application for nonprofit corporation. A nonprofit corporation seeking Public Health Council approval shall comply with the provisions of Part 600 of this Title and in addition shall file the following:

(a) a photocopy of the executed proposed corporate certificate;

(b) a request for the council's approval of such certificate, which request shall be properly executed by one or more authorized persons and shall contain the prescribed information;

(c) approval of another State department or agency where required by law, provided:

(1) such approval or consent shall be obtained and attached to application; or

(2) in the absence thereof, the processing of such an application shall not be delayed provided that evidence is submitted that a concurrent application has been made in good faith to obtain the approval or consent of such State department or agency as required by law. Such approval shall be obtained prior to action on the application by the council;

(d) a certified copy of the resolution of the board of directors authorizing the under taking which is the subject of the application and the subscribing and submission thereof by an appropriate designated individual;

(e) such additional pertinent information or documents necessary for the council's consideration.
 

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Section 610.2 - Application to solicit contributions

610.2 Application to solicit contributions. A nonprofit corporation seeking Public Health Council approval for authority to solicit contributions for any corporate purpose or two or more purposes which require the approval of the council shall:

(a) File with its application the documents and information required by section 600.1 of this Title and section 610.1 of this Part.

(b) Demonstrate to the satisfaction of the council that it would be successful in raising funds necessary to establish the proposed facility or program within the period planned, which shall not be more than five years from the date of the council's approval. An application of this kind shall otherwise be denied or granted on the basis of the same criteria as required by section 600.2 of this Title.
 

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Section 610.3 - Annual statement

610.3 Annual statement. (a) Each corporation operating a facility shall file annually, upon forms provided by the State Department of Health, a statement identifying the members of the board of directors and the officers of the corporation.

(b) If any change has occurred in the members of the board of directors or officers of the corporation, the corporation shall file, for evaluation by the department which shall report to the council, information and data with reference to:

(1) the character, experience, competency and standing in the community of such director or officer on forms provided by the department;

(2) such additional pertinent information or documents as requested.
 

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Section 610.4 - Director voting and conflicting interests

610.4 Director voting and conflicting interests.

(a) (1) No director of a nonprofit corporation operating a hospital shall vote, or be counted in determining the quorum for any vote, on any transaction between such hospital corporation and another corporation, firm, association or other entity in which that director is an officer or director or has a direct or indirect substantial financial interest. Any such quality of interest shall be disclosed to the other directors of the hospital corporation and made a matter of record. Such disclosure shall be made by the director involved or, in his absence, by another director having knowledge of the facts. In addition to refraining from voting, such director shall not participate in the deliberations nor use personal influence in the matter and any such transaction shall be at least as fair and reasonable to the hospital corporation as would otherwise then be obtainable by such corporation.

(2) For the purposes of paragraph (1) of this subdivision, a director or officer shall be deemed to have a direct or indirect substantial financial interest in any corporation, firm, association or other entity in which such person together with such person's parents and spouse, and all descendants of either of such person's parents or such person's spouse, have an aggregate beneficial equity interest of 10 percent or more.

(3) This section shall not apply to such directors of a nonprofit corporation operating a hospital who also serves as an unsalaried officer or director of other nonprofit corporations which, having received all requisite approvals, exist for the purpose of raising funds for the operation and maintenance of, or to provide administrative, planning and research support services to the nonprofit corporation operating the hospital, with respect to transactions between the hospital corporation and such other nonprofit corporations.
 

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Part 620 - Incorporations and Transfers of Proprietary Businesses

Effective Date: 
Friday, September 4, 1970
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2801-a(10)

Section 620.1 - Establishment of business corporations

Section 620.1 Establishment of business corporations. Persons seeking the approval of the Public Health Council for the formation of a business corporation to be established as the operator of a hospital shall file, in addition to the requirements of Part 600 of this Subchapter, information, documents and data as follows:

(a) A photocopy of the executed proposed certificate of incorporation which shall, in all respects, conform to the applicable provisions of the Business Corporation Law and all other pertinent laws of the State of New York. Such certificate of incorporation shall contain provisions to the following effect:

(1) The corporate powers and purposes shall be limited to the ownership and operation, or operation, of a hospital or hospitals specifically named and the location or locations of which are specifically designated by street address, city, town, village or locality and county; provided, however, that the corporate powers and purposes may also include the ownership and operation, or operation, of a hospice or hospices, as defined in article 40 of the Public Health Law, a certified home health agency or licensed home care services agency or agencies as defined in article 36 of the Public Health Law, or a health maintenance organization as defined in article 44 of the Public Health Law; if the corporation has received all approvals required under such law to own and operate, or operate, such hospice or hospices, home care services agency or agencies or health maintenance organization.

(2) The location of the principal office of the corporation which shall be at the same address as a hospital, hospice, home care services agency or health maintenance organization which is to be operated by the corporation in the State of New York.

(3) No person may own 10 percent or more of the stock of the corporation who has not been approved for the ownership of such stock by the Public Health Council.

(4) All stock certificates of the corporation shall bear on the face thereof the following:

(i) no person shall own 10 percent or more of the stock of the corporation unless he has been approved for such ownership by the Public Health Council;

(ii) a statement that any transfer, assignment or other disposition of 10 percent or more of the stock or of 10 percent of the voting rights thereunder of the corporation or the transfer, assignment or other disposition of the stock or voting rights of the corporation which results in the ownership or control of more than 10 percent of the stock or voting rights thereunder of the corporation by any person shall be subject to approval by the Public Health Council; and

(iii) a statement that no stock or voting rights thereunder of the corporation may be owned or controlled by another corporation.

(5) Stock shall consist of one class of common stock only.

(b) An affidavit from each applicant setting forth:

(1) that he is to be the sole beneficial owner of the voting shares of which he is to be the holder of record in the proposed corporation;

(2) the number of voting shares in the proposed corporation of which he is to be the holder of record; and

(3) that all stock authorized by the certificate of incorporation will be issued and outstanding.

(c) The proposed stock certificate, bearing imprinted on the face thereof legend that any transfer, assignment or other disposition of 10 percent or more of the stock or of the voting rights thereunder of the corporation, or the transfer, assignment or other disposition of the stock or voting rights of the corporation which results in the ownership or control of more than 10 percent of the stock or voting rights thereunder of the corporation by any person shall be subject to approval by the Public Health Council, and that another corporation is prohibited by law from owning or controlling any of the stock or voting rights thereunder of the corporation.

(d) Information as to the character, experience, competency and standing in their community of the proposed incorporators and directors.

(e) Such additional pertinent information or documents necessary for the Public Health Council's consideration, as requested.

(f) The person, or partners, who are operating a proprietary nursing home, in accordance with the provisions of applicable law, may apply to the Public Health Council for its approval of the incorporation of such business. In addition to the aforesaid requirements for business corporations, the applicant for such approval shall file a copy of the document giving approval of the establishment of the applicant as operator of the nursing home, or proof that such nursing home was being operated by the applicant, in accordance with applicable provisions of law.

(g) The ownership or control by another corporation of any of the stock or voting rights thereunder of the corporation shall constitute sufficient grounds for the revocation, limitation or annulment of the approval of establishment. (h) Within 30 days after approval of establishment, the corporation shall furnish to the New York State Department of Health a list of the names of all of the shareholders of the corporation, duly certified by the secretary of the corporation as to completeness and accuracy, and shall thereafter furnish such a certified list at annual intervals. Failure to comply with the provisions of this subdivision shall constitute sufficient grounds for the revocation, limitation or annulment of the approval of establishment.
 

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Section 620.2 - Transfers of interest by sole proprietors or partnerships

620.2 Transfers of interest by sole proprietors or partnerships. (a) An individual or partnership seeking Public Health Council approval of transfer of all or part of the ownership of the business shall file information, documents and data as follows:

(1) a certified copy of the applicant's certificate of doing business, or where the applicant proposes to continue the partnership name, a photocopy of the executed proposed certificate of doing business;

(2) where the applicant is a partnership, full and true copies of all partnership agreements;

(3) a declaration of the percentage of the business to be transferred;

(4) a financial statement setting forth the purchase price of the interest in the business being sold and the financial resources available to make such purchase, or the basis on which such transfer is to be financed;

(5) where any transfer is to be by gift, a statement of the relationship between the donor and donee;

(6) information as to the character, experience, competence and standing in their community of the proposed proprietor or partners;

(7) where the applicant proposes a change of name by which the facility is doing business, a photocopy of the executed proposed certificate of doing business; and

(8) such additional pertinent information or documents necessary for the council's consideration, as requested.

(b) In addition to meeting the applicable requirements of subdivision (a) of this section, an application for the transfer of less than a twenty (20) percent interest in a partnership shall be processed as follows:

(1) the local health systems agency may waive review, but, if such review is not waived, it shall make its recommendation within 90 days from the date a complete application is received by the department;

(2) the department shall process an application subject to this subdivision and submit it to the State Hospital Review and Planning Council for a recommendation and to the Public Health Council for a decision within 150 days from the date a complete application is received by the department, provided that such time period may be extended for a time not to exceed the time the department awaited a response from the applicant to requests for additional documentation and information. The Public Health Council shall act on the application within the same such time period. If the Public Health Council defers the application, the Council shall advise the applicant in writing of the reasons for such deferral. A deferred application shall be returned to the Public Health Council, and the Council shall propose to approve or disapprove such application no later than the second Council meeting following the meeting at which the application was deferred; and

(3) in accordance with subdivision (4) of section 2801-a of the Public Health Law, an application solely for a transfer of interest in an existing established partnership shall not be subject to a public need review.
 

Effective Date: 
Wednesday, January 23, 1991
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Section 620.3 - Transfers of stock

620.3 Transfers of stock. (a) An applicant who proposes to purchase stock in a business corporation, the transfer of the stock of which requires the approval of the Public Health Council, shall fine an application for such approval in accordance with the requirements of Part 600 of this Subchapter, and in addition, the following documents:

(1) a copy of the document giving approval for the incorporation of the hospital business;

(2) an affidavit from each applicant setting forth:

(i) that he is to be the sole beneficial owner of the voting shares of the corporation of which he is to be the holder of record; and

(ii) the number of voting shares of the corporation of which he is to be the holder of record.

(3) an affidavit from the seller of the stock setting forth his name and address and stating that:

(i) he was authorized by the aforesaid document to own 10 percent or more of the stock of the corporation or that he was authorized by the Public Health Council to acquire ownership of 10 percent or more of the stock of the corporation;

(ii) the number of voting shares of the corporation which he proposes to transfer to the applicant; and

(iii) the purchase price of the shares to be transferred to the applicant.

(4) the financial resources available for the acquisition of the stock to be transferred, or the basis on which such transfer is to be financed;

(5) if such transfer of stock is to be by gift, a statement of the relationship between the donor and donee;

(6) such additional pertinent information or documents necessary for the council's consideration, as requested; and

(7) any transfer, assignment or other disposition of 10 percent or more of the stock or voting rights thereunder to the corporation, or any transfer, assignment or other disposition of the stock or voting rights thereunder which results in the ownership or control of more than 10 percent of the stock or voting rights thereunder by the corporation, or any transfer, assignment or other disposition of 10 percent or more of the stock or voting rights thereunder by the corporation shall be subject to approval by the Public Health Council in accordance with the requirements of Part 600 of this Subchapter and the requirements of this section.

(b) In addition to meeting the applicable requirements of subdivision (a) of this section, an application, requiring Public Health Council approval, which involves a transfer of less than twenty (20) percent of the stock of a corporation shall be processed as follows:

(1) the local health systems agency may waive review, but, if such review is not waived, it shall make its recommendation within 90 days from the date a complete application is received by the Department;

(2) the Department shall process an application subject to this subdivision and submit it to the State Hospital Review and Planning Council for a recommendation and to the Public Health Council for a decision within 150 days from the date a complete application is received by the Department, provided that such time period may be extended for a time not to exceed the time the Department awaited a response from the applicant to requests for additional documentation and information. The Public Health Council shall act on the application within the same such time period. If the Public Health Council defers the application, the Council shall advise the applicant in writing of the reasons for such deferral. A deferred application shall be returned to the Public Health Council, and the Council shall propose to approve or disapprove such application no later than the second Council meeting following the meeting at which the application was deferred; and

(3) in accordance with subdivision (4) of section 2801-a of the Public Health Law, an application solely for a transfer of stock in an existing established corporation shall not be subject to a public need review.
 

Effective Date: 
Wednesday, January 23, 1991
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Section 620.4 Reserved

Section 620.5 - Limitation on transfer

620.5 Limitation on transfer. Any transfer pursuant to section 620.2 or section 620.3 of this Part shall be completed within 90 days of issuance by the Public Health Council of its approval for such transfer unless extended by the council and the council notified of the transfer within 10 days thereafter. Any request for an extension of time shall set forth reasons why such transfer could not be completed within the prescribed time. Failure to complete a transfer within the time prescribed or as extended by the council or failure to notify the council within the time prescribed shall constitute a withdrawal of the application.
 

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Part 630 - Special Requirements for Local Governmental Applicants

Effective Date: 
Friday, September 4, 1970
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2801-a

Section 630.1 - Local governmental applicants

Section 630.1 Application for approval for the establishment of hospitals, public home infirmaries or other facilities for inpatient care of the sick by a county, city, town, village or other governmental subdivision. (a) An application to the Public Health Council for approval for the establishment of a public general hospital, public home infirmary or other facility for inpatient care shall comply with the provisions of Part 600 of this Title. Such application shall include:

(1) A request for the council's approval for the establishment of the pro posed facility or for the establishment of an agency concerned with the establishment of any such facility which request shall be made on the forms supplied therefor, be properly executed by one or more authorized persons and contain the prescribed information.

(2) All other data and documents required or submitted as part of the application.

(b) The application shall provide the information and data necessary for the council to refer the application to and obtain the recommendations and advice from the sources required by law, and to enable the council properly to consider and act on the application. It shall also indicate the name of the county, city. town, village or other governmental subdivision; purpose for which the request is made (creation of an agency "concerned with the establishment of", the proposed facility and/or establishment of a facility); type of facility proposed to be established (public general hospital, public hospital for the chronically ill, public home infirmary or other); name and location of proposed facility and the territory to be served; and bed capacity, appropriately classified (single, semiprivate, ward, free).

(c) The application shall provide the information and data with reference to:

(1) public need for the existence of the proposed facility at the time and place and under the circumstances proposed.

(2) financial resources and sources of future revenue of the facility that is proposed to be established and of the applicant.
 

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Part 640 - Procedures for Approval of the Development of Comprehensive Health Services And the Establishment of Such Facilities

Effective Date: 
Wednesday, June 14, 1972
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2801-a

Section 640.1 - General provisions

Section 640.1 General provisions. The provisions of this Part shall apply to all persons interested in the development of comprehensive health services, which may include but are not necessarily limited to in-patient hospital and physician care, ambulatory health care and out-patient preventive medical services, and which might require the establishment of hospital facilities. While it is not necessary that such parties comply with the provisions of sections 640.2, 640.3 and 640.4 of this Part in sequence, it is recommended that they do so, although any party capable of meeting the requirements of any such section need not comply with the provisions of any other section in order to obtain the approval provided for in the section pursuant to which application has been made.
 

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Section 640.2 - Applications for approval of planning for comprehensive health services

640.2 Applications for approval of planning for comprehensive health services. Any person, partnership or corporation interested in planning for comprehensive health services, not having sufficient information necessary to determine whether the establishment of such facilities is feasible at the time and place and under the circumstances proposed, should file an application in accordance with the applicable provisions of Part 600 of this Title for approval by the Public Health Council of the conduct of studies and any other research and informational gathering techniques intended to provide information as to the feasibility of the comprehensive health services proposed.
 

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Section 640.3 - Applications for authority for non-profit corporations to solicit or apply for funds for development and establishment of comprehensive health services facilities

640.3 Applications for authority for nonprofit corporations to solicit or apply for funds for development and establishment of comprehensive health services facilities. Any person, partnership or corporation which does not have the finances necessary to support the development of comprehensive health services and the establishment of such facilities shall make application to the Public Health Council for its approval of the solicitation of or application for funds to be used for such development and establishment. Such application shall be made in accordance with the provisions of Parts 600 and 610 of this Title.
 

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Section 640.4 - Applications for establishment of comprehensive health services facilities

640.4 Applications for establishment of comprehensive health services facilities. An applicant for approval of establishment to provide a comprehensive health services facility shall make application for the approval of the Public Health Council of such establishment in accordance with the provisions of Parts 600, 610, 620 and 630 of this Title, as applicable.
 

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Part 650 - Dissolution of Corporations

Effective Date: 
Wednesday, June 14, 1972
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2801-a

Section 650.1 - Applications for dissolution of corporations

Section 650.1 Applications for dissolution of corporations. Corporations seeking the approval of the Public Health Council of voluntary dissolution shall file information, documents and data as follows:

(a) the public need for such dissolution;

(b) the proposed disposition of the assets of the corporation;

(c) the proposed certificate of dissolution which shall in all respects conform with the applicable provisions of the Not-for-Profit Corporation Law and all other pertinent laws of the State of New York;

(d) the proposed plan of dissolution and distribution of assets which shall in all respects conform with the applicable provisions of the Not-for-Profit Corporation Law and all other pertinent laws of the State of New York;

(e) the petition proposed to be submitted to the court in support of the application for judicial approval of the proposed plan of dissolution and distribution of assets; and

(f) such additional pertinent information and documents which are deemed necessary for the council's consideration, as requested.
 

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Section 650.2 - Contingencies relative to approval of corporate dissolutions

650.2 Contingencies relative to approval of corporate dissolutions. If the Public Health Council approves the dissolution of the corporation, such approval shall be contingent upon the approval of the plan of dissolution and distribution of assets by a court of competent jurisdiction and the filing of a certified copy of the court order of such approval.
 

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Part 660 Reserved

Part 670 - Determination of Public Need for Medical Facility Establishment

Effective Date: 
Tuesday, December 22, 1998
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2801-a(10)(a)

Section 670.1 - Determination of public need pursuant to section 2801-a(3) of the Public Health Law

Section 670.1 Determination of public need pursuant to section 2801-a(3) of the Public Health Law. (a) The factors for determining public need for the establishment of medical facilities shall include, but not be limited to:

(1) the current and projected population characteristics of the service area, including relevant health status indicators and socioeconomic conditions of the population;

(2) normative criteria for age and sex specific utilization rates to correct for unnecessary utilization of medical facilities and health services;

(3) standards for facility and service utilization, comparing actual utilization to capacity, taking into consideration fluctuation of daily census for certain services, the geography of the service area, size of units, and specialized service networks;

(4) the patterns of in and out migration for specific services and patient preference or origin;

(5) the need that the population served or to be served has for the services proposed to be offered or expanded, and the extent to which all residents in the area, and in particular low income persons, racial or ethnic minorities, women, handicapped persons, and other underserved groups and the elderly, will have access to those services;

(6) in cases involving the reduction or elimination of a service, including those involving the relocation of a facility or service, the extent to which need will be met adequately and the effect of the reduction, elimination, or relocation of the service or facility on the ability of low income persons, racial and ethnic minorities, women, handicapped persons, and other underserved groups, and the elderly, to obtain needed health care;

(7) the contribution of the proposed service or facility in meeting the health needs of members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to health services (for example, low income persons, racial and ethnic minorities, women, and handicapped persons), particularly for those whose needs are identified in the medical facilities plan. For the purpose of determining the extent to which the proposed service or facility will be accessible to such persons, the following shall be considered:

(i) the extent to which medically underserved populations currently use the applicant's services in comparison to the percentage of the population in the applicant's service area which is medically underserved, and the extent to which medically underserved populations are expected to use the proposed services if approved;

(ii) the performance of the applicant in meeting its obligations under applicable civil rights statutes prohibiting discrimination on the basis of race, color, national origin, handicap, sex, and age;

(iii) the extent to which Medicare, Medicaid and medically indigent patients are or will be served by the applicant; and

(iv) the extent to which the applicant offers a range of means by which a person will have access to its services.

(b) The evaluative procedure for review of public need pursuant to section 2801-a(3) of the Public Health Law shall include, but not be limited to: (1) description of proposal as submitted by applicant for establishment; (2) identification of use rates in the service area for the type(s) of facility(s) and service(s) involved; (3) identification of current and projected user population of the service area; (4) identification of resulting estimate of future quantitative need as projected for a period of five years from last complete calendar year reported; (5) identification of existing facility(s) and service(s), which are the same as those pro-posed by the applicant available in the service area; (6) identification of existing facility(s) and service(s), which are the same as those proposed by the applicant, which will be available to meet future need in the service area; (7) identification of facility(s) and service(s), which are the same as those proposed by the applicant and which have been approved for establishment and/or construction but are not in operation in the service area; (8) identification of resulting resource(s) available in service area five years in future to meet need; (9) identification of percent of need met for proposed facility(s) and service(s); (10) description of the current utilization for all facility(s) and service(s) which are the same as those proposed by applicant in the service area; (11) description of the current utilization for allied or alternate facilities and services in the service area; (12) description of any migration patterns for health care in the service area; (13) description of any evidence of inappropriateness of placement in the service area for the subject facility(s), service(s) and related service(s); and (14) description of the distribution of facility(s) and service(s) in relation to the popula-tion’s distribution. (c) The public need analysis for each proposal will include a determination of the appropriate service area. The factors to be considered by the Public Health Council for determining the appropriate service area shall include, but not be limited to, the substantive criteria set forth in subdivision (c) of section 709.1 of this Chapter. (d) Any application for establishment wherein a determination of public need is made pursuant to this section shall be subject to the following: (1) The Public Health Council may, during the processing of an application, propose to disapprove the application solely on the basis of a determination of public need in advance of its consideration of the other review criteria required by Public Health Law, section 2801-a(3) without, however, waiving its right to consider such other criteria at a later date. (2) In the event the Public Health Council proposes to disapprove an application on the basis of a lack of public need and the applicant requests a hearing, the Public Health Council may direct the completion of the other reviews required by Public Health Law, section 2801-a(3). The application shall then be returned to the Public Health Council to consider such reviews, the results of which may then be included as grounds for the proposed disapproval to be considered at the hearing. If the Public Health Council directs the completion of such reviews, a copy of the report containing the results of the reviews shall be mailed to the applicant at least 60 days prior to the date set for hearing. (3) In the processing of an application, the commissioner may recommend disapproval based on a review limited to a determination of public need. In the event the Public Health Council does not concur with the commissioner’s recommendation of disapproval, it shall return the application to the department at which time all other reviews required by Public Health Law, section 2801-a(3) shall be completed. At such time as all reviews are completed, the application shall be returned to the Public Health Council for action.

Effective Date: 
Tuesday, November 22, 1988
Doc Status: 
Complete

Section 670.2 - Acute care facilities

670.2 Acute care facilities. The factors and methodology to be considered by the Public Health Council for determining the public need for acute care facilities, beds and services, shall include, but not be limited to, the substantive criteria and methodology set forth in section 709.2 of this Chapter.
 

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Section 670.3 - Residential health care facilities

Residential health care facilities. (a) Notwithstanding the provisions of subdivisions (a), (b) and (c) of section 670.1 of this Part, the factors, methodology and procedures to be used by the Public Health Council for determining the public need for residential health care facility beds shall include, but not be limited to, the substantive criteria, methodology and procedures set forth in section 709.3 of this Chapter and the provisions of subdivision (c) of this section.

(b) Any application for establishment wherein a determination of public need is made pursuant to this section, shall be subject to the provisions of subdivision (d) of section 670.1 of this Part.

(c)(1) In determining the need for residential health care facilities, beds and services, consideration shall be given to the needs of persons who receive or are eligible to receive medical assistance benefits at the time of admission to a facility pursuant to Title XIX of the federal Social Security Act and Title 11 of Article 5 of the State Social Services Law, hereafter referred to as Medicaid patients, and the extent to which the applicant serves or proposes to serve such persons, as reflected by factors including, but not necessarily limited to, the applicant's admissions policies and practices. An application by an applicant that is or will be a provider that participates in the medical assistance (Medicaid) program shall not be approved unless the applicant agrees to comply with the requirements of this subdivision. An applicant that, at the time of consideration of its application by the Public Health Council, proposes not to participate in the Medicaid program may be approved, provided all other review criteria have been met, upon the condition that if, in the future, it does participate in the Medicaid program, it would comply fully with the requirements of this subdivision.

(2) To ensure that the needs of Medicaid patients in an applicant's service area are met and that such patients have adequate access to appropriate residential health care facilities, beds and services, applicants shall be required to accept and admit at least a reasonable percentage of Medicaid patients as determined pursuant to this subdivision. Such reasonable percentage of Medicaid patient admissions, also referred to herein as the Medicaid patient admissions standard, shall be equal to 75 percent of the annual percentage of all residential health care facility admissions, in the long term care planning area in which the applicant facility is located, that are Medicaid patients. The calculation of such planning area percentage shall not include admissions to residential health care facilities that have an average length of stay of 30 days or less. If there are four or fewer residential health care facilities in a planning area, the applicable Medicaid patient admissions standard for such planning area shall be equal to 75 percent of the planning area annual percentage of all residential health care facility admissions that are Medicaid patients or 75 percent of the annual percentage of all residential health care facility admissions, in the health systems agency area in which the facility is located, that are Medicaid patients, whichever is less. In calculating such percentages, the department will use the most current admissions data which have been received and analyzed by the department. An applicant will be required to make appropriate adjustments in its admissions policies and practices so that the proportion of its own annual Medicaid patient admissions is at least equal to 75 percent of the planning area percentage or health systems agency area percentage, whichever is applicable.

(3) The proportion of an applicant's admissions that must be Medicaid patients, as calculated under paragraph (2) of this subdivision, may be increased or decreased based on the following factors:

(i) the number of individuals within the planning area currently awaiting placement to a residential health care facility and the proportion of total individuals awaiting such placement that are Medicaid patients, provided that patients awaiting placement include, but need not be limited to, alternate level of care patients in general hospitals;

(ii) the proportion of the facility's total patient days that are Medicaid patient days and the length of time that the facility's patients who are admitted as private paying patients remain such before becoming Medicaid eligible;

(iii) the proportion of the facility's admissions who are Medicare patients or patients whose services are paid for under provisions of the federal Veterans' Benefit Law;

(iv) the facility's patient case mix based on the intensity of care required by the facility's patients or the extent to which the facility provides services to patients with unique or specialized needs; (v) the financial impact on the facility due to an increase in Medicaid patient admissions.

(4)(i) An applicant shall submit a written plan, subject to the approval of the department, for reaching the Medicaid patient admissions standard required by this subdivision. The plan shall provide for reaching the standard within no longer than a two year period and the facility shall give preference, as necessary, to Medicaid patients in order to reach the admissions standard within the prescribed time period.

(ii) Once the Medicaid patient admissions standard is reached, the facility shall not reduce its proportion of Medicaid patient admissions so as to go below the standard unless and until the applicant, in writing, requests the approval of the department to adjust the standard and the department's written approval is obtained. In reviewing requests to adjust a facility's Medicaid patient admissions standard, the department shall consider factors which may include, but need not be limited to, those factors set forth in paragraphs (2) and (3) of this subdivision.

(iii) After a facility's initial Medicaid patient admissions standard has been reached, the department may increase such facility's Medicaid patient admissions standard, based on the criteria set forth in this subdivision, if the percentage of Medicaid patients admitted by residential health care facilities in the facility's planning area or health systems agency area, as appropriate, increases due to factors other than an increase in Medicaid patient admissions by the applicant.

(5)(i) Subject to the provisions of subparagraph (ii) of this paragraph, after the phase-in period provided for in paragraph (4) of this subdivision, a facility shall be prohibited from failing, refusing or neglecting to accept or admit a Medicaid patient for whom it is otherwise able to provide care, regardless of whether the level of reimbursement received for such patient is less than the rate the facility charges private pay patients, unless the facility has reached and is maintaining compliance with the Medicaid patient admissions standard imposed by this subdivision. Compliance with the requirements of this subdivision shall be determined on the basis of a facility's total annual admissions, so that a facility may exercise its discretion in determining when during a year it will admit a sufficient number of Medicaid patients to maintain its Medicaid patient admissions standard.

(ii) A facility may be exempt from the requirement of admitting a Medicaid patient in order to meet or maintain its Medicaid patient admissions standard if it can demonstrate in writing to the satisfaction of the commissioner that the Medicaid patient was denied admission solely in order to admit another patient who had a greater need of residential health care facility services, as determined by the intensity of care anticipated to be required by such patient, and that there was only one bed available in the facility at the time of the admission decision to accommodate a new admission. Facilities shall not be required to obtain prior department approval in order to accept a non-Medicaid patient in place of a Medicaid patient pursuant to this subparagraph, but shall maintain sufficient documentation including, but not necessarily limited to, a copy of the Patient Review Instrument for the patient admitted and the Medicaid patient denied admission in order to justify the admission decision. Copies of such documentation shall be provided to the department upon request.
 

Effective Date: 
Monday, September 18, 1989
Doc Status: 
Complete

Section 670.4 - Ambulatory surgery services

670.4 Ambulatory surgery services. The factors and methodology to be considered by the Public Health Council for determining the public need for ambulatory surgery services and facilities, shall include, but not be limited to those set forth in section 709.5 of this Chapter.
 

Effective Date: 
Wednesday, March 11, 1998
Doc Status: 
Complete

Section 670.5 - Long-term inpatient rehabilitation programs for head-injured patients

670.5 Long-term inpatient rehabilitation programs for head-injured patients. The factors and methodology to be considered by the Public Health Council for determining the public need for long-term inpatient rehabilitation program beds and services for head-injured patients shall include, but not be limited to, the substantive criteria and methodology set forth in section 709.11 of this Chapter.
 

Effective Date: 
Wednesday, November 29, 1989
Doc Status: 
Complete

Section 670.6 - End stage renal dialysis service

670.6 End stage renal dialysis service. (a) This methodology will be utilized in the evaluation of certificate of need applications involving the construction or establishment of new or replacement dialysis stations used in the treatment of End Stage Renal Disease. It is the intent of the Public Health Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 670.1 of this Part, become a statement of basic principles and planning/decision making tools for guiding and directing the development of dialysis stations for End Stage Renal Disease services throughout the state. Additionally, it is intended that the methodology will provide the health systems agencies and potential applicants with sufficient flexibility to consider the unique characteristics of their respective areas in determining need. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate supply of dialysis stations are available to provide access to care to all those in need of in-facility dialysis.

(b) The factors to be considered in determining the public need for dialysis stations shall include, but not be limited to, the following:

(1) evidence that the proposed dialysis services capacity proposed will be utilized sufficiently to be financially feasible as demonstrated by a five year analysis of projected costs and revenues associated with the program;

(2) evidence that the proposed service or additional capacity will enhance access to services by patients including members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to health services (for example, low-income persons, racial and ethnic minorities, women and handicapped persons), and/or appropriate rural populations;

(3) evidence that the facilities hours of operation and admission policies will promote the availability of services which are acceptable to those in need of such services, in particular, operational hours that permit individuals in dialysis to continue employment;

(4) the facility's willingness and ability safely to serve dialysis patients; and

(5) evidence, derived from analysis of factors including, but not necessarily limited to, patient referral and use patterns of existing dialysis facilities and services and projected referral and use patterns of both the proposed facility, and of existing facilities or services within the applicant's planning area which would result from approval of the proposed facility, indicating that approval of the proposed facility will not jeopardize the quality of services provided at or the financial viability of such existing facilities or services. However, a finding that the proposed facility will jeopardize the financial viability of one or more existing facilities will not of itself require a recommendation of disapproval of the proposed application.

(c) Public need for a proposed facility or station shall be deemed to exist when review and consideration of evidence concerning each of the five factors set forth in subdivision (b) of this section results in an affirmative finding.
 

Effective Date: 
Wednesday, December 28, 1994
Doc Status: 
Complete

Part 680 - Central Services Facility Rural Health Networks

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2801-a(10)(a) and 2801-a(14)

Section 680.1 - Definitions

Section 680.1 Definitions. For purposes of this Subchapter, unless the context indicates otherwise, the following term shall have the following meaning:

(a) "Central services facility rural health network" shall mean a rural health network organized pursuant to the not-for-profit corporation law and established pursuant to subdivision 14 of section 2801-a of the Public Health Law which provides or arranges for the provision of health care services pursuant to a network operational plan to residents of a rural area, which health care services shall include, at a minimum, comprehensive primary care; emergency care; outpatient and inpatient care. Such network may offer any medical and health related service approved for practice, licensure, or certification in accordance with state law and regulation for which it is able to provide appropriate technical and human resources, respond to community need, and assure quality in the delivery of services.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.2 - Applications for Central Services Facility Rural Health Network

680.2 Applications for central services facility rural health network establishment. (a) An application to the Public Health Council for its approval, as required by law, shall be in writing on application forms provided by the State Department of Health, and subscribed by the chief executive officer or other officer duly authorized by the board of a corporate applicant. In the event that an application is to be submitted by an entity which necessarily remains to be legally incorporated, it shall be subscribed and submitted by one of the proposed directors. The original and eight copies of the applications shall be filed with the council.

(b) The following documents and information shall be filed:

(1) A photocopy of the executed proposed certificate of incorporation or certificate of amendment which shall, in all respects, conform to the applicable provisions of the Not-for-Profit Corporation Law and all other pertinent laws of the State of New York. The certificate may include and shall be limited to the following powers and purposes:

(i) perform studies, feasibility surveys and planning with respect to the development and operation of such network;

(ii) implement a network operational plan upon obtaining public health council and the commissioner's approval to operate as a central services facility rural health network;

(iii) enter into agreements with non-network affiliated providers and other individuals, partnerships, associations, corporations and appropriate federal and state agencies as necessary to effectuate the purposes of the corporation;

(iv) solicit and accept grant awards and make disbursements to affiliated network providers to effectuate the purposes of the corporation;

(v) directly operate or share operational authority with a hospital or hospitals as defined in subdivision one of section twenty-eight hundred one of the Public Health Law upon receiving public health council approval pursuant to subdivisions two and three of section twenty-eight hundred one-a of the Public Health Law; and

(vi) solicit contributions from the public to support the establishment or operation of hospitals.

(2) a certified copy of the applicant's certificate of doing business under an assumed name, if applicable;

(3) the applicant's proposed or amended bylaws;

(4) identification of each member of the corporation, individual, corporate or other;

(5) the certificate of incorporation and bylaws of each corporate member of the applicant; together with any proposed amendments thereto reflecting the member's affiliation with the applicant;

(6) the proposed network operational plan, if available;

(7) information concerning the character, experience, competency and standing in the community of the proposed incorporators, directors, and officers of the corporation. An applicant to-be-formed shall identify the proposed incorporators, initial directors and those individuals to be proposed for election or appointment to the board of directors at the applicant's organization meeting. An applicant's board shall at all times include an appropriate balance of representatives of the general public and consumers, and representatives of providers. Directors representative of consumers and the general public shall not be affiliated in any way with a provider of health care services; and

(8) such additional documentation and information as the council may require.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.3 - Requirements for approval

680.3 Requirements for approval. (a) The application must be in proper form and complete.

(b) The applicant must satisfactorily demonstrate to the council:

(1) that the incorporators, members of the board of directors and officers are of such character, experience, competence and standing in the community as to give reasonable assurance of their ability to conduct the affairs of the corporation in its best interests and in the public interest; and

(2) that, with respect to each incorporator, director and officer of the proposed central services facility rural health network corporation who is already or within the past 10 years has been an incorporator, director, sponsor, principal stockholder or operator of any facility or plan licensed or certified pursuant to Articles 28, 36, 40 or 44 of the Public Health Law, a substantially consistent high level of care has been rendered in each such facility or plan with which the applicant is or has been affiliated during the past 10 years in accordance with paragraph (4) of subdivision (b) and subdivision (c) of section 600.2 of this Title.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.4 - Amendments

680.4 Amendments. (a) An application made to the Public Health Council pursuant to this Part may be amended while the matter is pending before the council. Such amendments shall be made on appropriate forms supplied by the department.

(b) Any amendment to an application which constitutes a substantial change in the information contained in the original application, or any prior amendments thereto, must be accompanied by a satisfactory written explanation as to the reason such information was not contained in the original application.

(c) Prior to the issuance of final council approval, any change as set forth in this subdivision shall constitute an amendment to the application and the applicant shall submit appropriate documentation as may be required in support of such amendment. The amended application shall be referred to the State Hospital Review and Planning Council for their comments. The approval of the Public Health Council must be obtained for any amended application. Any change in the principals of the applicant as considered by the Council shall constitute an amendment.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.5 - Decisions

680.5 Decisions. (a) Copies of the resolution of the Public Health Council approving or disapproving an application shall be transmitted to the applicant, the State Hospital Review and Planning Council and the Commissioner of Health.

(b) Copies of a notice that the council is considering the disapproval of an application or action contrary to the recommendation of the State Hospital Review and Planning Council and affording an opportunity to request a public hearing shall be transmitted to the applicant, the State Hospital Review and Planning Council and the Commissioner of Health.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.6 - Hearings

680.6 Hearings. (a) Necessary hearings shall be conducted by the Public Health Council, a committee of the council, or a person designated by the council.

(b) Requests for hearings by applicants shall be made within 20 days after notification that such request may be made. If such request is made by the State Hospital Review and Planning Council, it must be made within 10 days subsequent to the meeting of such council which took place after notification that such request may be made.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.7 - Annual Statement

680.7 Annual statement. (a) Each central services facility rural health network shall file annually with the council a statement identifying the members of the board of directors, the members and the officers of the corporation.

(b) If any change has occurred in the members of the board of directors, the members or officers of the corporation, the corporation shall file, for evaluation by the department which shall report to the council, information and data with respect to:

(1) the character, experience, competency and standing in the community of each such new director or officer;

(2) the identity of each new member together with the certificate of incorporation and bylaws of each new corporate member; and

(3) such additional information or documentation as may be required.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.8 - Withdrawals or abandonment of applications and failure to satisfy

680.8 Withdrawals or abandonment of applications and failure to satisfy contingencies. (a) An application made to the Public Health Council in accordance with this Part may, on written request of the applicant, be withdrawn prior to decision by the council at any time without prejudice to resubmission. Such resubmission shall be subject to the provisions relating to amendments.

(b) The failure, neglect or refusal of an applicant to submit documentation or information, within a stated time frame, to satisfy a contingency imposed by the Public Health Council in conjunction with the council's proposal to approve an application shall constitute and be deemed on abandonment or withdrawal of the application by the applicant without the need for further action by the council.

(c) When an applicant submits documentation or information, within the stated time frame, in an attempt to satisfy a contingency imposed by the Public Health Council but the department, on behalf of the council, does not consider the documentation or information sufficient to satisfy the contingency, the application shall be returned to the council for whatever action the council deems appropriate.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.9 - Revocation, limitation and annulment of approvals of establishment

680.9 Revocation, limitation and annulment of approvals of establishment (a) An approval of establishment to operate as a central services facility rural health network may be revoked, limited or annulled by the Public Health Council if it finds:

(1) that the established operator has been guilty of fraud or deceit in procuring such approval of establishment or has made statements or furnished information in support of the application which were not true, accurate, or complete in any material respect;

(2) that the operating certificate of a hospital operated by a central services facility rural health network established pursuant to section 680.10 of this Part has been revoked, limited or annulled pursuant to the applicable provisions of law;

(3) that a hospital operated by a central services facility rural health network established pursuant to section 680.10 of this Part caused or allowed a patient to be subjected to violence or abuse by an employee, consultant, volunteer or other person serving in any capacity in the hospital or that a hospital has failed to comply with the provisions of article 28 of the Public Health Law or the rules and regulations promulgated thereunder;

(4) that the established operator has been convicted in a court of competent jurisdiction, either within or without the State, of a crime;

(5) that the operator has transferred operating control of the central services facility rural health network, or a hospital which it operates, within the meaning of subdivision (c) of section 405.1 of this Title without Public Health Council approval;

(6) that the established operator has granted any person convicted of a crime relating to hospital activities the authority to direct or cause the direction of the operations, management or policies of the corporation or a hospital operated by the corporation;

(7) that the established operator has failed to comply with any condition, limitation or other requirement imposed by this Part or as part of, or in conjunction with, the approval of establishment;

(8) that a final disapproval to operate as a central services facility rural health network has been issued by the Commissioner; or

(9) that the commissioner has revoked approval of a central services facility rural health network operational plan in accordance with subdivision (a) of section 408.4 of this Title.

(b) For purposes of this section, "established operator" shall include a central services facility rural health network and any incorporator, director, established member or officer thereof whose application for establishment has been approved, regardless of whether the commissioner has approved the corporation's network operational plan.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

Section 680.10 - Approval to operate a hospital

680.10 Approval to operate a hospital. A corporation which has received Public Health Council establishment approval to operate as a central services facility rural health network and seeks approval to establish and construct or acquire a hospital, or seeks joint establishment approval to share operational authority with the operator a hospital in accordance with subdivision (c) of section 405.(1) of this Title, shall comply with the provisions of Parts 600 and 610 of this Title.
 

Effective Date: 
Wednesday, January 11, 1995
Doc Status: 
Complete

SubChapter C - State Hospital Code

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete

Article 1 - General Provisions

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete

Part 700 - General

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2803, 3612, 4010

Section 700.1 - Title

Section 700.1 Title. This Subchapter shall be known and may be cited as the "State Hospital Code."
 

Doc Status: 
Complete

Section 700.2 - Definitions

700.2 Definitions.

(a) The following definitions of medical facilities, based on standards approved by the commissioner, shall apply to this Chapter unless the context otherwise requires:

(1) Accredited hospital or other accredited medical facility, as defined in article 28 of the Public Health Law, shall mean a hospital or facility which has been accredited by an accreditation agency to which the Centers for Medicare and Medicaid Services has granted deeming status and which the Commissioner has determined has accrediting standards sufficient to assure the Commissioner that hospitals or facilities so accredited are in compliance with operational standards under this Chapter.

(2) Emergency room or department shall mean a designated area of a hospital that includes one or more reception and treatment rooms appropriately staffed and equipped to provide prompt and efficient care of emergency patients in accordance with the provisions of Subchapter C of this Chapter.

(3)(i) Existing hospital or other existing medical facility shall mean a facility which, on the day prior to the effective date of this subparagraph, had a valid operating certificate under article 28 of the Public Health Law.

(ii) New hospital or other new medical facility shall mean that physical area included in a project for which, both on and after the effective date of this subparagraph, an application is submitted under provisions of Part 710 of Subchapter B of this Title, and which encompasses any or all of the following:

(a) change in scope of services of an existing facility;

(b) acquisition of a physical plant, which was not previously operated as a health care facility for the same level of care, as is proposed;

(c) acquisition of property and construction of a new physical plant;

(d) construction of a new physical plant on property already owned by an established facility;

(e) renovations and/or alterations to an existing facility, which involve:

(1) major physical and/or structural changes;

(2) major fixed equipment changes, other than replacements;

(3) the classification as a new medical facility shall be limited only to those sections and/or wings of an existing facility, for which such renovation, alterations and/or equipment changes are approved.

(f) one or more additions to an existing facility. The classification as a new medical facility shall be limited to the additions.

(iii) The provisions of clause (ii)(e) of this paragraph shall not apply to an existing hospital or medical facility, as defined by subparagraph (i) of this paragraph which does not meet the minimum requirements of sections 711.4, 711.5, 711.6, 711.7 and 711.8 of this Title, because of life safety, structural, physical, mechanical and/or electrical deficiencies, and which is approved to perform such alterations, renovations and/or fixed equipment changes as are necessary to achieve compliance with the aforementioned sections.

(4) Health-related facility shall mean a facility, institution, intermediate care facility, or a separate or distinct part thereof, providing therein lodging, board and social and physical care, including but not limited to the recording of health information, dietary supervision and supervised hygienic services incident to such care to six or more residents not related to the operator by marriage or by blood within the third degree of consanguinity.

(5) Hospital shall mean an institution with beds for one or more inpatients not related to the operator which is primarily engaged in providing services and facilities to inpatients by or under the supervision of a physician, and which meets the following requirements:

(i) provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery;

(ii) has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry;

(iii) has bylaws, rules and regulations pertaining to standards

of medical care and service rendered by its medical staff;

(iv) maintains medical records for all patients;

(v) has a requirement that every patient be under the care of a member of the medical staff;

(vi) provides 24-hour patient services;

(vii) has in effect a written, currently applicable utilization review plan, acceptable to the department, which provides for utilization review studies designed to evaluate the appropriateness of admissions to the hospital, lengths of stay, discharge practices, use of medical and hospital services and all related factors which may contribute to the efficient provision of hospital and physician services;

(viii) has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements.

(6) Home care services agency shall mean an organization primarily engaged in arranging and/or providing, directly or through contract arrangement, one or more of the following: nursing services, home health aide services, advanced home health aide services, medical supplies, equipment and appliances, and other therapeutic and related services which may include, but shall not be limited to, physical and occupational therapy, speech pathology, nutritional services, medical social services, personal care services, homemaker services and housekeeper services which may be of a preventive, therapeutic, rehabilitative, health guidance and/or supportive nature to persons at home.

(7) Certified home health agency shall mean a home care services agency which possesses a valid certificate of approval issued pursuant to the provisions of article 36 of the Public Health Law, or a residential health care facility or hospital possessing a valid operating certificate issued under article 28 of the Public Health Law which is authorized under article 36 to provide a long-term home health care program. Such an agency or program must participate as a home health agency under the provisions of titles XVIII and XIX of the Federal Social Security Act.

(8) Long term home health care program shall mean a coordinated plan of care and services provided at home to invalid, infirm or disabled persons who are medically eligible for placement in a hospital or residential health care facility and who would require such placement

for an extended period of time if such program were unavailable.

(i) Such program shall be provided in the person's home or in the home of a responsible relative or other responsible adult.

(ii) Such program shall be provided in adult care facilities, other than shelters for adults, certified pursuant to section 460-b of the Social Services Law, provided that the person meets the admission and continued stay criteria for such facility. Services provided by the program shall not duplicate or replace those which the facility is required by law or regulation to provide.

(iii) Approved long term home health care program providers may include, as part of their long term home health care program, upon approval by the commissioner, a discrete AIDS home care program as defined in this section.

(iv) A long term home health care program that does not obtain authorization to provide an AIDS home care program shall not be precluded from providing services within its existing authority to patients who are diagnosed as having AIDS, or are deemed by a physician, within his judgement, to be infected with the etiologic agent of acquired immune deficiency syndrome, and who have an illness, infirmity or disability which can be reasonably ascertained to be associated with such infection.

(9) The terms treatment center and diagnostic center shall mean a medical facility with one or more organized health services not part of an inpatient hospital facility or vocational rehabilitation center primarily engaged in providing services and facilities to out-of-hospital or ambulatory patients by or under the supervision of a physician or, in the case of a dental service or dispensary, of a dentist, for the prevention, diagnosis and, in the case of a treatment center, treatment of human disease, pain, injury, deformity or physical condition, not including the individual or group private practice of medicine.

(10) Narcotic addiction rehabilitation center shall mean an institution with beds for one or more inpatients not related to th e operator, which is primarily engaged in providing facilities and services by or under the supervision of a physician to patients addicted to narcotic drugs, and which meets the following requirements:

(i) provides rehabilitation services for individuals addicted to narcotic drugs, pursuant to the provisions of article 9 of the Mental Hygiene Law;

(ii) has an organized rehabilitation staff which shall include, but not be limited to, physicians, dentists and narcotic rehabilitation officers;

(iii) has rules and regulations pertaining to standards of rehabilitation services rendered by its rehabilitation staff, approved by the department;

(iv) maintains medical and rehabilitation records for all clinical patients;

(v) provides 24-hour patient services; and

(vi) has in effect a utilization review plan approved by the department and an affiliation agreement with an accredited hospital for the provisions of those hospital services not provided by the center.

(11) Nursing home shall mean a facility, institution, or portion thereof, providing therein, by or under the supervision of a physician, nursing care and other health, health-related and social services as specified in this Chapter for 24 or more consecutive hours to three or more nursing home patients who are not related to the operator by marriage or by blood within the third degree of consanguinity, including, but not limited to, an infirmary section which is identifiable as a nursing home unit in a special area, wing or separate building of a public or voluntary home or of a general or special hospital.

(12) Reserved

(13) Outpatient department shall mean a hospital division or department primarily engaged in providing services for ambulatory patients, by or under the supervision of a physician, for the prevention, diagnosis or treatment of human disease, pain, injury, deformity or physical condition.

(14) Patient care unit or nursing unit shall mean a designated area, including a group of patient rooms with adequate supporting rooms, areas, facilities, services and personnel providing nursing care and management of patients, which is planned, organized, operated and maintained to function as a unit so as to encourage the efficient delivery of patient services and effective observation of and communication with patients.

(15) Multiphasic health screening facility shall mean a treatment center or diagnostic center wherein a battery of tests is performed for the purpose of discovering the presence or absence of clinical findings which may be indicators of early disease and which may provide physicians with a base line of clinical data useful in the medical care and follow-up of patients.

(16)-(18) Reserved

(19) Cardiac surgical center shall mean an inpatient care unit of a hospital which shall be approved as such by the department and shall be appropriately staffed and equipped to provide both diagnostic and surgical services.

(20) A cardiac diagnostic center shall mean an inpatient care unit of a hospital, approved by the department, which may exist independent of a complete cardiac surgical service. The diagnostic center shall be appropriately staffed and equipped to provide a full range of diagnostic services, including coronary arteriography and/or other cardiac invasive diagnostic procedures.

(21) Rural hospital shall mean any hospital as defined in this subdivision, which does not meet any of the absolute criteria of subparagraph (ii) of this paragraph and which, when assessed against the weighted criteria of subparagraph (i), achieves a total score greater than or equal to six points. Facilities which meet the definition are expected to develop appropriate linkages with hospitals providing a greater range of services and/or medical equipment. Identification as a rural hospital shall not be construed as diminishing the need for such planning efforts.

(i) Weighted criteria. (a) Size. Facility size shall be measured by capacity as listed on the operating certificate. A certified capacity of 75 beds or less shall be worth 3 points; a certified capacity of greater than 75 and less than or equal to 100 beds shall be worth 2 points; a certified capacity of greater than 100 beds shall be worth 0 points.

(b) Population density. Population density shall be measured by use of the most recently used New York State Economic Development Board statistics. Location of the facility in a county which has a population density of 100 persons per square mile or less shall be worth 3 points; location in a county with a population density of greater than 100 and less than or equal to 150 persons per square mile shall be worth 2 points; location in a county with a population density of greater than 150 persons per square mile shall be worth 0 points.

(c) Facility budget. The size of the facility budget shall be measured by base year financial and statistical data submitted to the department pursuant to Subpart 86-1 of this Title. A budget of $6,500,000 or less shall be worth 2 points; a budget of greater than $6,500,000 but less than or equal to $7,500,000 shall be worth 1 point; a budget of greater than $7,500,000 shall be worth 0 points.

(d) Admissions. The number of admissions shall be measured by base year financial and statistical data submitted to the department pursuant to Subpart 86-1 of this Title. Total base year admissions of less than or equal to 4,000 shall be worth 2 points; total base year admissions of greater than 4,000 but less than or equal to 4,500 shall be worth 1 point; total base year admissions of greater than 4,500 shall be worth 0 points.

(ii) Absolute criteria. A facility which meets any of these criteria shall not be a rural hospital if;

(a) the facility is located in New York City, or in the counties of Monroe, Erie, Nassau, Suffolk, Albany, Westchester, Orange, Schenectady, Rensselaer, Onondaga and Oneida;

(b) the facility is the subject of an action by the commissioner seeking revocation, suspension, limitation or annulment of its operating certificate for structural or operational deficiencies;

(c) the commissioner has found, after considering public need, that suspension, limitation modification or revocation of the facility's operating certificate is consistent with the public interest in conservation of health resources;

(d) the facility is a specialty hospital; or

(e) the facility is located within five miles of an existing acute care unit.

(22) Part-time clinic site shall mean an ambulatory care program site operated less than 60 hours per month (as determined by the aggregate hours of program site operation) by a general hospital or a diagnostic or treatment center which is approved to operate part-time clinics. A part-time clinic site is a site other than the primary delivery site(s) listed on the primary facility's operating

certificate; provided, however, that any health care services provided in elementary or secondary schools to students during regular school hours shall not qualify as part-time clinic sites under this Title.

(23) Hospice shall mean a coordinated program of home and inpatient care which treats the terminally ill patient and family as a unit, employing an interdisciplinary team acting under the direction of an autonomous hospice administration. The program provides palliative and supportive care to meet the special needs arising out of physical, psychological, spiritual, social and economic stresses which are experienced during the final stages of illness, and during dying and bereavement.

(24) Outpatient surgery is a service organized to provide those surgical procedures of less intensity than ambulatory surgery which are performed in an outpatient treatment room for patients at low risk, require minimal pre- and post-procedure observation and treatment, are not likely to be time-consuming or followed by complications, are not associated with a condition which would require hospitalization and includes those procedures listed in section 85.6 of this Title.

(25) Licensed home care services agency means a home care services agency issued a license pursuant to article 36 of the Public Health Law.

(26)(i) "AIDS home care program" means a coordinated plan of care and services provided at home to persons who are medically eligible for placement in a hospital or residential health care facility and who:

(a) are diagnosed by a physician as having acquired immune deficiency syndrome (AIDS); or

(b) are deemed by a physician, within his judgment, to be infected with the etiologic agent of acquired immune deficiency syndrome, and who have an illness, infirmity or disability which can be reasonably ascertained to be associated with such infection.

Such program shall be provided by a long term home health care program specifically authorized pursuant to Article 36 of the Public Health Law to provide an AIDS home care program; or an AIDS Center, as defined in Part 405 of this Chapter, specifically authorized pursuant to Article 36 of the Public Health Law to provide an AIDS home care program. Such program shall be provided in the person's home or in the home of a responsible relative, other responsible adult, adult care facilities specifically approved to admit or retain residents for such program, or in other residential settings as approved by the commissioner in conjunction with the commissioner of social services. Such program shall provide services including, but not be limited to, the full complement of health, social and environmental services provided by long term home health care programs in accordance with regulations promulgated by the commissioner. Such programs shall also provide such other services as required by the commissioner to assure appropriate care at home for persons eligible under such program.

(ii) A long term home health care program that does not obtain authorization to provide an AIDS home care program shall not be precluded from providing services within its existing authority to patients who are diagnosed as having AIDS, or are deemed by a physician, within his judgement, to be infected with the etiologic agent of acquired immune deficiency syndrome, and who have an illness, infirmity or disability which can be reasonably ascertained to be associated with such infection.

(27) Hospice residence shall mean a hospice operated home which is residential in character and physical structure, and operated for the purpose of providing more than two hospice patients, but not more than sixteen (16) hospice patients, with hospice care.

(28) Dually certified hospice residence bed shall mean a bed located in a hospice residence that has been approved by the Department to be used alternately for residential hospice care and inpatient hospice care.

(b) The following definitions of medical staff and paramedical personnel, based on standards approved by the commissioner, shall apply to this Chapter unless the context otherwise requires:

(1) Associate narcotic rehabilitation counsellor shall mean a person who:

(i) has a master's degree from a college or university approved by the Education Department; or

(ii) has had three years' experience, one year of which must have been in a supervisory capacity, in social casework, guidance counseling, vocational rehabilitation, or an appropriate subject-matter program in a social science field.

(2) Audiologist shall mean a person who is licensed as required by article 159 of the New York State Education Law.

(3) Auxiliary nursing personnel shall mean unlicensed, nonprofessional workers employed to assist registered professional nurses in hospitals.

(4) Dietician shall mean a person who has received a baccalaureate degree with major studies in food and nutrition from a college or university approved by the Education Department and is registered or is eligible for registration by The American Dietetic Association, or has the equivalent of such training and experience and who participates annually in continuing dietetic education.

(5) Reserved.

(6) Full-time health officer shall mean the county, part-county or city health commissioner in cities of 50,000 population or over, or the district health officer, having jurisdiction in the geographic area in which the medical facility is located.

(7) Medical staff shall mean all physicians and dentists appointed by the governing authority and responsible to such authority for the adequacy and quality of the medical care rendered to patients in a medical facility.

(8) Narcotic rehabilitation chief officer shall mean a person who has a bachelor's degree from a college or university approved by the Education Department or holds a license as a registered professional nurse and has had two years' supervisory experience in custodial care of inmates or patients or who has four years' experience in professional nursing or custodial care of inmates or patients, two years of which must have been in a supervisory capacity.

(9) Home health aide shall mean a person who carries out health care tasks under the supervision of a registered nurse or licensed therapist and who may also provide assistance with personal hygiene, housekeeping and other related supportive tasks to a patient with health care needs in his/her home. Home health aides shall have successfully completed a basic training program in home health aide services or an equivalent exam approved by the department and possess written evidence of such completion.

(10) Nurse aide shall mean any nonlicensed or noncertified person who provides direct personal patient/resident services, including safety, comfort, personal hygiene or patient/resident protection services under the supervision of a registered professional nurse or licensed practical nurse in a residential health care facility.

(11) Occupational therapist shall mean a person who is registered with the American Occupational Therapy Association, or either a graduate of a program in occupational therapy approved by the Council on Medical Education of the American Medical Association in collaboration with the American Occupational Therapy Association or a graduate of a curriculum in occupational therapy which is recognized by the World Federation of Occupational Therapists and is eligible for registration with the American Occupational Therapy Association.

(12) Occupational therapy assistant shall mean a person who is certified by and currently registered with the New York State

Education Department. When working in an occupational therapy program, approved by the department, the assistant must work under the supervision of an occupational therapist who is licensed by and currently registered with the New York State Education Department.

(13) Personal attendant shall mean a person who assists residents of a health-related facility with carrying out daily activities related to personal hygiene and social fellowship under satisfactory supervision.

(14) Personal care aide shall mean a person who, under professional supervision, provides patients assistance with nutritional and environmental support and personal hygiene, feeding and dressing and/or, as an extension of self-directed patients, selects health-related tasks. A personal care aide shall have successfully completed:

(i) a training program in home health aide services or equivalent exam as specified in paragraph (9) of this subdivision; or

(ii) one full year of experience in providing personal care services through a home care services agency within three years preceding the effective date of an initial license issued pursuant to article 36 of the Public Health Law; or

(iii) a training program in personal care services as specified in 18 NYCRR 505.14(a) and (e). A copy of 18 NYCRR 505.14(a) and (e) is available for inspection and copying at the offices of the records access officer, Department of Health, Corning Tower, Empire State Plaza, Albany; and

(iv) in those instances where the personal care aide is to be providing assistance with health-related tasks, such aide shall be trained as in subparagraph (iii) of this paragraph and training in health-related tasks shall be completed in full prior to the personal care aide's assignment to any patient, as evidenced by written documentation of such completion.

(15) Homemaker shall mean a person who meets standards established by the Department of Social Services and assists and instructs persons at home because of illness, incapacity or absence of a caretaker relative in managing and maintaining a household, dressing, feeding and incidental household tasks.

(16) Housekeeper shall mean a person who meets the standards established by the Department of Social Services and, in situations

in which services of a trained homemaker are not required, does light work or household tasks for persons at home because of illness, incapacity or the absence of a caretaker relative.

(17) Qualified hospital administrator shall mean a person who:

(i) holds a degree of doctor of medicine or a master's degree or its equivalent in hospital administration, public health, science, administrative medicine, or business administration when granted for a program in hospital administration, from a college or university approved by the Education Department or whose program is approved by the Association of University Programs of Hospital Administration, and has served a minimum of two years as the administrator, associate or assistant administrator of an accredited hospital or in health service administration acceptable to the commissioner; or

(ii) is a registered professional nurse who has served a minimum of three years as an administrator, associate or assistant administrator of an accredited hospital; or

(iii) holds a bachelor's degree from a college or university approved by the Education Department and has served a minimum of five years as an administrator, associate or assistant administrator in an accredited hospital; or

(iv) is, or has been prior to January 1, 1968, the administrator of a hospital, or has served a minimum of seven years as an associate or assistant administrator of a hospital with a valid hospital operating certificate; or, prior to February 1, 1966, the administrator of a hospital, or has served a minimum of seven years as an associate or assistant administrator of a hospital which would meet the standards for hospital certification.

(18) A community health nurse shall mean a nurse whose primary functions, under qualified nursing supervision, are to plan, provide, direct and evaluate nursing care in a variety of settings and offer instruction and guidance in health practice for individuals and families. Such nurse shall be licensed and currently registered and shall have the following additional qualifications:

(i) a baccalaureate degree in nursing from an approved program;

(ii) a baccalaureate degree in nursing from a nonapproved program supplemented by content which can be equated to the approved program; or

(iii) be a registered professional nurse with:

(a) a baccalaureate degree in a health or human services field; or

(b) two years experience in home care.

(19) A supervising community health nurse shall mean a licensed and currently registered professional nurse whose primary functions are to supervise, instruct and guide nursing and auxiliary personnel in providing high quality nursing services. Such nurse shall have the following qualifications:

(i) a baccalaureate degree in nursing or a health or human services field and two years' experience in home care; or

(ii) the following combination of education, experience and/or training:

(a) four years' experience in home care; and

(b) six credit hours, or the equivalent, of education/training in public health and principles of management.

(20) Director of patient services shall mean a licensed and currently registered nurse who is responsible for clinical direction and supervision of patient care services. Such individual shall meet the following qualifications:

(i) two years as a supervising community health nurse; or

(ii) two years of home care nursing experience plus a masters degree in nursing, public health, business administration or another health related field.

(21) Certified home health agency administrator shall mean a person who is responsible to the governing authority for the administrative operation of a certified home health agency and who meets the following minimum qualifications:

(i) is a licensed physician;

(ii) is a registered professional nurse; or

(iii) is a person who has training and experience in health services administration and at least one (1) year of supervisory or administrative experience in home health care or related health programs.

(22) A certified registered nurse anesthetist or registered nurse anesthetist or nurse anesthetist shall mean a registered professional nurse licensed and currently registered with the New York State Education Department who:

(i) has satisfactorily completed a prescribed course of study in a school of nurse anesthesia accredited by the Council on Accreditation of Nurse Anesthesia Education Programs/Schools or other accrediting body which the commissioner finds to be substantially equivalent;

(ii) has passed the national certifying examination given by the Council on Certification of Nurse Anesthetists or other certifying examination which the commissioner finds to be substantially equivalent; and

(iii) is currently certified by the Council on Certification of Nurse Anesthetists or by the Council on Recertification of Nurse Anesthetists or other accrediting body which the commissioner finds to be substantially equivalent.

A registered professional nurse licensed and currently registered with the New York State Education Department who does not meet the requirements as set forth in subparagraphs (i), (ii) and (iii) of this paragraph, shall be permitted to continue the practice of nurse anesthesia only under the supervision of a qualified anesthesiologist until one year after the effective date of these regulations.

(23) Qualified radiation physicist shall mean a graduate physicist who has been certified, by the American Board of Radiology, by the American Board of Industrial Hygiene or by the American Board of Health Physics, as a qualified radiation physicist.

(24) Qualified social worker shall mean a person who holds a master's degree in social work after successfully completing a prescribed course of study at a graduate school of social work accredited by the Council on Social Work Education and the Education Department, and who is certified or licensed by the Education Department to practice social work in the State of New York. When employed by a certified home health agency, long-term home health care program or hospice, such social worker must have had one year of social work experience in a health care setting.

(25) Qualified specialist shall mean a physician who holds a current

license to practice medicine in the State of New York, and who:

(i) is a diplomate of the appropriate American board or who has been certified as a specialist by the American osteopathic specialty board for the respective specialty; or

(ii) has been notified of admissibility to examination by such board, or presents evidence of completion of an approved qualifying residency in such specialty; or

(iii) holds the rank of attending or associate attending specialist in an accredited voluntary or governmental hospital which is approved for training in the specialty in which the physician has privileges; or

(iv) holds an appropriate specialist rating granted by the Workers' Compensation Board after May 1960, provided the award is based on training approved by the respective specialty board.

(26) Recreation assistant shall mean an individual who has an associate degree in recreation supervision from an approved two-year college curriculum or from a New York State community college, which training shall include or be supplemented by one or more credit courses relative to the aging process and related disabilities.

(27) Therapeutic recreation specialist shall mean a person who, prior to the effective date of this paragraph, was approved by the department as a qualified therapeutic recreationist, or, on or after its effective date:

(i) holds a master's degree with a major in therapeutic recreation and has one year of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or

(ii) holds a master's degree with a major in general recreation and has two years of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or

(iii) holds a master's degree in a field allied to therapeutic recreation and has three years of full-time, paid work experience in an activities program for the ill, aged and handicapped in a health care setting; or

(iv) holds a baccalaureate degree with a major in therapeutic recreation and has three years of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or

(v) holds a baccalaureate degree in general recreation and has four years of full time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or

(vi) holds a baccalaureate degree in a field allied to therapeutic recreation and has five years of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; and

(vii) has submitted credentials to the department which shall include an application for verification of qualifications, official college transcripts, and resume of work experience, including name and address of facility or agency, dates of employment, job description and job title.

(28) Social work assistant or case aide shall mean a person who holds a baccalaureate degree in social work from a college or university having a course of study accredited by the Council on Social Work Education, or an associate degree in the human services, or who has had four years of full-time, paid experience in social work in a social agency adhering to acceptable standards, or who has an equivalent combination of the foregoing education and experience satisfactory to the department.

(29) Speech pathologist shall mean a person who is licensed as required by article 159 of the New York State Education Law.

(30) Activities director shall mean a person who, prior to the effective date of this paragraph, was approved by the department as a qualified trained activities leader, or, on or after its effective date:

(i) is a qualified occupational therapist; or

(ii) is a qualified therapeutic recreation specialist; or

(iii) is a qualified occupational therapy assistant; or

(iv) is a qualified recreation assistant; or

(v) has a minimum of two years' full-time, paid experience, acceptable to the department, in an activities program in a health care setting.

(31) Activities program consultant shall mean a person who is qualified either as an occupational therapist or as a therapeutic recreation specialist as defined in this Subchapter.

(32) Physical therapist assistant shall mean an individual who is licensed by and currently registered with the New York State Education Department, or who has been issued a valid limited permit by that Department. The assistant must work under the supervision of a physical therapist who is licensed by and currently registered with the New York State Education Department.

(33) Physical therapy aide shall mean a nonprofessional person who assists with the implementation of a physical therapy program under the supervision of a physical therapist who is licensed by and currently registered with the New York State Education Department.

(34) Registered physician's assistant shall mean an individual who has completed program for the education and training of physician's assistants, or its equivalent approved by the New York State Education Department, and who is currently registered as a physician's assistant by the New York State Education Department.

(35) Registered specialist's assistant shall mean an individual who has completed a program for the education and training of specialist's assistants, or its equivalent, approved by the New York State Education Department, and who is currently registered as a specialist's assistant by the New York State Education Department.

(36) Licensed-midwife shall mean an individual licensed by the State Education Department under Artile 140 of the Education Law to practice midwifery.

(37) Respiratory therapist shall mean a person who is licensed and currently registered as a respiratory therapist pursuant to Article 164 of the New York State Education Law.

(38) Dietetic service supervisor shall mean a person who:

(i) is a dietician; or

(ii) has a baccalaureate degree with major studies in food and nutrition, dietetics or food service management, has one year of supervisory experience in the dietetic service of a health care institution; or

(iii) is a graduate of a dietetic technician training program, corresponding or classroom, approved by the American Dietetic Association; or

(iv) is a graduate of a State-approved course that provided 90 or more hours of classroom instruction in food service supervision and has experience as a supervisor in a health care institution with consultation from a dietician; and

(v) has submitted credentials to the department for verification of qualifications.

(39) Supervising nurse in a skilled nursing facility shall mean a person who is currently registered as a licensed professional nurse in New York State, and who:

(i) is responsible for the supervision of more than one nursing unit and is not assigned simultaneously head nurse and/or charge nurse functions;

(ii) critically observes the courses of actions of nursing personnel and is free to move from place to place in the facility in order to do so; and

(iii) is responsible for teaching, counseling and developing the skills of nursing personnel in relation to diagnosing the nursing care problems of patients, to treating patients in emergency situations and to providing that care which requires the knowledge and skill of a registered professional nurse as so defined.

(40) Head nurse shall mean a person who:

(i) is currently registered as a licensed professional nurse in New York State; and

(ii) is responsible for diagnosing nursing needs of patients and for planning, coordinating and evaluating patient care on one nursing unit for a 24-hour period.

(41) Charge nurse shall mean a person who is:

(i) currently registered in New York State either as a:

(a) licensed professional nurse; or

(b) licensed practical nurse who has licensure by successful completion of the New York State licensure examination or, if licensed previously in another state, has licensure in New York State on the basis of successfully completing the examinations in the other state; and

(ii) responsible for nursing activities on one tour of duty on one nursing unit.

(42) Registered professional nurse shall mean a person who is licensed and currently registered as a registered professional nurse pursuant to Article 139 of the New York State Education Law.

(43) Licensed practical nurse shall mean a person who is licensed and currently registered as a licensed practical nurse pursuant to Article 139 of the New York State Education Law.

(44) Physical therapist shall mean a person who is licensed by and currently registered with the New York State Education Department or who has been issued a valid limited permit by that Department.

(45) Acting leisure-time activities director shall mean a person who is in the process of completing any of the requirements for that of a qualified leisure-time activities director.

(46) Medical record practitioner shall mean a person who:

(i) is eligible for certification as a registered record administrator (RRA) or an accredited record technician (ART), by the American Medical Record Association under its requirements in effect; or

(ii) is a graduate of a school of medical record science that is accredited jointly by the Council on Medical Education of the American Medical Association and the American Medical Record Association.

(47) Hospice administrator shall mean a person who possesses a baccalaureate or higher degree from a regionally accredited college or university or one approved by the New York State Education Department, and has a minimum of two years of professional experience in the delivery of health care services, which shall include at least one year in a responsible administrative position.

(48) Hospice medical director shall mean a physician who is licensed and currently registered to practice medicine in the State of New York.

(49) Hospice nurse coordinator shall mean a registered professional nurse who is currently licensed and registered in the State of New York and (i) possesses a baccalaureate degree in nursing and has a minimum of four years of professional experience in the delivery of nursing services which shall include at least two years in a supervisory or administrative position, or (ii) has a minimum of six years of professional experience in the delivery of nursing services which shall include at least two years in a supervisory or administrative position.

(50) Pastoral care coordinator shall mean a person who has had a minimum of one year of training and experience in pastoral/spiritual counseling, and has a baccalaureate degree from a regionally accredited college or university or one recognized by the New York State Education Department.

(51) Coordinator of hospice volunteer services shall mean a person who has demonstrated, to the satisfaction of the hospice administrator, the ability to organize and coordinate volunteer services.

(52) Hospice volunteer shall mean a lay or professional person who contributes time and talent to a hospice program without economic remuneration and is considered one of the hospice's personnel.

(53) Respiratory therapist technician shall mean a person who is licensed and currently registered as a respiratory therapy technician pursuant to Article 164 of the New York State Education Law.

(54)  Advanced home health aide shall mean a certified home health aide who has satisfied all requirements to perform advanced tasks set forth in subdivision two of section 6908 of the education law and regulations issued by the state education department thereunder and who is currently listed in the home care worker registry maintained by the department pursuant to subdivision nine of section 3613 of the Public Health Law as having satisfied all applicable requirements for performing advanced tasks as an advanced home health aide.  An advanced home health aide shall have successfully completed a training program for advanced home health aides that is approved by the department or the state education department.

(c) The following general definitions, based on standards approved by the commissioner, shall apply to this Chapter, unless the context otherwise requires:

(1) Ambulant patient shall mean a person who has the ability to walk on level surfaces and to negotiate stairs and ramps independent of

human assistance or supervision, using the following mechanical devices or aids when necessary: prosthesis, brace, cane or handrail.

(2) Applicant shall mean a government agency, corporation or individual or partnership of individuals established or incorporated as required by the Public Health Law proposing to construct or operate a medical facility who has submitted an application for such construction or an operating certificate to the department.

(3) Board shall mean the provision of food and drink appropriate for the physical needs and medical conditions of hospital patients and residents, including the provision of therapeutic diets appropriate for individual patients and residents.

(4) Commissioner shall mean the State Commissioner of Health.

(5) Council shall mean the State Hospital Review and Planning Council.

(6) Department shall mean the New York State Department of Health.

(7) Reserved

(8) Governing authority or operator shall mean the policy-making body of a government agency, the board of directors or trustees of a corporation or the proprietor or proprietors of a proprietary facility, agency or program to which the department has issued an operating certificate, certificate of approval or license.

(9) A health-related facility resident shall mean a person who, because of social, physical, developmental or mental condition, requires institutional care and services above the level of room and board in order to secure basic services necessary to function, but who does not require the inpatient care and services provided by a hospital or skilled nursing facility and, in addition, may have one or more of, but is not limited to, the following characteristics:

(i) possesses a degree of functional capacity permitting varied degrees of independence that reflect chronic disease conditions which may be stabilized, or mental and emotional impairment requiring medications and a range of care and services which stress health and social maintenance and prevention of further deterioration;

(ii) whose stay in the health-related facility is usually long-term and whose admission, which is not for social reasons alone, reflects the absence of alternate community, family or personal resources to meet the individual's needs;

(iii) needs a planned program of care and supervision on a continuous 24-hour-a-day basis emphasizing personal care and services under the direction of a physician;

(iv) needs assistance in securing planned, basic recreational and diversional activities and services of other disciplines such as nutritional and social work counseling, through coordinated resident care plans which also include sustaining contacts with the community and which support the need and desire to function as independently as possible and prevent withdrawal and other symptoms of early deterioration;

(v) needs health services which are under the direct supervision of a registered nurse or other health professionals who have responsibility for developing and coordinating nursing care and resident care plans and who periodically review and revise such plans;

(vi) needs periodic or intermittent skilled nursing care and services but not continuous skilled services which in the aggregate require the direct supervision by licensed nursing personnel; and

(vii) requires services which can usually be delivered by nonlicensed personnel and are primarily support kinds of services such as assistance with activities of daily living.

(10) Lodging shall mean the provision of a clean, safe, healthy, sheltered environment suitably equipped and staffed for the residential and protective care of patients and residents.

(11) Nonambulant patient shall mean a person who is bedfast, chairfast or roombound, or who can sit in, but not propel, a wheelchair.

(12) Nursing home patient shall mean a person:

(i) diagnosed by a physician as having one or more clinically determined illnesses or conditions that cause the person to be so incapacitated, sick, invalid, infirm, disabled or convalescent as to require at least medical and nursing care; and

(ii) whose assessed health care needs, in the professional judgment of his physician or a medical team:

(a) do not require care or active treatment of the patient in a general or special hospital in or near his community;

(b) cannot be met satisfactorily in the person's own home or home substitute through providing such home health services, including medical and other health and health-related services as are available in or near his community; and

(c) cannot be met satisfactorily in a physician's office, hospital clinic or other ambulatory care setting because of the unavailability of medical and other health and health-related services for the person in such setting in or near his community.

(13) Reserved.

(14) Home care services shall mean one or more of the following services provided to persons at home:

(i) those services provided by a home care services agency;

(ii) home health aide services;

(iii) personal care services;

(iv) advanced home health aide services;

(iv) homemaker services; or

(v) housekeeper services.

(15) Home health aide services shall mean health care tasks, personal hygiene services, housekeeping tasks and other related supportive services essential to the patient's health.

(16) Personal care services shall mean assistance to the patient with personal hygiene, dressing, feeding and household tasks essential to his/her health.

(17) Advanced home health aide services shall mean assistance to the patient with advanced tasks defined in subdivision two of section 6908 of the education law and regulations issued by the state education department thereunder and assigned by the supervising registered professional nurse.

(18) Homemaker services shall mean assistance and instruction in managing and maintaining a household, dressing, feeding and incidental household tasks for persons at home because of illness, incapacity or the absence of a caretaker relative. Such services shall be provided by persons who meet the standards established by the Department of Social Services.

(19) Housekeeper services shall mean the provision of light work or

household tasks which do not require the services of a trained homemaker. Such services may be provided, for persons at home because of illness, incapacity or the absence of a caretaker relative, by persons who meet the standards established by the Department of Social Services.

(20) Government funds shall mean funds provided under the provisions of title 11 of article 5 of the Social Services Law.

(21) Reserved.

(22) Personal service shall mean the service provided to each resident of a health-related facility which contributes to a clean, safe, healthy and attractive environment, and which provides supervision or assistance in daily activities in order to maintain an optimal state of health and physical and emotional well-being and safeguard the individual rights and privileges of the resident.

(23) Reserved.

(24) Semiambulant patient shall mean a person who is not an ambulant or a nonambulant patient and who:

(i) can walk assisted by crutches only, or who has the ability to walk on level surfaces independently, but needs human assistance or supervision when negotiating stairs;

(ii) can move from place to place by using a walker or by propelling a wheelchair; or

(iii) needs human assistance or supervision for walking on a level surface.

(25) Sponsor shall mean the agency and/or the person or persons, other than the patient or resident, responsible in whole or in part for the financial support of the patient or resident including the costs of care in the medical facility.

(26) Activities program shall mean a planned schedule of recreational, social and other purposeful activity for nursing home patients designed to make their life more meaningful; to stimulate and support the desire to use their physical and mental capabilities to the fullest extent; to enable them to maintain a sense of usefulness and self-respect, but not specifically designed to correct or remedy any disability.

(27) Hospital ambulance service means the service of a hospital, as

defined in article 28 of the Public Health Law, in transporting sick, disabled or injured persons by motor vehicle or other forms of transport to and from facilities or institutions providing hospital service when such service is provided by a hospital operating such service, or contracting therefor.

(28) Ambulance means a motor vehicle, or other form of transport, equipped to transport sick, disabled or injured individuals.

(29) Reserved.

(30) Rehabilitation therapy services shall include but not be limited to audiology, occupational therapy, physical therapy, speech pathology and audiology.

(31) Verification of qualifications shall mean a department review and approval of the education, related experience and, where required, licensure, registration or certification of each occupational and physical therapist, speech pathologist, audiologist, occupational therapy assistant, physical therapist's assistant, recreation assistant, activities director and therapeutic recreation specialist providing service to health facilities certified by the department.

(32) Reserved.

(33) Reserved.

(34) Nutritional services shall mean the:

(i) assessment of nutritional needs and food patterns;

(ii) planning for and/or the provision of foods and drink appropriate for the individual's physical and medical needs and environmental conditions; and

(iii) providing nutrition education and counseling to meet normal and therapeutic needs.

(35)-(41) Reserved

(42) Restraint shall mean a physical device or chemical used to limit, restrict or keep under control patient movements.

(43) Family planning shall mean the planning for children, including the spacing and limiting of childbirth by medical means and the overcoming of involuntary infertility.

(44) Reserved.

(45) Reserved.

(46) Reserved.

(47) Leisure-time activities department shall mean a department whose personnel are responsible for working with the healthy aspects of residential health-care facility patients/residents by making available a planned, scheduled program of diverse and meaningful activities to meet residents' needs and interests. These activities can be pursued on a voluntary basis individually, independently, in a group, and at group functions. These activities are designed to ensure continuity of the resident's prior life style, but are not specifically designed to correct or remedy any physical or mental disability or dysfunction.

(48) Verification of qualifications shall mean a department review and approval of the education and related experience of each leisure-time activities director, acting leisure-time activities director, leisure-time activities consultant, and physical therapist's assistant providing services to health facilities certified by the department.

(49) Rehabilitation therapy (skilled therapy) is administered by a qualified professional to restore physical function insofar as possible and/or help patients adjust or compensate for loss of function. These objectives should be accomplished within a reasonable length of time.

(50) A maintenance program is established and monitored by the qualified occupational therapist or physical therapist. This program helps the patient/resident retain an existing level of function and may be continued for an undetermined period of time. In general, maintenance is not skilled therapy. With few exceptions, it is carried out by support personnel.

(51) Medical social services shall mean the identification, assessment and management of social problems related to illness, the receipt of medical care and the attainment and maintenance of health as performed by qualified social workers.

(52) Medical supplies, equipment and appliances shall mean those items primarily and customarily used to serve a medical purpose and which are generally not useful to a person in the absence of an injury or illness.

(53) State health planning and development agency shall mean the State health planning and development agency designated pursuant to the National Health Planning and Resources Development Act of 1974, and any amendments thereto.

(54) Autonomous hospice administration shall mean a identifiable administrative group that has a distinct organizational structure, accountable to the hospice's governing authority either directly or through the governing authority's chief executive officer, for all aspects of the hospice.

(55) Hospice patient shall mean a person in the terminal stage of illness, with a life expectancy of approximately twelve months or less, who, alone or in conjunction with designated family member(s), has voluntarily requested admission and has been accepted into a hospice for which the department has issued a certificate of approval; provided, however, that nothing herein shall be construed to require provision of services to a patient that are not covered by the patient’s payment source.

(56) Hospice patient's family shall mean the hospice patient's immediate relations, including a spouse, brother, sister, child or parent. In addition, other relations and individuals with significant personal ties to the hospice patient may be designated as members of the hospice patient's family by mutual agreement among the hospice patient, the relation or individual and the hospice.

(57) Bereavement services shall mean those supportive services provided to the family to assist them in coping with the death of the patient.

(58) Palliative and supportive care shall mean services provided to a hospice patient for the reduction and abatement of pain and other symptoms and stresses associated with terminal illness and dying.

(59) Pastoral care shall mean services provided for the spiritual, religious and emotional support of the patient and family.

(60) Palliative care shall mean active, interdisciplinary care provided to a patient and/or a hospice patient with advanced, life-limiting illness, focusing on relief of distressing physical and psychosocial symptoms and meeting spiritual needs with the goal of achievement of the best quality of life for patients and families.

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Secions 2803, 2803-b and 3612

Section 700.3 - Assessment of long-term care patients

700.3 Assessment of long-term care patients.

(a) (1) For patients who require placement or continued stay in a nursing home or health-related facility, the Hospital/Community PRI or the PRI shall be completed by a registered professional nurse who has successfully completed a training program in patient case mix assessment approved by the department to train individuals in the completing of the patient review form (PRI) as contained in section 86-2.30(i) of this Title, or the Hospital/Community patient review form (Hospital/Community PRI) as contained in section 400.13 of this Title. For patients who require placement or continued stay in a nursing home or a health-related facility, the SCREEN shall be completed by a professional with demonstrated skills in assessing psychosocial situations, including but not limited to social work and discharge planning professionals, who has successfully completed a training program in patient case mix screening approved by the department to train individuals in the completion of the patient screening form (SCREEN), as contained in section 400.12 of this Title; or

(2) Each general hospital shall have on staff trained and qualified screener(s) and assessor(s) in such numbers as specified in section 85.8(c)(1)(ii) of this Title, who shall be responsible for and attest to the accuracy of Hospital/Community PRI's, PRI's and SCREEN's as contained in sections 400.13, 86-2.30(i) and 400.12 of this Title, respectively. Each residential health care facility shall have on staff trained and qualified screener(s) and assessor(s) who shall be responsible for and attest to the accuracy of PRI's and SCREEN's.

(b) The commissioner may waive the requirements of this section or any part thereof for recognized demonstration projects to effect the development of additional knowledge and experience in different types of assessments for long-term care patients.

(c) The patient and/or the patient's designated representative shall be given an explanation of the information contained on the SCREEN, including the determination of setting for care for that particular patient.

(d) Residential health care facilities not participating in the Medicare and Medicaid programs (titles XVIII and XIX of the Federal Social Security Act) are required to complete the PRI and SCREEN forms for prior to admission and admission review purposes pursuant to sections 730.2(a), 740.2(b), 781.11(a) and 741.14(a) of this Title. The continued stay review requirements of sections 731.11(b), (f) and 741.14(a), (f) of this Title shall not apply. An alternate schedule for completion and submission of the forms may be established by the commissioner for such continued stay review requirements.
 

Doc Status: 
Complete

Section 700.4 - The role of the licensed practical nurse in intravenous therapy procedures

700.4 The role of the licensed practical nurse in intravenous therapy procedures.

(a) For purposes of this section, agency shall mean an entity licensed, authorized or certified to operate pursuant to Articles 36 or 40 of the Public Health Law.

(b) An agency may allow specially trained licensed practical nurses, under the supervision of a qualified registered professional nurse or physician, to perform all intravenous therapy procedures except for the administration of blood and blood products, intravenous anti-neoplastic agents, a bolus of medication by intravenous push unless it is administered in the course of chronic hemodialysis treatment as permitted in this chapter and procedures involving central venous lines.

(c) In order to utilize a licensed practical nurse to perform intravenous therapy procedures in a home setting, the agency shall require that:

(1) the licensed practical nurse has satisfactorily completed a training program and supervised clinical experience in intravenous therapy procedures in a general hospital and is assigned to perform such procedures only for patients who are considered to be medically stable;

(2) a registered professional nurse initiates and monitors all new intravenous therapy medications the patient receives and continues to administer subsequent doses if it is determined to be necessary by the registered professional nurse;

(3) a registered professional nurse who is competent and knowledgeable about the administration of intravenous medications and familiar with the patient's condition be available immediately to the licensed practical nurse by telephone for consultation; and

(4) licensed practical nurses not be assigned to handle any central venous line procedure.

(d) The agency shall ensure that licensed practical nurses allowed to perform intravenous therapy procedures have satisfactorily completed a training program, received supervised clinical experiences and demonstrated competence in the performance of intravenous therapy procedures.

(e) The training program for intravenous therapy shall include as a minimum instruction in:

(1) the agency's policies and procedures related to intravenous therapy;

(2) the agency's quality assurance and risk management program;

(3) anatomy and physiology related to intravenous therapy;

(4) the solutions and drugs used in intravenous therapy, their pharmacological action and therapeutic effects;

(5) procedures used for mixing intravenous medications and solutions;

(6) the signs and symptoms of complications and adverse reactions to intravenous therapy;

(7) the functions, use and maintenance of intravenous devices and equipment; and

(8) infection control techniques.

(f) The agency shall ensure that all intravenous therapy procedures performed by the licensed practical nurse are provided in accordance with written policies and procedures which are reviewed and updated as needed, but at least annually.

(g) The agency shall ensure that there is documentation in the licensed practical nurse's personnel file which indicates the training program attended, number of hours and content of the program, supervised clinical experiences and approval to perform intravenous therapy procedures.

(h) Inservice education programs shall be conducted to update and inform the licensed practical nurse of new intravenous therapy procedures, equipment and medications. The programs shall be conducted as often as necessary but at least on an annual basis and be documented in the personnel file of the licensed practical nurse.
 

Effective Date: 
Wednesday, September 20, 1989
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Section 700.5 REPEALED

Effective Date: 
Wednesday, March 26, 2014

Part 701 Reserved

Part 702 - Environmental Health

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Statutory Authority: 
Public Health Law, Section 2803

Section 702.1 - Engineering and maintenance

Section 702.1 Engineering and maintenance. (a) Water supplies of medical facilities shall be operated in conformance with the following requirements:

(1) all water used in operation shall be provided from a public water supply or from an alternate source, in either event, as approved by the department;

(2) no changes shall be made in the source or treatment of the water supply without approval of the department;

(3) water shall be adequate in volume and pressure for all medical purposes;

(4) the water system shall not be operated with physical connections to other piping systems or connections to fixtures that may permit contamination of the water supply;

(5) the water system shall be operated with a hot water system adequate for all medical purposes; and

(6) the hot water supply shall be regulated by thermostatic or other control devices which shall be either locked or located in places not accessible to patients or the general public so that the hot water used by patients and by the public is maintained at an even temperature which cannot cause personal injury.

(b) Waste systems shall be operated so that all sewage and other liquid wastes are disposed of by connection to a public sewer system or by an alternate method, in either event, as approved by the department.

(c) Plumbing and plumbing fixtures shall be properly maintained.

(d) Ventilation, heating, air conditioning, and air changing systems shall:

(1) be maintained in good repair and shall be operated in a manner which will prevent the spread of infection and provide for patient or resident health and comfort;

(2) be maintained and operated in such manner that air shall not be circulated from operating rooms, patient isolation rooms, laboratories in which work is done in pathology, virology, or bacteriology, autopsy rooms, kitchen and dishwashing areas, toilet and bathrooms, janitors' closets, and soiled linen rooms to any other part of the facility;

(3) be provided, as needed, with acceptable air filtration equipment that is cleaned and serviced at adequate intervals; and

(4) assure that the relative humidity is maintained at a minimum of 50 percent in those areas where conductive floors are required.

(e) Grounds and buildings shall be maintained:

(1) in a clean condition free of safety hazards;

(2) in such manner as will prevent standing water, flooding or leakage; and

(3) free of excessive noise, odors, pollens, dusts, or other environmental pollutants and such nuisances as may adversely affect the health or welfare of patients or residents.
 

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Section 702.2 - Housekeeping

702.2 Housekeeping. (a) The entire facility, including but not limited to the floors, walls, windows, doors, ceilings, fixtures, equipment, and furnishings, shall be maintained in good repair, clean and free of insects, rodents and trash.

(b) Responsibility for direct supervision of housekeeping service shall be assigned to one person, properly qualified by training and experience.

(c) Dusting, mopping and vacuum cleaning shall be done in a manner which will not spread dust or other particulate matter.

(d) Adequate supplies and equipment for housekeeping functions shall be provided with cleaning compounds and hazardous substances properly labeled and stored.

(e) Solid wastes, including garbage, rubbish and other refuse, biological wastes and infectious materials, shall be collected, stored and disposed of in a manner that will prevent the transmission of disease and not create a nuisance or fire hazard, nor provide a breeding place for insects or rodents; dressings, surgical, biological and obstetrical wastes, infectious materials and disposable syringes and needles shall be destroyed on the premises by incineration, or as approved by the department.
 

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Section 702.3 - Fire and safety

702.3 Fire and safety. (a) Buildings and equipment shall be maintained and operated so as to prevent fire and other hazards to personal safety.

(b) The facility shall comply with the pertinent provisions of NFPA 101, Life Safety Code. Further details concerning this referenced material are contained in section 711.2(a) of this Title.

(c) The facility shall comply with the pertinent provisions of NFPA 99, Standard for Health Care Facilities. Further details concerning this referenced material are contained in section 711.2(a) of this Title.

(d) The facility shall maintain a procedure to investigate fires. A written report of the investigation containing all pertinent information shall be made. The report shall remain on file for not less than six years.

(e) The facility shall maintain a procedure for reporting to a designated administrative officer on a standard form adopted for the purpose, all accidents to patients, staff, employees or visitors. The report shall include all pertinent information and shall be kept on file for not less than six years after the occurrence was reported.
 

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Section 702.4 - Infection control and reporting

702.4 Infection control and reporting. Medical facilities shall:

(a) Establish an infection control committee, composed of representative staff, which shall be responsible for establishing policies and procedures for investigating, controlling and preventing infections in the facility. The policies and procedures shall include those for the isolation of patients with communicable or infectious diseases or patients suspected of having such diseases, for training all personnel rendering care to such patients in the employment of standard infection control techniques, and for obtaining periodic reports of nosocomial infections. Nosocomial infections shall include an in creased incidence or outbreak of disease due to biological, chemical or radioactive agents or their toxic products occurring in patients or persons working in the hospital. The committee shall establish methods to ensure that policies and procedures are executed and the infection control program is effective.

(b) Assure that written effective procedures is aseptic and isolation techniques are followed by all personnel. Procedures are to be reviewed annually and revised if appropriate for effectiveness and improvement.

(c) Report immediately to the regional health director or associate commissioner for New York City affairs the presence of nosocomial infections.

(d) Report immediately to the city, county, or district health officer the presence of any communicable disease as defined in section 2.1 of this Title (State Sanitary Code).
 

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Section 702.5 - Linen and laundry

702.5 Linen and laundry. The governing authority or operator shall:

(a) Provide a sufficient quantity of clean linen to meet the requirements of patients and residents; nursing homes and health-related facilities shall maintain a linen inventory equal to at least three times the average daily census and of this one-third shall be in use, one-third in laundry and one-third in reserve.

(b) Maintain linen in proper condition for use, free from rips and tears.

(c) Provide for satisfactory laundering of linens and other washable fabrics.

(d) Handle, store and process laundry in a manner that will prevent the spread of infection and assure the maintenance of clean linen.

(e) Wash all linen, including blankets, between patient use.

(f) Bag or enclose all used linen in suitable containers within the patient care unit for transportation to the laundry.

(g) Separately bag or enclose used linens from isolation rooms, infectious patients and the pathology department in readily identifiable containers distinguishable from other laundry.

(h) Properly maintain space and equipment for laundry storage and transportation.

(i) Launder only in areas and with equipment properly maintained and approved for such purpose by the department.

(j) Launder in a manner designed to prevent contamination of clean linen and to prevent infection.

(k) Transport clean linen in clean covered containers used exclusively for the purpose, and store clean linen in clean storage areas in a manner to prevent its contamination.
 

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Section 702.6 - Animals

702.6 Animals. (a) No birds, turtles, dogs, cats or other animals exclusive of those required for laboratory purposes shall be allowed in a medical facility, except in a residential health care facility pet therapy program as permitted in subdivisions (b) and (c) of this section. Guide dogs may accompany sightless persons.

(b) A residential health care facility may board one dog or one cat, provided:

(1) the health, safety, welfare and rights of all patients/residents are assured;

(2) a staff member has been designated to be responsible for the care and management of the animal;

(3) the animal is free from disease and has received all immunizations as recommended by a licensed veterinarian; and

(4) the animal shall not be allowed in laundry, utensil storage or food preparation areas.

(c) Pet visitations are permitted in a residential health care facility, provided:

(1) the visit is prescheduled and approved by the operator;

(2) the health, safety, welfare and rights of all patients/residents are assured;

(3) all animals are free from disease and have received all immunizations as recommended by a licensed veterinarian;

(4) the animal shall not be allowed in laundry, utensil storage or food preparation areas; and

(5) the animal will at all times be accompanied by a person familiar with and capable of controlling the animal's behavior.
 

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Section 702.7 - Emergency and disaster preparedness

702.7 Emergency and disaster preparedness. Medical facilities shall have an acceptable written plan, rehearsed and updated at least twice a year, with procedures to be followed for the proper care of patients and employees, including the reception and treatment of mass casualty victims, in the event of an internal or external emergency or disaster arising from the interruption of normal services resulting from earthquake, tornado, flood, bomb threat, strike, interruption of utility services and similar occurrences. All employees are to be trained in all aspects of preparedness for any interruption of services and for any disaster.
 

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Part 703 - Ambulatory Services

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Statutory Authority: 
Public Health Law, Section 2803

Section 703.1 - Applicability

Section 703.1 Applicability. The provisions of this Part shall apply to hospitals with outpatient departments and to independent out-of-hospital health facilities which accept primary responsibility for health supervision and medical care of patients.
 

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Section 703.2 - General standards

703.2 General standards. Facilities providing ambulatory services shall conform to all applicable provisions of this Chapter, including, but not limited to, meeting the standards for adequate child health services, the educational and training needs of any interns and residents and the requirements for review of medical records.
 

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Section 703.3 - Medical service plan

703.3 Medical service plan. Facilities providing ambulatory services shall submit to the department a plan governing the provision of medical services to patients, which has been approved by the governing authority and the medical staff, including, as a minimum, the following:

(a) a comprehensive medical evaluation for such patients on a periodic basis indicating the method of selection of patients for annual or other periodic examination;

(b) continuity of care when such patients require hospitalization, home care or emergency care when such services in the facility are not available;

(c) the method of scheduling patient visits to physicians with general scheduling of not more than five patients per hour with an allowance of at least 30 minutes for the first complete patient workup;

(d) where a specific provision of the plan required cannot be implemented immediately, a plan of implementation shall be included, with the anticipated time limit for achieving each phase of the objective specified; and

(e) where it is deemed necessary that any provision of the plan required should be waived indefinitely because of practical difficulties or unnecessary hardships in complying therewith, where such waiver is in the community interest and does not adversely affect the protection of the health of the patient, a request for such waiver and the reasons therefor.
 

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Section 703.4 - Extension clinics

703.4 Extension clinics. Notwithstanding the requirements of this Chapter, extension clinics shall submit to the department a plan acceptable to the commissioner governing the location and objectives of the extension clinic, the relationships to the parent organization and a detailed program of operation.
 

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Section 703.5 - Multiphasic health screening facilities

703.5 Multiphasic health screening facilities. (a) The requirements of section 703.3 of this Part with respect to submission of a medical service plan shall not apply to a multiphasic health screening facility.

(b) A multiphasic health screening facility shall have an affiliation with a backup medical facility. The affiliation agreement between a screening and a backup facility shall be in writing and the responsibilities of these facilities shall be clearly stated.

(c) Mobile health screening units shall be either an extension of an established and certified medical facility or have an affiliation with a certified facility or an organized medical facility acceptable to the commissioner.

(d) The geographic area to be served shall be designated.

(e) Services provided shall be under the supervision of a currently licensed physician.

(f) Services shall be provided only to persons referred by a practicing physician, except in a case where the screening facility is under the auspices of a general hospital or an independent out-of-hospital health facility which has been certified by the department, a public health agency, or a health insurance group or plan approved by the Superintendent of Insurance.

(g) The components of any battery of tests to be performed shall be tailored to the population to be screened and each proposed screening facility shall present justifications for the tests offered.

(h) All findings of screening tests performed shall be provided in writing to the referring physician or agency making the referral.
 

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Section 703.6 - Part-time clinics

Section 703.6 Part-time clinics.

(a) Applicability. In lieu of Parts 702, 711, 712 and 715 of this Title, this section shall apply to part-time clinic sites, except for those operated by the State Department of Health (other than those part-time clinics which are operated as an extension of Article 28 hospitals operated by the State Department of Health) or by the health department of a city or county as such terms are defined in section 614 of the Public Health Law. Such cities and counties shall submit to the State Department of Health information which lists the location(s), hours of operation and services offered at each part-time clinic operated by or under the authority of the city or county health department. This information shall be submitted annually, by January 30 of each year, as an update to the Municipal Public Health Services Plan (MPHSP) submitted by the city or county pursuant to section 602 of the Public Health Law, and shall provide such information for each part-time clinic operated by or under the authority of the city or county health department in the previous calendar year. Consistent with the definition of part-time clinic site in section 700.2(a)(22) of this Title, a part-time clinic shall:

(1) provide services which shall be limited to low-risk (as determined by prevailing standards of care and services) procedures and examinations which do not normally require backup and support from the primary delivery site of the operator or other medical facility. Such services may include health screening (such as blood pressure and HIV screening), preventive health care and other public health initiatives (such as HIV services), procedures and examinations (such as well child care, the provision of immunizations and screening for chronic or communicable conditions which are treatable or preventable by early detection or which are of public health significance).

(2) be located at a site that has adequate and appropriate space and resources to provide the intended services safely and effectively and is located in proximity to the primary delivery site to ensure that supervision and quality assurance are not compromised; and

(3) not be located at a private residence or apartment, an intermediate care facility, an individualized residential alternative, congregate living arrangements, (not including a shelter for adults or other group shelter operated by governmental or other organizations to provide temporary housing accommodations in a safe environment to at-risk populations), an area within an adult home, a residence for adults or enriched housing program as defined in section 2 of the Social Services Law, unless such part-time clinic is operated as part of an approved State Department of Health public health initiative. A part-time clinic also shall not be located in space which is part of another facility licensed under Article 28 of the Public Health Law, unless such part-time clinic is operated as part of an approved State Department of Health public health initiative, or in space which is part of the private office of a health care practitioner or group of practitioners licensed by the State Education Department.

(b) Department approval and/or notification.

(1) An operator of part-time clinics may initiate patient care services at a specific site only upon written approval from the department in accordance with the department's limited review process set forth at section 710.1(c)(5)(iv)(e) of this Title. To request such approval, the operator shall submit to the department, for each such site, information and documentation in a format acceptable to the department and in sufficient detail to enable the commissioner to make a decision, including the following:

(i) the location, type and nature of the building, days and hours of operation, expected duration of operation (specified limited period of time, for example, seasonally), staffing patterns and objectives of the part-time clinic;

(ii) the leasing or other arrangement for gaining access to the site's real property, (including a copy of the agreement which grants the applicant the right to use and occupy the space for the part-time clinic site);

(iii) the plans and strategies for meeting the operational standards set forth in this section and an explanation of how the operator will provide adequate supervision and ensure quality of care;

(iv) a listing of all part-time clinic sites already operated by the applicant;

(v) a description of the services to be provided and the populations to be served;

(vi) procedures or strategies for advising patients on making arrangements for follow-up care; and

(vii) the annual aggregate number of part-time clinic services (based on the number of visits) already provided by the applicant and the percentage such visits represent of all outpatient visits provided by the applicant, the number of visits anticipated to be provided at the new part-time clinic and the impact such new site will have on the percentage of the applicant's total annual outpatient visits that will be part-time clinic visits.

(2) After initiating patient care services, an operator of part-time clinics may relocate a part-time clinic or change a category of service only upon written approval from the department in accordance with the department's limited review process as set forth in section 710.1(c)(5)(iv)(e) of this Title. To request approval, the operator shall submit to the department, for the site of relocation, change in hours of operation or change in services, information concerning:

(i) the location, type and nature of the building, days and hours of operation, and expected duration of operation (specified limited period of time, for example, seasonally);

(ii) the leasing or other arrangement for gaining access to the site's real property (including a copy of the agreement which grants the applicant the right to use and occupy the space for the part-time clinic site);

(iii) a description of the services to be provided and the populations to be served; and

(iv) the type of information concerning the volume of visits as required under subparagraph (1)(vii) of this subdivision.

(3) After initiating patient care services, the operator shall give written notification, including a closure plan acceptable to the department, to the Director of the Bureau of Hospital and Primary Care Services of the department at least 15 days prior to the discontinuance of a part-time clinic site other than a scheduled discontinuance as indicated in accordance with subparagraph (i) of paragraph (l) of this subdivision. No part-time clinic site shall discontinue operation without first obtaining written approval from the department.

(4)(i) The operator of any part-time clinic that was in operation on August 15, 2000, and in conformance with all pertinent statutes and regulations in effect prior to that date, and has submitted request(s) to the department for approval to continue providing services for each such site by November 13, 2000 in accordance with requirements in effect at that time shall be permitted to operate until and unless the department issues a written denial of approval to continue operation. If a request to continue operation of a part-time clinic site is denied, the operator shall, within 30 days of receipt of such denial submit to the department and obtain written approval of a closure plan consistent with the provisions of paragraph (3) of this subdivision for the expeditious termination of services at the site. Notwithstanding any other provision of this section, the operator of such part-time clinic site shall cease providing services at and close such site within 60 days of receipt of the notice of denial to continue operation regardless of whether a plan of closure has been approved by the department.

(ii) The operator of any part-time clinic site for which an application to continue providing services at such site was not submitted to the department by November 13, 2000, shall cease operations by December 31, 2000.

(c) Policies and procedures. (1) The operator shall ensure the development and implementation of written policies and procedures specific to each part-time clinic site, which shall include, but need not be limited to:(i) security, confidentiality, maintenance, access to and storage of medical records for each patient, including documentation of any diagnoses or treatments;

(ii) handling and storage of drugs in accordance with state law and regulation;

(iii) standards for maintaining asceptic conditions including the provision and storage of sterile supplies; sterilization equipment as necessary; disposal of contaminated supplies, equipment and medical waste; sharps disposal; and hand washing;

(iv) the prohibition of smoking within the facility;

(v) handling of patient emergencies, including written transfer agreements with hospitals within the service area;

(vi) a fire plan consistent with local laws;

(vii) training and education of staff in fire safety, evacuation and emergency procedures specific to each site, including those policies established by the building owner or operator;

(viii) credentialing of staff by the governing authority of the operator and assurance that only appropriately licensed and/or certified staff perform functions that require such licensure or certification;

(ix) quality assurance/improvement initiatives coordinated with such activities at the operator's primary delivery site(s);

(x) utilization review;

(xi) community outreach efforts designed to ensure that community members are aware of the availability of and the range of clinic services and hours of operation; and

(xii) assurance that patients can access necessary services without regard to source of payment.

(2) The following services shall not be provided at a part-time clinic site:

(i) services that require specialized equipment such as radiographic equipment, computerized axial tomography, magnetic resonance imaging or that required for renal dialysis;

(ii) services that involve invasion or invasive treatment procedures or disruption of the integrity of the body that normally require a surgical operative environment; and

(iii) services other than those available at the primary delivery site(s) listed on the primary facility's operating certificate.

(d) Services and personnel. The operator shall ensure that all health care services and personnel provided at the part-time clinic site shall conform with generally accepted standards of care and practice and with the following:

(1) part-time clinics operated by hospitals shall comply with pertinent standards established in Part 405 of this Title including, but not limited to, sections 405.7 (Patients' rights) and 405.20 (Outpatient services), which cross-references the outpatient care provisions of sections 752.1 and 753.1 of this Title; and

(2) part-time clinics operated by diagnostic and treatment centers shall comply with the pertinent provisions of Parts 750, 751, 752 and 753 of this Title including, but not limited to, section 751.9 (Patients' rights).

(e) Environment. The operator shall ensure that:

(1) the site is located in a building that complies with all applicable building construction and fire safety regulations and is acceptable to the local authority having jurisdiction, as evidenced by a valid Certificate of Occupancy or other written documentation;

(2) exits and access routes to exits are readily identified and accessible to patients and staff during all hours of occupancy or operation;

(3) continuous lighting, including provisions for emergency lighting in the event of electrical power interruptions, is provided for all exit route components and signage, during all hours of occupancy or operation;

(4) passageways, corridors, doorways and other means of exit are kept unobstructed; and

(5) all water used at the part-time clinic site is provided from a water supply which meets all applicable standards set forth in Part 5 of this Title.

(f) Limitation on the size of part-time clinic programs. An operator of part-time clinic sites shall limit the size and scope of its total part-time clinic program and operations so that the annual aggregate number or amount of outpatient services (based on the number of visits) provided by an operator at all of its part-time clinic sites in the aggregate does not exceed 20 percent of all outpatient services visits provided by such operator at all of its Article 28 sites, so that at least 80 percent of all outpatient visit services provided by such operator must be provided at its main site of operation and/or approved extension clinics. Operators of part-time clinics who are not in compliance with the requirements of this subdivision on the effective date of this subdivision shall have ninety days from such effective date within which to come into full compliance with such requirements.

(g) Waivers. The Commissioner, upon a request from the operator, may waive one or more provisions of this section upon a finding that such waiver would:

(1) enable at risk or medically underserved patients to obtain needed care and services, which are otherwise unavailable or difficult to access;

(2) contribute to attaining a generally recognized public health goal;

(3) not jeopardize the health or safety of patients or clinic staff; and

(4) not conflict with existing federal or state law or regulation.

Effective Date: 
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Part 704 Reserved

Part 705 - New Medical Technology and Health Services Demonstration Projects

Effective Date: 
Wednesday, November 2, 1983
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Statutory Authority: 
Public Health Law, Section 2803

Section 705.1 - Purpose and intent

Section 705.1 Purpose and intent. Due to the frequent development of new medical technologies involving innovations in both medical equipment and health services, it is necessary and appropriate in order for the department to carry out its responsibilities under article 28 of the Public Health Law and to assure that such equipment and services will be of a high quality, of adequate safety, efficiently provided at a reasonable cost and properly utilized, to evaluate the medical efficacy, cost effectiveness and efficiency of and need for such equipment and services before such equipment and services may be considered as usual, customary and generally accepted modalities of providing patient diagnosis, care, treatment or other health services in medical facilities.
 

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Section 705.10 - Termination of a demonstration project

705.10 Termination of a demonstration project. In addition to any other basis upon which an operating certificate or an approval of construction may be cancelled, terminated, withdrawn, or annulled pursuant to article 28 of the Public Health Law and this Chapter, an applicant's approval to participate in a medical technology demonstration project may be cancelled or terminated by the commissioner if:

(a) the applicant deviates significantly from its approved demonstration project design or protocols without approval from the commissioner;

(b) there is a significant change in the information or assurances contained in the application which were relevant factors upon which the application was granted a favorable recommendation by the technical advisory groups and approved by the commissioner; or

(c) the applicant submits a written request to withdraw from the demonstration and the request is approved by the commissioner. A request to terminate a demonstration project prior to its scheduled completion must include documentation of at least one of the following factors:

(1) that sufficient evidence of the costs associated with and benefits of the technology is available; or

(2) that continuation of the project would result in serious financial hardship to the facility.
 

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Section 705.11 - Reimbursement

705.11 Reimbursement. The pertinent provisions of Part 86 of this Title shall apply to approved medical technology demonstration projects; provided, however, that reimbursement pursuant to title 11 (Medical Assistance for Needy Persons) of article 5 of the Social Services Law shall not be available unless there is Federal financial participation pursuant to title XIX of the Social Security Act (Medicaid).
 

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Section 705.2 - Definition

705.2 Definition. New medical technology and health services demonstration projects. For purposes of this Chapter, a new medical technology and health services demonstration project shall mean a time limited project approved under section 2802 of the Public Health Law and this Subchapter to evaluate the medical efficacy, safety, cost effectiveness and efficiency of, and need for, an innovation in medical technology including, but not limited to, equipment and services, in or by a medical facility, that has not yet been generally recognized and accepted by the medical profession and institutional health care industry as a usual and customary modality of providing patient diagnosis, care, treatment or other health services.
 

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Section 705.3 - Selection of innovations for evaluation

705.3 Selection of innovations for evaluation. (a) The commissioner shall determine those innovations in medical technology which shall require evaluation through a demonstration project before they may be considered for review and approval pursuant to section 2802 of the Public Health Law and Part

710 of this Subchapter without limitation as to time or scope, after affording the health systems agencies and the State Hospital Review and Planning Council an opportunity to submit their recommendations, based on pertinent factors including, but not limited to, the following:

(1) the relative costs associated with acquiring, operating or providing the innovation when compared to the costs associated with other methods of providing comparable services;

(2) the potential for patient or personnel harm or injury associated with the use and operation of the innovation;

(3) the need to demonstrate the medical usefulness of efficacy of the innovation; and

(4) the need to identify and collect data in order to develop appropriate need and utilization standards for the innovation.

(b) After the commissioner has determined that an innovation in medical technology will be eligible for evaluation through a demonstration project pursuant to this Part, he will so notify all medical facilities that provide a level and type of care and service for which the innovation in medical technology would be appropriate, as determined by the commissioner, based upon generally accepted standards of medical practice.
 

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Section 705.4 - Application for approval

705.4 Application for approval. An application to the commissioner for approval of a demonstration project shall be in a format prescribed by the department. An original and eight copies of the application shall be forwarded to the Department's Project Management Unit, Corning Tower, Governor Nelson A. Rockefeller Empire State Plaza, Albany, NY 12237 within 45 days after issuance of the notice by the commission as referred to in section 705.3(b) of this Part.
 

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Section 705.5 - Technical advisory groups

705.5 Technical advisory groups. The commissioner shall appoint appropriate technical advisory groups to be comprised of members with expertise in the area of innovations in medical technology, the medical profession. and health care industry to review, and make recommendations relating to, the selection of applications for demonstration projects. The technical advisory groups shall meet as appropriate.
 

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Section 705.6 - Review criteria

705.6 Review criteria. The technical advisory groups in reviewing applications and making recommendations, and the commissioner in making his determinations. shall consider pertinent factors including, but not limited to, the following:

(a) the extent to which an applicant's proposal meets the goals of the demonstration as set by the commissioner;

(b) the adequacy of the methodology proposed for the demonstration;

(c) the ability of the proposed demonstration to collect data required for an analysis of the project;

(d) the adequacy and appropriateness of the plan for organizing and carrying out the project;

(e) the technical qualifications of the principal investigator and the proposed project staff;

(f) the reasonableness of the proposed budget in relation to the proposed project;

(g) the adequacy of the facility and resources available to the applicant;

(h) where an application involves activities which could have an adverse health effect upon individuals participating in the demonstration, the adequacy of the proposed means for protecting against or minimizing such effects;

(i) the relevance and status of any approvals required by the Federal Food and Drug Administration for the subject of the demonstration project; and

(j) the number of applications to be approved.
 

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Section 705.7 - Application review process

705.7 Application review process. (a) Applications will be subject to full review, consistent with the requirements of Part 710 of this Subchapter, affording the State Hospital Review and Planning Council an opportunity to submit its recommendations prior to a decision by the commissioner. The commissioner shall approve a limited number of applications sufficient to evaluate any identified innovation in medical technology. (b) Notwithstanding subdivision (c) of section 600.9 of this title, in the case of an application for a new medical technology and health services demonstration project where the portion of the total project cost which is directly related to the new medical technology or health service exceeds $100,000,000, the commissioner may approve the use of innovative forms of financing, provided that: (1) sufficient or affordable financing is not available from more traditional sources; and (2) the new medical technology or health service has the potential to substantially improve treatment for one or more life threatening medical conditions, based on scientific evidence; (3) the project will provide access to the medical technology or health service for under-served populations, including Medicaid beneficiaries and uninsured individuals.
 

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Wednesday, July 7, 2010
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Section 705.8 - Demonstration project requirements

705.8 Demonstration project requirements. (a) Demonstration projects shall be limited to such period of time as the commissioner deems appropriate consistent with the nature of the project.

(b) During the course of a demonstration project, the medical facility shall submit, every six months, written progress reports to the department in a format prescribed by the department.

(c) Upon completion of a demonstration project, the medical facility shall submit a final written report to the department in a format prescribed by the department.

(d) Patient medical records and data shall be afforded confidential treatment consistent with applicable Federal and State statutes, regulations and policies.
 

Effective Date: 
Wednesday, July 7, 2010
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Section 705.9 - Review of demonstration project data

705.9 Review of demonstration project data. The commissioner and the technical advisory groups shall review and analyze the reports and data submitted with respect to the demonstration projects and evaluate the medical efficacy, cost effectiveness and efficiency of, the need for, and the quality of care and safety associated with the innovation in medical technology being evaluated and shall report their findings and recommendations to the State Hospital Review and Planning Council and Public Health Council. Upon completion of a demonstration project and a determination by the commissioner that the subject of the demonstration meets an identifiable need, is cost effective and efficient and meets generally accepted medical standards for safety and effectiveness, applicants participating in the demonstration, as well as other medical facilities, must apply in order to acquire, operate or provide the innovation in technology that was the subject of the demonstration pursuant to section 2802 of the Public Health Law and Part 710 of this Title.
 

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Part 706 Reserved

Part 707 - Physician's Assistant and Specialist's Assistants

Effective Date: 
Thursday, April 1, 1976
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Statutory Authority: 
Public Health Law, Section 2803

Section 707.1 - Medical staff applicability

Section 707.1 Medical staff applicability. All hospitals as defined under article 28 of the Public Health Law shall be subject to the provisions of this Part.
 

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Section 707.2 - Medical board responsibility

707.2 Medical board responsibility. The medical board, or for medical facilities having no medical board a medical advisory committee composed of at least two currently registered physicians, shall adopt with governing board approval by-laws, rules and regulations which provide formal procedures for the evaluation of the application and credentials of registered physician's assistants and registered specialist's assistants applying for employment or privileges in the facility for the purpose of providing medical services under the supervision of a physician.
 

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Section 707.3 - General standards

707.3 General standards. Medical facilities employing or extending privileges to registered physician's assistants, registered specialist's assistants or both shall:

(a) Employ or extend privileges only to physician's assistants and specialist's assistants who are currently registered with the New York State Department of Education.

(b) Designate in writing the licensed and currently registered staff physician or physicians responsible for the supervision and direction of each physician's assistant and specialist's assistant employed or extended privileges. No physician shall be designated to supervise and direct more than six physician's assistants or specialist's assistants or a combination thereof.

(c) Employ or extend privileges only to physician's assistants and specialist's assistants whose training and experience are within the scope of practice for which the physician or physicians to whom they are assigned are qualified.

(d) Be approved for providing the specialized medical services for which the specialist's assistant is employed or extended privileges and employ and extend privileges only to specialist's assistants whose training and experience are appropriate to the delivery of the specialized service.
 

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Part 708 - Appropriateness Review

Effective Date: 
Wednesday, May 16, 2018
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2803, 2901, 2904

Section 708.1 - General provisions

708.1 General provisions. The commissioner shall review, at least every five years, those hospital services and home care services with respect to which goals have been established in the State Health Plan, and, after consideration of the recommendations submitted by health systems agencies and the State Hospital Review and Planning Council, make public his findings as to the appropriateness of such services within one year after receipt of the health systems agency recommendations. The commissioner's reviews shall follow the procedures and utilize the criteria set forth in this Part. Such criteria shall relate to need, accessibility and availability, financial viability, cost effectiveness, and the quality of the service provided, except that criteria adopted for review may vary according to the type of service being reviewed and the purpose of the review.
 

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Section 708.2 - Definitions

708.2 Definitions. (a) For the purposes of this Part, the following terms shall have the following meanings:

(1) A finding of appropriateness means a finding that a hospital service or home care service substantially meets the criteria set forth in this Part.

(2) Areawide review means the review of a specific hospital service or home care service as delivered by all providers of such service in a health service area of the State which:

(i) shall culminate in findings regarding the appropriateness of that service over the entire health service area or the State; and

(ii) may result in institution-specific findings.

(3) Areawide finding means a finding regarding the appropriateness of a specific hospital service or home care service as delivered by all providers of such service in a health service area or the State which is based on the areawide review of the service in accordance with the criteria set forth in this Part.

(4) Institution-specific finding means a finding regarding the appropriateness of a specific hospital service or home care service as delivered by a specific provider which is based on the areawide review of the service in accordance with the criteria set forth in this Part.

(5) Hospital service means a health service which:

(i) is provided by a hospital or other provider as defined in article 28 of the Public Health Law, including hospital services and health-related services as defined therein; and

(ii) is offered at the time of review for appropriateness, or was offered in the 12 months prior to the review and also will be offered in the 12 months following the review, or which will be offered during the 12 months following the review.

(6) Home care service means a home care service as defined in article 36 of the Public Health Law which:

(i) is provided by a certified home health agency as defined in article 36 of the Public Health Law; and

(ii) is offered at the time of the review for appropriateness, or was offered in the 12 months prior to the review and also will be offered in the 12 months following the review, or which will be offered during the 12 months following the review.

(7) Affected persons include: the persons or entities whose service is being reviewed; the State Health Planning and Development Agency having jurisdiction; the health systems agency for the health service area in which the service is offered; health systems agencies serving contiguous health service areas; other hospitals and certified home health agencies within the health service area; any agency which establishes rates for hospitals or certified home health agencies; and members of the public who regularly use the service being reviewed.

(8) State Health Plan means the plan required to be developed by the State Health Planning and Development Agency and the Statewide Health Coordinating Council pursuant to the provisions of the National Health Planning and Resources Development Act of 1974, Public Law 93-641, as amended.

(b) The services subject to review are defined as follows:

(1) (i) Burn care services is that care provided to burn patients in a facility having the capability, equipment and personnel to provide those highly skilled treatment measures required by such victims. Three degrees of severity of burn injury are identified to define the level of treatment:

(a) Major burn injury is at least a second degree burn requiring hospitalization of the patient whose chances of survival are less than 95 percent or whose injury frequently results in disability. A 95 percent chance of survival can generally be described as a second degree burn of greater than 25 percent total body surface area (TBSA) in persons between the ages of 15 and 35 years, and greater than 20 percent TBSA in children younger than 15 years and adults between 35 and 60 years of age, and all burns involving poor-risk patients, that is anyone older than 60 years and anyone with a positive history of chronic and severe illness. Also included in this category are all third degree burns of 10 percent TBSA or greater, all burns significantly involving the hands, face, eyes, ears, feet or perineum, all circumferential burns, all serious inhalation injuries, and all electrical burns and complicated burn injuries involving fractures or other major trauma.

(b) Moderate uncomplicated burn injury is a burn injury requiring hospitalization and generally described as a second degree burn of less than 25 percent TBSA but more than 15 percent in persons between the ages of 15 and 35 years, and between 10 percent and 20 percent in children younger than 15 years and in adults between 35 and 60 years of age, and a third degree burn of less than 10 TBSA but more than 2 percent. Excluded from this category are all poor-risk patients, that is, anyone older than 60 years and anyone with a positive history of chronic and severe illness, all burns significantly involving the eyes, ears, face, hands, feet or perineum, all circumferential burns, all serious inhalation injuries, and all electrical burns and complicated burn injuries involving fractures or other major trauma. (c) Minor burn injury is a second degree burn of less than 15 percent TBSA in persons between the ages of 15 and 35, and less than 10 percent TBSA in children younger than 15 years and in adults between 35 and 60 years of age, and a third degree burn of less than two percent. Excluded from this category are all poor-risk patients, that is, anyone older than 60 years and anyone with a positive history of chronic and severe illness, all burns significantly involving the eyes, ears, face, hands, feet or perineum, all circumferential burns, all serious inhalation injuries, and all electrical burns and complicated burn injuries involving fractures or other major trauma.

(ii) Burn care takes place in the following treatment settings:

(a) Burn unit/center--a facility with a discrete intensive care unit, dedicated beds, highly skilled staff and equipment and which treats major burn victims.

(b) Burn program--a facility with the trained personnel and equipment to provide complete care of moderate uncomplicated burn injuries including rehabilitation.

(c) Hospital emergency room--a facility treating minor burn injuries and providing emergency care for moderate and major burn injuries until appropriate referral transfer can take place.

(2) Reserved

(3) (i) End stage renal disease (ESRD) is a stage of renal impairment that appears irreversible or permanent and requires a regular course of dialysis or transplantation to maintain life.

(ii) Dialysis is a process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another. The two types of dialysis in common use are:

(a) hemodialysis, which is a process utilizing an artificial kidney to remove fluids and metabolic end products from the bloodstream; and

(b) peritoneal dialysis, which is a process utilizing a natural semi-permeable membrane surrounding the peritoneal cavity to remove toxic metabolic waste products from the patient's bloodstream. This process takes place within the patient's body.

(iii) Transplantation is a process by which (a) a kidney is excised from a live or cadaveric donor, (b) that kidney is implanted in an ESRD patient, and (c) supportive care is furnished to the living donor and to the recipient following implantation.

(iv) Acute short-term dialysis is dialysis required by some persons on a short term emergency basis as a result of a disease or accident.

(v) End stage renal disease can be treated in such settings as specified in section 757.1 of this Subchapter.

(vi) Self-dialysis is dialysis performed with little or no professional assistance by an ESRD patient who has completed an appropriate course of training.

(vii) Home dialysis training is a program that trains ESRD patients to perform self-dialysis or home dialysis with little or no professional assistance, and trains other individuals to assist patients in performing self-dialysis or home dialysis.

(viii) Need and utilization of the service will be determined using the following factors:

(a) certified capacity, which is the number of stations approved to accommodate chronic renal dialysis patients per patient shift;

(b) station, which is the combination of the chair, the water and electrical supply and the machine for treatment of the chronic renal patient; and

(c) a patient shift, which is the length of time required to dialyze one patient, usually 4-5 hours.

(4) (i) Computed tomography is a technique where a sharply collimated X-ray beam is passed from the gantry through the body from a source which rotates around the body in a specific arc. As the beam passes through the body from its perimeter, its intensity is reduced. The transmitted intensity of the beam varies in accordance with the density of the tissue it passes through and is measured by sensitive detectors and, from this information, cross-sectional pictures or other images may be generated. A computer is used to generate the image from the measurements of X-ray beam intensity. Tissue images can be done with or without contrast agents. Computed tomography services are rendered by computed tomography (C.T.) scanners.

(ii) Computed tomography scanner is an imaging machine which combines the information generated by a scanning X-ray source and detector system with a computer to reconstruct an image of the full body, including the head.

(iii) Scan or a patient procedure includes the initial image plus any additional images relating to the same area of diagnostic interest occurring during a single visit.

(iv) A host facility for the purposes of this Part is a hospital which is certified to provide computed tomography services and houses a computer tomography scanner. A host facility provides services to members of a computed tomography scanner consortium and/or other institutions not certified for computed tomography services. (v) Computed tomography scanner consortium for purposes of this Part is a formal referral network of hospitals, all of which are certified to provide computed tomography scanning services which are provided by a host facility.

(5) Reserved (6) (i) Comprehensive physical medicine and rehabilitation. Rehabilitation is the process of providing, in a coordinated manner, those comprehensive services deemed appropriate to the needs of a person with a disability, in a program designated to achieve objectives of improved health, welfare, and realization of one's maximum physical, social, psychological, and vocational potential for useful and productive activity.

(ii) A comprehensive inpatient physical medicine and rehabilitation program is a distinct organizational unit within a general hospital, a rehabilitation hospital, or residential health care facility which provides coordinated and integrated services that include evaluation and treatment, and emphasizes education and training of those served. The program is applicable to those individuals who require an intensity of services which includes, as a minimum, physician coverage 24 hours per day. seven days per week, with daily (at least five days per week) medical supervision, complete medical support services including consultation, 24-hour-per-day nursing, and daily (at least five days per week) multidisciplinary rehabilitation programming for a minimum of three hours per day.

(a) A spinal cord injury program provides coordinated and integrated services for spinal cord injured persons, whether from trauma or disease, within a designated area (beds) within a facility providing a comprehensive physical medicine and rehabilitation program, enabling those served to achieve optimal functions. A spinal cord injury program is consistent with the standards for a comprehensive inpatient physical medicine and rehabilitation program.

(b) A brain injury program is an intensive rehabilitation program designed to prevent and/or minimize chronic disabilities while restoring the individual to the optimal level of physical, cognitive, and behavioral functioning. Persons served are generally not in a chronic vegetative state and the population of the unit consists primarily of those with traumatically acquired, nondegenerative, structural brain damage resulting in residual deficits and disability. Inclusion of other cerebral disorders should be based upon age, disability profiles, and service needs. The program is not intended to function as a stroke rehabilitation program, although some persons with a cerebral vascular accident may be served. A brain injury program is consistent with the standards for a comprehensive inpatient physical medicine and rehabilitation program.

(iii) Outpatient physical medicine and rehabilitation is a program of coordinated and integrated evaluation and/or treatment services with emphasis on education and training of those served. It is applicable to those individuals with disabling impairments requiring an intensity of services including, as a minimum: medical supervision, medical support services and consultation, patient education, and appropriate allied therapies.

(7)(i) Emergency departments and emergency services. Emergency departments and emergency services consist of staff, facilities and resources to evaluate, initially manage, treat or transfer patients to another facility that can provide definitive treatment.

(ii) An emergency visit is any unscheduled visit to the emergency facility. Emergency care begins in the prehospital setting, continues in the emergency facility, and concludes when the responsibility for the patient is transferred to another physician or the patient is discharged. The care of the patient during the continuum of emergency care is under the direction of the emergency physician who is responsible for the timely evaluation, treatment and transfer of the patient.

Effective Date: 
Wednesday, May 16, 2018
Doc Status: 
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Section 708.3 - Procedures

708.3 Procedures. (a) Any person or entity subject to review under this Part shall, at the request of the commissioner, submit data relating to criteria developed for review in a manner and format specified by the commissioner to effectuate his review. Any such person or entity shall, in response to such request, furnish any information or documentation as is required to effectuate the review by the commissioner within 30 days of such request.

(b) The commissioner shall provide to the applicable health systems agency that information which he has collected and which is relevant to the review and the preparation of a recommendation with regard to the appropriateness of the hospital service or home care service being reviewed.

(c) The commissioner shall establish procedures to be followed by health systems agencies for transmittal of recommendations to the commissioner.

(d) The commissioner shall commence his review by providing written notice to affected persons of the beginning of such review.

(e) No review by the commissioner shall, to the extent practicable, take longer than 180 days from the date of notification of the beginning of a review to the date of the commissioner's proposed finding. The commissioner shall not make a proposed finding until the health systems agency has had 180 days to make a recommendation to the commissioner.

(f) During the course of his review, the commissioner shall provide an opportunity for affected persons to present their views about the service under review in a public hearing.

(g) The commissioner shall, upon the written request of persons or entities subject to appropriateness review, make available information relative to such review to such persons or entities.

(h) The commissioner shall prepare an analysis of the service being reviewed, and shall forward the health systems agency recommendation, together with his analysis and recommendation, to the State Hospital Review and Planning Council. The State Hospital Review and Planning Council shall review the commissioner's analysis and recommendation and the health systems agency recommendation regarding the appropriateness of the service being reviewed, and, in accordance with the criteria established pursuant to this Part, make a recommendation to the commissioner with regard to the appropriateness of the service. Where the State Hospital Review and Planning Council recommends that the commissioner make a finding that a service is not appropriate, such a recommendation shall include a recommendation for remedial action.

(i) After consideration of the recommendations made by a health systems agency and by the State Hospital Review and Planning Council, the commissioner shall, in accordance with the procedures and criteria set forth in this Part, make a written finding as to the appropriateness of the service reviewed, subject to the provisions of subdivisions (j), (k) and (l) of this section, and make such finding public.

(j) The commissioner shall afford to any affected person, for good cause shown, within 30 days of making his proposed finding, a public hearing respecting such proposed finding. For purposes of this section, "good cause" shall require such person to establish that a public hearing is required for:

(1) presentation of significant, relevant information not previously considered by the commissioner; or

(2) demonstration that there have been significant changes in factors or circumstances relied upon by the commissioner in reaching his decision. "Good cause" shall not be deemed to be established where information or documentation was previously available and could reasonably have been submitted to the commissioner.

(k) Where the commissioner proposes to make an institution-specific finding that a service is not appropriate, the commissioner shall provide written notification of such proposed finding, by certified or registered mail, to the person or entity whose service is being reviewed. Within 30 days of receipt of such written notification, such person or entity may file a notice of appeal with the commissioner by registered or certified mail. Such notice shall set forth the reasons for disagreement with the proposed finding. The appeal shall be reviewed by the appropriateness review administrative review board, which shall make a recommendation to the commissioner based upon the data and information previously submitted and on any written arguments submitted with such notice of appeal. The appropriateness review administrative review board shall consist of such members as designated by the commissioner. At least one of these members shall be a member of the State Hospital Review and Planning Council. The commissioner shall make his finding upon consideration of the recommendation of the appropriateness review administrative review board.

(l) Where the commissioner proposes to make an appropriateness review finding which is inconsistent with a recommendation made by the respective health systems agency, he shall provide written notification of his proposed decision to such health systems agency and provide an opportunity for administrative review, in accordance with the provisions of subdivision (k) of this section, prior to making his finding. (m) Written findings shall be based on an areawide review and shall address the appropriateness of the service over the health service area or the entire State. Where a health systems agency recommendation in regard to a particular service is institution-specific, the commissioner shall also make an institution-specific finding. Where a health systems agency recommendation is not institution-specific, the commissioner shall, where practicable, make an institution-specific finding. Where the health systems agency has made an areawide recommendation and the commissioner proposes to make an institution-specific finding, the commissioner shall request the health systems agency to provide, within 60 days, an institution-specific recommendation or a written statement of the reasons for not making an institution-specific recommendation.

(n) Where the commissioner makes a written finding that a service is not appropriate, such a finding shall be accompanied by a statement that the service does not meet one or more of the criteria for appropriateness established pursuant to this Part which shall address the ways in which the service failed to meet the criteria. In addition, such a finding shall, to the extent practicable, be accompanied by a written recommendation for remedial action.
 

Effective Date: 
Friday, August 29, 1980
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Section 708.4 - General review criteria

708.4 General review criteria. (a) The specific review criteria for specific services, as set forth in section 708.5 of this Part, relate to the need, accessibility and availability, financial viability, cost effectiveness and quality of the service as characteristics of appropriateness, and shall consider, where appropriate, the following general considerations:

(1) the relationship of the health service being reviewed to the applicable health systems plans, annual implementation plans, and State Health Plan;

(2) the relationship of the service being reviewed to the long-range development plan, if any, of the person or entity providing such service;

(3) the need that the population served has for the service, and the extent to which low-income persons, handicapped persons, and other underserved groups have access to such service;

(4) the availability of less costly or more effective alternative methods of providing the service being reviewed;

(5) the relationship of the service being reviewed to the existing health care system of the area in which such service is provided;

(6) the availability of resources, including health manpower, management personnel and funds for capital and operating costs, for the provision of the service being reviewed, and the availability of alternative uses of these resources for the provision of other health services.

(7) the special needs and circumstances of those persons or entitles which provide a substantial portion of their services or resources, or both, to individuals not residing in the health service areas in which such persons or entities are located, or in adjacent health services areas. These persons or entities may include medical and other health-profession schools, multidisciplinary clinics, and specialty centers;

(8) the special needs and circumstances of Health Maintenance Organizations (HMO's). In the case of areawide reviews which result in institution-specific findings regarding services provided by or through an HMO, the needs and circumstances shall be limited to:

(i) the needs of enrolled members and reasonably anticipated new members of the HMO for the existing institutional health services provided by the organization;

(ii) whether the services can be obtained from non-HMO, or other HMO, providers in a reasonable and cost-effective manner which is consistent with the basic method of operation of the HMO; and

(iii) any other factors which the commissioner may propose, consistent with the National Health Planning and Resources Development Act of 1974, Public Law 93 641, as amended;

(9) the special needs and circumstances of biomedical and behavioral research projects which are designed to meet a national need and for which local conditions offer special advantages;

(10) the contribution of the existing institutional health services in meeting the health-related needs of members of medically underserved groups and other groups which have traditionally experienced difficulties in obtaining equal access to health services--for example, low-income persons, racial and ethnic minorities, women and handicapped persons--particularly those needs identified in the applicable health systems plan and annual implementation plan as deserving of priority;

(11) the special circumstances of health service institutions with respect to the need for conserving energy;

(12) the effect of competition on the supply of the health services being reviewed;

(13) improvements or innovations in the financing and delivery of health services which foster competition and serve to promote quality assurance and cost effectiveness; and

(14) the quality of care provided by the services or facilities in the past.

(b) Specific review criteria may vary according to the type of service being reviewed, purpose of the review, and need not address all of the characteristics of appropriateness.
 

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Section 708.5 - Specific review criteria

708.5 Specific review criteria. In the review of the following specific hospital and home care services, in order to arrive at a determination regarding the appropriateness thereof, the following criteria shall be applied:

(a) Reserved.

(b) Burn care services. (1) All services.

(i) The standards of this Chapter shall be applicable to the extent that such standards relate to the service under review or to the physical location in which the service is being provided.

(ii) Every hospital has and follows a prescribed protocol for burn triage, emergency burn care, and referral. The protocol includes as a minimum:

(a) the Lund-Browder chart or a similar chart for estimating total body surface area;

(b) a provision that major burn injury is to be treated, to the extent possible, in a burn unit/center except for emergency care prior to referral to such unit/center; and

(c) a provision that moderate uncomplicated burn injury is to be treated, to the extent possible, in a burn program or burn unit/center.

(iii) The burn unit/center is responsible for training facility and other personnel within the service area on emergency treatment procedures, assessment of total body surface area affected, and the classification of burns and triage protocols.

(iv) A burn service is provided by a financially viable facility.

(v) Reviews of each patient with major burn injury or moderate uncomplicated burn injury are undertaken on a weekly basis by the burn care team.

(2) Burn unit/center. (i) Each burn unit/center has a minimum of six beds.

(ii) Each burn unit/center treats a minimum of 50 patients with major burn injury to moderate uncomplicated burn injury per year.

(iii) The burn unit/center refers patients for whom there are no available beds to another burn unit/center which can provide the care needed.

(iv) The three-year average occupancy of a burn unit/center is at least 75 percent.

(v) There is no more than one burn unit/center bed for every 225,000 in population. As appropriate, the standard may be adjusted to reflect actual incidence in a health service area.

(vi) Each burn unit/center has available either through direct control or through a network of clearly identified relationships, a system of land and/or air transport which will bring severely burned victims, to the unit/center.

(vii) A burn unit/center has a designated director who is: a board-certified or board-eligible general or plastic surgeon with one additional year of specialized training in burn therapy or equivalent experience in burn patient care.

(viii) Staff for the burn unit/center includes:

(a) a head nurse of the facility who is a registered nurse, with two years intensive care unit or equivalent training and a minimum of six months burn experience;

(b) one nurse for every two intensive care patients at all times;

(c) one nurse for every three non-intensive care patients at all times;

(d) a designated field-trained and licensed and/or registered physical therapist and occupational therapist with a minimum of three months training or six months experience in burn treatment available as needed;

(e) a designated registered dietician available as needed;

(f) a designated medical social worker responsible for referral and follow-up care and individual and group counseling available as needed; and

(g) a psychologist and/or psychiatrist available as needed.

(ix) A burn unit/center has a designated area for providing specialized intensive care and an operating room easily accessible within the hospital.

(3) Burn program. (i) A burn program treats a minimum of 75 patients with moderate uncomplicated burn injuries per year.

(ii) There is no more than one burn program for every 326,000 in population. As appropriate, the standard may be adjusted to reflect actual incidence and number of patients per program in a health service area. (iii) The average length of stay per patient in a burn program is no more than 14 days.

(iv) Staff for a facility with a burn program includes:

(a) a board-certified or board-eligible general or plastic surgeon with experience in burn care (preferably a three-month period of burn training) who is responsible for a written plan of burn therapy, maintains and periodically reviews the burn program's admissions and transfer protocols for burn patients having major burn injury, moderate uncomplicated burn injury, or minor burn injury;

(b) a registered nurse with six months intensive care unit experience (preferably three months burn nursing experience) who is responsible for nursing care protocol for burn patients, coordination of care for in-patients requiring burn care, and training of nursing personnel involved in burn care;

(c) a licensed and/or registered occupational therapist or physical therapist with splinting experience available as needed;

(d) on staff or through formal arrangement, a medical social worker responsible for referral and follow-up and individual and group counseling available as needed;

(e) on staff or through formal arrangement, a registered dietician, available as needed; and

(f) on staff or through formal arrangement, a psychologist or psychiatrist, available as needed.

(v) A burn program has these support services:

(a) general surgery;

(b) internal medicine;

(c) pediatrics;

(d) respiratory services;

(e) infectious disease control; and

(f) anesthesiology.

(d) End stage renal disease services. (1) All services.

(i) The standards of Chapter V of this Title shall be applicable to the extent that such standards relate to the service under review or to the physical location in which the service is being provided.

(ii) Any facility providing services to ESRD patients must comply with Federal regulations for ESRD services.

(iii) The ESRD service is provided by a financially viable facility.

(2) Dialysis services. (i) Dialysis services are provided to patients at their convenience whenever feasible and arrangements are made to accommodate employed patients who wish to be dialyzed during nonworking hours, either through extended shifts or cooperative arrangements among facilities.

(ii) Medical care for emergencies on a 24-hour day, seven-day week basis is provided. There is posted at the nursing/monitoring station a roster with the names of the physicians on duty to be called for emergencies and instructions as to how they can be reached.

(iii) Ninety-five percent of the total population of each health region is within a one hour mean travel time, adjusted for permitting weather conditions, of a renal dialysis center/facility providing dialysis services.

(iv) Each renal dialysis center/facility (except those located in New York City) is working toward a goal of at least 15 percent of its patients on home dialysis. As appropriate, a center/facility having less than 15 percent of its total patient load on home dialysis submits its plan and protocols for increasing home dialysis and a statement as to why the minimum goal cannot be attained. In New York City each renal dialysis center/facility is working toward a goal of at least 11 percent of its patients on home dialysis. As appropriate, a center/facility having less than 11 percent of its total patient load on home dialysis submits its plan and protocols for increasing home dialysis and a statement as to why the minimum goal cannot be attained.

(v) Each facility providing dialysis services has a written protocol to screen candidates for transplantation, institutional dialysis, home dialysis, early identification of home dialysis patients, and the training of patients and family in home dialysis training. This protocol would require at a minimum that:

(a) the facility has a goal of increasing its current home dialysis patient load, including criteria for identifying appropriate candidates for home dialysis; and

(b) each patient has been informed of all treatment options and has signed an informed consent document to be placed in his/her medical records file acknowledging his/her choice of modalities.

(vi) Each facility providing dialysis services shall provide directly or by formal arrangements, home training and supervision.

(vii) All personnel of the facility participate in educational programs for initial orientation, continuing in-service training and procedures for infection control on a regular basis.

(viii) Each facility maintains and reviews for each patient a written long-term program and a written patient care plan. The care plan includes at a minimum an annual evaluation of the dialysis patient by a transplant surgeon, where available, nephrologist, nurse, social worker, nutritionist, and medical director of the home dialysis training program.

(ix) Each renal dialysis center/facility maintains complete medical records for all patients, including self dialysis patients within the self dialysis unit and home dialysis patients whose care is under the supervision of the facility.

(x) Each renal dialysis center/facility reports to the Kidney Disease Institute, as required, patient information, including up-to-date information on medical and socioeconomic status.

(xi) A home dialysis care plan provides for periodic monitoring of the patient's home adaption, including provisions for visits to the home by qualified personnel to the extent possible and a back-up for the patient's emergency needs.

(xii) The medical director of a renal dialysis center/facility:

(a) is board-eligible or board-certified in internal medicine or pediatrics by a professional board and has at least 12 months combined experience and/or training in the care of patients at ESRD facilities; or

(b) has during the five-year period prior to September 1, 1976, served for at least 12 months as director of a dialysis or transplantation program.

(xiii) The responsibilities of the physician-director shall include: (a) selection of a suitable treatment modality;

(b) development of adequate training of facility personnel in dialysis procedures and techniques;

(c) monitoring of the patients and the dialysis process including periodic assessment of patient performance of dialysis tasks;

(d) development and implementation of a patient care policy and procedure manual; and

(e) provision of self dialysis or home dialysis patients with teaching materials for self dialysis or home dialysis training.

(xiv) A renal dialysis center/facility has on staff:

(a) a licensed registered nurse who:

(1) has at least 12 months of experience in clinical nursing and an additional six months of experience in nursing care of patients with permanent kidney failure or who are undergoing or have undergone kidney transplantation, including training in and experience with the dialysis process; or

(2) has at least 18 months of experience in nursing care of patients on maintenance dialysis or in nursing care of patients with kidney transplant, including training and experience with the dialysis process; and

(b) a nurse responsible for self care dialysis who has as part of her total ESRD experience at least three months of experience in training self-care patients.

(xv) A renal dialysis center/facility has available on staff or through formal arrangement:

(a) a certified social worker, whose services include social services to patients and their families directed at supporting and maximizing the social functioning and adjustment of patients. The social worker's responsibilities include:

(1) conducting psychosocial evaluations;

(2) participating in team review of patient progress;

(3) recommending changes in treatment based on the patient's current psychosocial needs;

(4) providing casework and group services; and

(5) identifying community social agencies and resources; and

(b) a dietitian who is eligible for registration by the American Dietetic Association and has one year of experience in clinical nutrition, or a bachelor of arts or advanced degree with major studies in food and nutrition or dietetics and one year experience in clinical nutrition. The dietitian's services include:

(1) evaluating nutritional needs of patients in consultation with attending physicians;

(2) recommending the nutritional and dietetic programs;

(3) developing therapeutic diets;

(4) counseling patients on the importance of diet; and

(5) monitoring the diets.

(xvi) A renal dialysis center performs a minimum of nine dialyses per station per week.

(xvii) A renal dialysis facility performs a minimum of 10.8 dialyses per station per week.

(3) Renal transplantation center. (i) A renal transplantation center performs at least 15 renal transplants annually.

(ii) Each renal transplant center participates in research of renal disease of related areas.

(iii) Each renal transplant center provides access to the full range of diagnostic and therapeutic services necessary to support its function including medical, surgical, radiological, and radio-isotopic services.

(iv) Each renal transplant center has access, either within the facility or through formal contract arrangement, to laboratory services, including tissue typing.

(v) The renal transplantation center participates in a patient registry program for patients who are awaiting cadaveric donor transplantation.

(vi) If a renal transplantation center utilizes the services of an organ procurement agency to obtain donor organs, it has a written agreement covering these services.

(vii) Transplantation shall be performed by physicians trained in the disciplines of general or vascular surgery and urology and who have at least 12 months training or experience in the performance of renal transplant and the care of patients with renal transplants.

(viii) Transplantation teams consist of:

(a) a surgeon or urologist trained in general and vascular surgery with documented experience in renal transplantation;

(b) an internist with subspecialty training in nephrology and hemodialysis and with documented experience in the management of renal transplant patients; (c) a physician who is assigned the primary responsibility for post-operative management of patients and whose experience in management of such patients must be documented;

(d) consultants for immunology and infectious disease who must be associated with the transplantation center; and

(e) a pediatrician, when the renal transplant of a child is performed, who is trained in the subspecialty of pediatric nephrology and who has documented experience in the management of renal-transplant pediatric patients.

(e) Computed tomography services. (1) The standards of Chapter V of this Title shall be applicable to the extent that such standards relate to the service under review or to the physical location in which the service is being provided.

(2) Each facility providing computed tomography services does not refuse treatment of a patient on the basis of the referring physician or his/her facility affiliation. All referrals from outside the provider facility will be reviewed by a board-eligible or board-certified radiologist at the provider facility prior to the scan being performed.

(3) Institutions will accommodate patients who require computed tomography diagnostic or treatment planning services outside normal working hours.

(4) Ninety-five percent of the total population of each health region is within 45 minutes mean travel time, adjusted for permitting weather conditions, of a facility providing computed tomography services.

(5) Each facility providing computed tomography services must accept referrals from other institutions. Facilities that are members of a computed tomography service consortium have a written plan which describes the shared service and the participation of each facility within the shared service plan. The written plan provides at a minimum, the following information:

(i) the identification of the host facility and satellite facilities in the shared service;

(ii) stated commitment of the provider facility to give priority to bona fide medical emergencies independent of referral source, and equal consideration to inpatients and outpatients independent of referral source;

(iii) the process used by the provider facility to determine instances of bona fide medical emergency;

(iv) the process used by a certified radiologist at the provider facility to determine, prior to the procedure being performed, the necessity and appropriateness of the procedure;

(v) the availability of the computed tomography services unit, on a 24-hour basis, seven day-a-week basis, for the diagnosis of emergency conditions;

(vi) clear delineation of the patient information which is to accompany a patient from a referral facility; and

(vii) assignment of nursing care responsibility for patients referred from other institutions.

(6) A facility offering computed tomography services has available, either directly or through formal arrangements, a full range of diagnostic services including, at a minimum, diagnostic and therapeutic radiology services, nuclear medicine and diagnostic ultrasound.

(7) A facility offering computed tomography services has available, either on staff or through formal arrangements, individuals for the treatment of neurological, thoracic, cardiac, abdominal, medical and radiological oncological, gynecological, neurosurgical and genitourinary conditions, as well as any other conditions diagnosed by computed tomography.

(8) A facility offering computed tomography services is responsible for guiding physicians and other staff at the host and referral facilities in order to encourage that physicians and other staff become familiar with the safe and appropriate use of the service.

(9) A computed tomography service is provided by a financially viable facility.

(10) On an individual basis, each C.T. scanner's utilization is at a minimum of 2,000 patient procedures or 3,400 head equivalent computed tomography (HECT) units per year at the end of the second year of operation.

(11) On a regional basis, C.T. scanner utilization is at a minimum average of 2,500 patient procedures or 4,250 head equivalent computed tomography (HECT) units per year.

(12) Based on the recognition that not all of the additional scanner time required for teaching can be obtained through expanded operation of equipment, a maximum variance of 25 percent from current utilization standards cited in this subdivision is established for teaching hospitals. In order to qualify for the variance, the teaching hospital must be able to:

(i) document its affiliation with a qualified medical school; and

(ii) document the existence of a diagnostic radiology program which averages a total of four residents per year for a period of at least three years.

(13) Variances from scanner utilization standards for research usage are recommended only for those units in teaching hospitals which can provide at a minimum:

(i) documentation of levels of past research;

(ii) copies of written protocols describing current research; and

(iii) proof that research funding from all sources exceeds $50,000 annually.

(14) The director of the service in which a C.T. scanner is located is a board-eligible or board-certified radiologist.

(15) The C.T. scanner is staffed by at least one full-time New York State licensed radiological technician per staff shift.

(16) A facility with a C.T. scanner has on staff, or through formal arrangements, a radiological physicist holding a degree in physics who is either certified or eligible for certification by the American Board of Radiology or the American Board of Health Physicists.

(f) Reserved.

(g) Comprehensive inpatient physical medicine and rehabilitation. (1) The standards of Chapter V of this Title shall be applicable to the extent that such standards relate to the service under review or to the physical location in which the service is being provided.

(2) The following general standards address the distribution of services and issues related to all facilities which provide comprehensive inpatient physical medicine and rehabilitation:

(i) The beds shall be in a designated area which is organized, staffed, and equipped for the specific purpose of providing a comprehensive physical medicine and rehabilitation program.

(ii) A free-standing inpatient facility devoted exclusively to providing a comprehensive physical medicine and rehabilitation program shall contain a minimum of 30 beds. Comprehensive physical medicine and rehabilitation units within a general hospital shall contain a minimum of 15 beds.

(iii) The comprehensive inpatient program shall maintain a minimum occupancy rate of 75 percent.

(iv) The program shall be directed by a chief of physical medicine and rehabilitation who dedicates full-time to the facility's rehabilitation services. The chief of physical medicine and rehabilitation shall be a board-certified physiatrist, or a physician who by training and experience is knowledgeable in physical and rehabilitative medicine.

(v) The physician of record for a patient in the program must be a rehabilitation physician, a physician who is board-certified in physical medicine and rehabilitation or a physician who by training and experience is knowledgeable in physical medicine and rehabilitation.

(vi) Nursing care shall be under the direction of a registered professional nurse with certification in rehabilitation nursing, or its equivalent, and progressive leadership experience.

(vii) The program shall include the following services which are provided by full-time staff whose training and experience are consistent with New York State licensure/certification/registration requirements: rehabilitation nursing, physical therapy, occupational therapy and social work. Psychologists and speech-language therapists shall be available as needed.

(viii) Dependent upon the needs of those served, the program shall provide to make formal arrangements for the following services: vocational rehabilitation, education, orthotics, prosthetics, rehabilitation engineering, driver education, audiology, and therapeutic recreation.

(ix) The following support services shall be available: dietetics, diagnostic radiology, laboratory, dentistry, chaplaincy and pharmacy.

(x) Physician consultive services shall include, but not be limited to: general surgery, internal medicine, neurology, neurosurgery, ophthalmology, orthopedic surgery, otorhinolaryngology, pediatrics, physical medicine and rehabilitation, plastic surgery, psychiatry, pulmonary medicine, urology.

(xi) Services shall be offered through a coordinated inter-disciplinary team approach, which shall include a comprehensive evaluation upon admission followed by regularly scheduled conferences. These conferences shall result in a documented decision on feasible rehabilitation goals, identification of services needed to progress toward those goals, and evaluation of progress toward meeting established goals.

(xii) Each facility shall have written guidelines that identify procedures to follow for the following areas: intake and orientation, assessment and evaluation, program management, referral discharge, and follow-up.

(xiii) The program shall establish formalized relationships with other area hospitals which shall include provision for consultation, inservice education, and the sharing of common treatment protocols.

(xiv) All facilities shall have written transfer agreements in place for the transfer of patients who need medical or specialty care not available at the facility of admission. Transfer agreements shall be mutually agreed upon by both the transferring and receiving facility and shall be reviewed on an annual basis.

(xv) There shall be an organized outpatient physical medicine and rehabilitation program at the facility which shall provide a range of services equal in scope to that of the inpatient program.

(xvi) There shall be an organized program for follow-up care to maintain and/or improve health status following discharge.

(xvii) The service area for determining public need for comprehensive inpatient physical medicine and rehabilitation shall be the designated health systems agency regions.

(xviii) The maximum number of comprehensive inpatient physical medicine and rehabilitation beds in each health systems agency required to meet public need shall be determined by dividing the projected annual patient days for the service by 365, and dividing the result by .90 to allow for 90 percent occupancy. The projected comprehensive inpatient physical medicine rehabilitation patients days used in this calculation shall be determined as follows:

(a) The diagnostic categories used in computing the need for comprehensive inpatient physical medicine and rehabilitation shall be: brain dysfunction, traumatic brain dysfunction, orthopedic disorders, spinal cord dysfunction, traumatic spinal cord dysfunction, stroke, amputation of limb, congenital deformities, neurological conditions, and arthritis.

(b) The annual number of potential comprehensive inpatient physical medicine and rehabilitation candidates shall be determined by calculating the total number of annual general hospital discharges from categories considered, excluding the number of discharges in these categories with a length of stay less than two days, and multiplying the resulting figure by .25.

(c) The number of potential comprehensive inpatient physical medicine and rehabilitation candidates shall be multiplied by a 34-day rehabilitation length of stay to project the annual number of comprehensive inpatient physical medicine and rehabilitation patient days.

(3) The following general standards address the distribution of services and issues related to all facilities which provide a spinal cord injury program.

(i) The spinal cord injury program shall be an organized program within a comprehensive physical medicine and rehabilitation program or a distinct comprehensive physical medicine and rehabilitation program for the spinal cord injured.

(ii) The spinal cord injury program shall maintain a minimum of 10 beds and/or 30 new admissions per year.

(iii) The spinal cord injury program shall maintain a minimum occupancy rate of 75 percent.

(iv) The spinal cord injury program shall be a designated unit for spinal cord injured people with a designated staff to serve the spinal cord injured patients.

(v) The spinal cord injury program shall be directed by a physician with special interest and competence in the area of those with spinal cord injury.

(vi) The nurse supervisor shall be a registered professional nurse with certification in rehabilitation nursing, or its equivalent, and clinical experience in the care of spinal cord injury.

(vii) The following services shall be available seven days a week, 24 hours per day: rehabilitation nursing, trained personnel capable of providing intermittent catheterization, and respiratory therapy.

(viii) In addition to the services previously identified, there shall be a formally organized program for patient/family spinal cord injury education regarding: bladder management, bowel management, pulmonary care, skin care, instruction in medications, nutrition, access to follow-up medical care, care of equipment, and sexual counseling.

(ix) There shall be an organized outpatient physical medicine and rehabilitation program which shall offer a range of services equal in scope to those of the inpatient spinal cord injury program.

(x) There shall be an organized program of follow-up care to maintain and/or improve health status following discharge.

(4) The following general standards address the distribution of services and issues related to all facilities which provide a brain injury program.

(i) The brain injury program shall be organized as a specialized unit within a comprehensive physical medicine and rehabilitation program or as a distinct comprehensive physical medicine and rehabilitation program for the brain injured.

(ii) The brain injury program shall maintain a minimum of 10 beds and/or 30 new admissions per year.

(iii) The brain injury program shall have formalized relationships with area hospitals which include provision for consultation, in-service education, the sharing of common treatment protocols, and transfer agreements.

(iv) The brain injury program shall be a designated unit with a designated staff to serve the brain injured.

(v) The brain injury program shall be directed by a physician with advanced training and experience in the care of the brain injured.

(vi) The nurse supervisor shall be a registered professional nurse with certification in rehabilitation nursing, or its equivalent, and clinical experience in the care of the brain injured.

(vii) The following diagnostic services shall be available: electrodiagnostic services, including EEG, EMG and evoked potentials, and CT scanner.

(viii) In addition to services previously identified, there shall be an integrated treatment program that addresses the following areas: medical and neurological issues, nutrition, sensorimotor capacity, cognitive, perceptual, and communicative capacity, affect and mood, activities of daily living, educational and/or vocational capacities, sexuality, family counseling and community reintegration.

(ix) There shall be an organized outpatient physical medicine and rehabilitation program which offers a range of services equal in scope to those in the inpatient brain injury program.

(x) There shall be an organized program of follow-up care to maintain and/or improve health status following discharge.

(h) Emergency department and emergency services. (1) The standards of this Chapter shall be applicable to the extent that such standards relate to the service under review or to the physical location in which the service is being provided.

(2) A hospital with a minimum volume of 15,000 emergency visits a year must meet the requirements for an emergency department. Those hospitals providing emergency care with less than 15,000 emergency visits per year may meet the requirements of an emergency department if they elect to provide these services, but at a minimum must meet the requirements of an emergency service.

(3) The following standards apply to emergency departments:

(i) A person presenting oneself to the emergency department for emergency care shall be promptly seen and evaluated by a physician.

(ii) Every emergency department shall have written policies and procedures for initial assessment of patients in the emergency department.

(iii) At least one emergency physician shall be on duty in the emergency department 24 hours a day, seven days a week.

(iv) The emergency department staff physicians must be licensed to practice medicine in New York State; and:

(a) be board certified in emergency medicine; or

(b) have three years post graduate experience in emergency medicine, surgery, internal medicine, family practice or pediatrics in addition to current certification in advance cardiac life support (ACLS), and advanced trauma life support (ATLS) or equivalent training and experience.

(v) The emergency department shall have a designated physician director qualified as an emergency department staff physician.

(vi) Emergency physicians shall be assigned exclusively to the emergency department. The number of patients seen by the emergency department physician shall not, on an annual average, exceed 20 patients per eight-hour period.

(vii) All nurses in the emergency department shall be registered professional nurses with New York State licensure and current registration. The nurse must have at least one year of clinical experience, have successfully completed the emergency nursing orientation program and be able to demonstrate skills and knowledge necessary to perform basic life support measures. Within one year of assignment to the emergency department, all emergency department staff nurses must obtain current advanced cardiac life support (ACLS) certification or the equivalent.

(viii) There shall be a nurse manager in the emergency department who is a registered professional nurse with New York State licensure and current registration who possesses all of the qualifications required of a staff nurse and who becomes a certified emergency nurse, or its equivalent, within one year of appointment. The nurse manager shall have at least three years clinical experience, two of which are in emergency nursing, and shall be assigned exclusively to that department.

(ix) On annual average there shall be a nurse to patient ratio of 1:10 unscheduled visits per eight-hour period, with a minimum of two nurses assigned to the emergency department on each shift. If, on average, the volume of patients per eight-hour shift is over 25, there shall be a charge nurse in addition to the minimum of two nurses per shift. If, on average, the volume exceeds 50 patients per shift, there shall be an assessment nurse in addition to the charge nurse and regular shift nurses. Staffing for scheduled visits shall be in addition to the staffing required for unscheduled visits.

(x) There shall be at least one person on duty at all times to perform patient registration, reception and other clerical duties as required. The clerical staff shall be responsible to, and function under the direction of, the emergency department staff.

(xi) There shall be sufficient support personnel, exclusive of the professional staff, available at all times to perform messenger service, acquisition of supplies and equipment, delivery of lab specimens, obtaining records, patient transport, and other duties as required. (xii) All personnel working in the emergency department must complete a hospital and department orientation program.

(xiii) An emergency department must have immediate access to laboratory services that are staffed and equipped 24 hours a day.

(xiv) X-ray capability, using both fixed and mobile equipment, must be immediately available in close proximity to the emergency department 24 hours a day.

(xv) The hospital's medical staff must have a schedule for every specialty represented on the hospital's medical staff, to provide back-up support to the emergency department in a timely manner, 24 hours a day, seven days a week. At a minimum, these specialties shall include general surgery, internal medicine, orthopedics, anesthesiology, radiology and pediatrics.

(xvi) Each emergency department must make provision for referral for needed follow-up care.

(xvii) The specific equipment and pharmacologic/therapeutic drugs and agents needed in the emergency department shall be determined jointly by the medical director and nurse manager by consulting recommendations such as the guidelines of the American College of Emergency Physicians. These requirements shall be reviewed every two years.

(xviii) Each emergency department shall have written protocols and agreements for the treatment, triage and transfer of patients who cannot receive definitive care at the receiving hospital. These shall include, but not be limited to, burn patients, spinal-cord injury patients, brain injury patients, cardiac patients, patients with behavioral problems, multiple injury patients, replantation patients, neonatal and pediatric patients, and patients in need of hemodialysis.

(xix) Each emergency department shall adopt and implement written policies and procedures for the following:

(a) provision for triage of patients and transfer to the most appropriate hospital;

(b) medical control and direction of prehospital emergency medical services;

(c) review of quality of patient care on a regular basis (at least quarterly) with prehospital providers, emergency department personnel, and physicians, in order to improve field operations and make recommendations for continuing education;

(d) clinical and continuing education in emergency medical services, for prehospital providers;

(e) provision of liaison and direction for the supply of medications, fluids, and other items utilized by ambulance organizations; and

(f) provision of patient utilization data for the State EMS Data System. Where there is an established regional emergency medical services system, the emergency department shall coordinate its performance of these functions with the other participants in the regional system.

(xx) The emergency department shall establish and implement written policies and procedures for:

(a) the provision of appropriate social services 24 hours a day;

(b) consultation with a poison control center; and

(c) the maintenance of sexual offense evidence as part of the hospital-wide provisions required by this Title.

(xxi) All cases of suspected child abuse or neglect shall be reported immediately to the New York State Central Register of Child Abuse and Maltreatment and with respect to such cases the hospital shall comply with article 6, title 6 of the Social Services Law.

(xxii) The emergency department personnel shall give information regarding community resources and the Domestic Violence Hotline telephone number to those persons who are suspected or confirmed victims of domestic violence.

(4) The following standards shall apply to emergency services:

(i) A person presenting to the emergency service for emergency care shall be promptly seen by a physician (or a nurse practitioner or a physician's assistant operating under the direction of the emergency services physician director), or evaluated by a registered nurse and seen by a physician, nurse practitioner, or physician's assistant prior to discharge.

(ii) Every emergency service shall have written policies and procedures for initial assessment of patients presenting to the emergency service.

(iii) At least one physician, nurse practitioner, or registered physician assistant shall be on duty in the emergency service 24 hours a day, seven days a week. In addition, a licensed physician shall be available within 30 minutes when a registered physician assistant or nurse practitioner is on duty in the absence of a licensed physician.

(iv) Emergency service staff physicians must be licensed to practice medicine in New York State and have:

(a) board certification in emergency medicine or family practice; or

(b) two years post graduate experience in emergency medicine, surgery, internal medicine, family practice or pediatrics in addition to current certification in advanced cardiac life support (ACLS), and advanced trauma life support (ATLS) or equivalent training and experience. The registered physician assistants must have current certification in advanced cardiac life support (ACLS) or the equivalent training and experience, as well as training in trauma management equivalent to ATLS.

(v) The emergency service shall have a designated physician director qualified as an emergency service staff physician.

(vi) All nursing staff in the emergency service shall be registered professional nurses with New York State licensure and current registration who possess current, comprehensive knowledge and skills in emergency health care. They must have at least one year of clinical experience, have successfully completed an emergency nursing orientation program and be able to demonstrate skills and knowledge necessary to perform basic life support measures. Within one year of assignment to the emergency service, all emergency service staff nurses must obtain current advanced cardiac life support (ACLS) certification or the equivalent.

(vii) There shall be a nurse manager in the emergency service who is a registered professional nurse with New York State licensure and current registration who possesses all the qualifications required of a staff nurse, who becomes a certified emergency nurse, or its equivalent, within one year of appointment, and who has at least three years clinical experience, two of which in emergency nursing.

(viii) On annual average, there shall be a nurse-to-patient ratio of 1:10 per eight-hour period, with a minimum of one nurse assigned to the emergency service and an additional nurse available on each shift. If, on average, the volume of patients per eight-hour shift is over 25, there shall be a charge nurse in addition to a minimum of two nurses per shift. If, on average, the volume exceeds 50 patients per shift, there shall be an assessment nurse counted separately in addition to the charge nurse and regular shift nurses.

(ix) There shall be sufficient support personnel to perform patient registration, reception, messenger service, acquisition of supplies, equipment, delivery of lab specimens, obtaining records, patient transport and other functions as required.

(x) All personnel working in the emergency service must complete a hospital orientation program.

(xi) Laboratory and X-ray capability must be available within 20 minutes, 24 hours a day.

(xii) The specific equipment and pharmacologic/therapeutic drugs and agents needed in the emergency service shall be determined jointly by the medical director and the nurse manager by consulting recommendations such as the guidelines of the American College of Emergency Physicians. These requirements shall be reviewed every two years.

(xiii) Each emergency service shall have written protocols and agreements for the treatment, triage and transfer of patients who cannot receive definitive care at the receiving hospital. These shall include but not be limited to burn patients, spinal cord injury patients, brain injury patients, cardiac patients, patients with behavioral problems, multiple injury patients, replantation patients, neonatal and pediatric patients.

(xiv) All emergency services shall adopt and implement written policies and procedures for:

(a) provision for triage and transfer of patients to the most appropriate hospital;

(b) medical control and direction of prehospital emergency medical services;

(c) review of quality of patient care on a regular basis (at least quarterly) with prehospital providers, emergency services personnel, and physicians, in order to improve field operations and make recommendations for continuing education;

(d) continuing education in emergency medical services;

(e) provision of liaison and direction for the supply of medications, fluids, and other items utilized by ambulance organizations; and

(f) provision of patient outcome data to the State EMS Data System. Where there is an established regional emergency medical services system, the emergency service shall coordinate its performance of these functions with the other participants in the regional system.

(xv) The emergency service shall establish and implement written policies and procedures for:

(a) the provision of appropriate social services 24 hours a day;

(b) consultation with a poison control center; and

(c) the maintenance of sexual offense evidence as part of the hospital-wide provisions required by this Title.

(xvi) All cases of suspected child abuse or neglect shall be reported immediately to the New York State Central Register of Child Abuse and Maltreatment and the hospital shall comply with article 6, title 6 of the Social Services Law.

(xvii) The emergency service personnel shall give information regarding community resources and the Domestic Violence Hotline telephone number to those persons who are suspected or confirmed victims of domestic violence.

 

Effective Date: 
Wednesday, May 16, 2018
Doc Status: 
Complete

Part 709 - Determination of Public Need for Medical Facility Construction

Effective Date: 
Wednesday, July 21, 2010
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2803

Section 709.1 - Determination of public need pursuant to section 2802 of the Public Health Law

Section 709.1 Determination of public need pursuant to section 2802 of the Public Health Law. (a) The factors for determining public need for health services and medical facilities shall include, but not be limited to:

(1) the current and projected population characteristics of the service area, including relevant health status indicators and socio-economic conditions of the population;

(2) normative criteria for age and sex specific utilization rates to correct for unnecessary utilization for health services;

(3) standards for facility and service utilization, comparing actual utilization to capacity, taking into consideration fluctuation of daily census for certain services, the geography of the service area, size of units, and specialized service networks;

(4) the patterns of in and out migration for specific services and patient preference or origin;

(5) the need that the population served or to be served has for the services proposed to be offered or expanded, and the extent to which all residents in the area, and in particular low-income persons, racial or ethnic minorities, women, handicapped persons, and other underserved groups and the elderly, will have access to those services;

(6) in cases involving the reduction or elimination of a service including those involving the relocation of a facility or service, the extent to which need will be met adequately and the effect of the reduction, elimination, or relocation of the service or facility on the ability of the low-income persons, racial and ethnic minorities, women, handicapped person, and other underserved groups, and the elderly, to obtain needed health care;

(7) the contribution of the proposed service or facility in meeting the health needs of members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to health services (for example, low-income persons, racial and ethnic minorities, women, and handicapped persons). For the purpose of determining the extent to which the proposed service or facility will be accessible to such persons, the following shall be considered:

(i) the extent to which medically underserved populations currently use the applicant's services in comparison to the percentage of the population in the applicant's service area which is medically underserved, and the extent to which medically underserved populations are expected to use the proposed services if approved;

(ii) the performance of the applicant in meeting its obligation under the applicable civil rights statutes prohibiting discrimination on the basis of race, color, national origin, handicap, sex and age;

(iii) the extent to which Medicare, Medicaid and medically indigent patients are served by the applicant; and

(iv) the extent to which the applicant offers a range of means by which a person will have access to its services.

(b) The evaluative procedure for review of public need pursuant to section 2802 of the Public Health Law shall include, but not be limited to:

(1) description of proposal as submitted by applicant for construction;

(2) identification of use rates in the service area for the service or services involved;

(3) identification of current and projected user population of the service area;

(4) identification of resulting estimate of future quantitative need as projected for a period of five years from last complete calendar year reported;

(5) identification of existing service(s) which are the same as those proposed by the applicant available in the service area;

(6) identification of existing service(s) which are the same as those proposed by the applicant which will be available to meet future need in the service area;

(7) identification of service(s) which are the same as those proposed by the applicant and which have been approved for construction but are not in operation in the service area;

(8) identification of resulting resource(s) available in service area five years in future to meet need;

(9) identification of percent of need met for proposed service(s) ;

(10) description of the current utilization for all service(s) which are the same as those proposed by applicant in the service area;

(11) description of the current utilization for allied or alternate services in the service area;

(12) description of any migration patterns for health care in the service area;

(13) description of any evidence of inappropriateness of placement in the service area for the subject service(s) and related service(s) ; and

(14) description of the distribution of service(s) in relation to the population's distribution.

(c) The public need analysis for each proposal will include a determination of the appropriate service area. The county in which the construction is proposed shall be the service area, unless the commissioner, upon consideration of the advice of the State Hospital Review and Planning Council, determines that a service area other than the county is more appropriate. The applicant or the health systems agency may delineate a service area other than the county together with evidence in support of such delineation. After reviewing the evidence, the commissioner, upon consideration of the advice of the council, may determine that the proposed service area is not acceptable. In cases wherein a service area other than the county is being proposed, the following shall be considered: (1) the patterns of in-and-out migration for specific services which are the same as those proposed by the applicant and patient preference or origin; and

(2) appropriateness of travel and referral patterns.

(d) Medical facilities shall be planned to achieve efficiency and economy of operation and care of high quality. In addition to the other pertinent provisions of this Part, the analysis to determine whether there is a public need for the proposed construction shall include consideration of additional factors as appropriate, including but not limited to the following:

(1) the condition of the facility's existing structures and equipment and the extent to which they are in compliance with the applicable standards of facility operation and construction under this Title;

(2) whether the architectural solutions proposed by the applicant to address the issues which are the subject of the application are:

(i) cost efficient with respect to the anticipated operational and capital cost impact of the proposal;

(ii) necessary to correct nonwaiverable requirements or standards of operation or construction under this Title;

(iii) necessary to address a problem or situation which will require corrective action within two years;

(3) reserved;

(4) whether the proposal is consistent with the applicant's long-range capital plan;

(5) whether the applicant will take advantage of opportunities for the efficient and economic reuse and recycling of existing physical plant resources, where feasible and appropriate;

(6) the life cycle incremental operational and capital cost effectiveness and efficiency of the proposal;

(7) whether the proposal could be adapted to accommodate changes in pertinent technology;

(8) whether the applicant will take advantage of opportunities to gain economies and improvements in the provision of services by entering into appropriate arrangements for sharing facilities, services or equipment with other facilities; and

(9) whether there are alternative methods or solutions available, which are more efficient, based on capital and operating costs, to address the subject problem or situation that will nevertheless ensure the provision of a level and quality of care and service that is in compliance with pertinent Federal and State statutes, rules and regulations.

(e) Any application for construction wherein a determination of public need is made pursuant to this section shall be subject to the following:

(1) The commissioner may, during the processing of an application, propose to disapprove the application solely on the basis of a determination of public need in advance of his consideration of the questions of the adequacy of financial resources, sources of future revenue and the character and competence of the applicant without, however, waiving his right to consider such criteria at a later date.

(2) In the event the commissioner upon the recommendation of the State Hospital Review and Planning Council proposes to disapprove an application solely on the basis of a lack of public need and the applicant then requests a hearing, the commissioner may direct the completion of the other required by Public Health Law, section 2802, the results of which shall be presented to the State Hospital Review and Planning Council for recommendations, which reviews may then be included as grounds for the proposed disapproval to be considered at the hearing. If the commissioner directs the completion of such reviews, a copy of the report containing the results of the reviews shall be mailed to the applicant at least 60 days prior to the date set for hearing.

(3) In the event the commissioner proposes to disapprove an application solely on the basis of no public need and the State Hospital Review and Planning Council does not concur with such proposed disapproval, the application shall be returned to the department without a formal recommendation. The commissioner shall then direct the completion of the other reviews required by Public Health Law, section 2802, and shall return the application to the State Hospital Review and Planning Council for its formal recommendation.
 

Effective Date: 
Wednesday, February 12, 1997
Doc Status: 
Complete

Section 709.2 - Acute care facilities

709.2 Acute care facilities. (a) The methodology will be utilized in the evaluation of certificate of need applications involving the construction or establishment of new or replacement beds in an acute care hospital and the need for acute care facilities and services. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in Part 708 and section 709.1 of this Title become a statement of basic principles and planning/decision making tools for guiding and directing the development of hospital services throughout the State. Additionally, it is intended that the methodology will provide potential applicants with a framework to develop specific hospital feasibility studies submitted as a part of certificate of need applications while allowing health systems agencies sufficient flexibility to consider the unique and special characteristics of their respective areas in determining bed need. The methodology is conceptually based on the application of uniform planning objectives at the county and/or State level. Its purpose is to provide guidance, to insure flexibility, and to assist the health systems agencies, the Commissioner of Health and potential applicants in determining the future need for acute care beds as consistent with the certificate of need program. The goals and objectives of the methodology expressed in this section are expected to insure that an adequate institutional bed supply is available for normal and emergency needs. The methodology helps identify counties where the projection of future acute care bed need implies a potential for excess capacity and where significant issues of hospital access and viability may occur. The goals and objectives of this methodology also are expected to result in minimizing the need for costly inpatient care by encouraging the development and expansion of more desirable lower cost alternatives, as well as insuring that high quality care and an adequate institutional bed supply are available.

(b) For purposes of this methodology, the base year shall be 1991 and the planning target year shall be 1996. The planning area shall be the county.

(c) The methodology uses the following steps to estimate the need for medical/surgical and pediatric beds in the planning target year:

(1) The normative discharge utilization rates by county of patient residence for males and females ages 0-9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and 85 and over are derived for medical/surgical and pediatric services for the base year and the year five years previous to the base year as set forth in paragraphs (1) through (3) of subdivision (d) of this section.

(2) The population, males and females ages 0-9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and 85 and over, is estimated by county for the base year, the year five years previous to the base year and for the planning target year as set forth in paragraph (4) of subdivision (d) of this section.

(3) Normative discharge utilization rates per 1,000 population by county of patient residence and by peer groups of counties for males and females ages 0-9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and 85 and over are estimated for the planning target year as set forth in paragraphs (5) through (8) of subdivision (d) of this section.

(4) The number of expected discharges is derived by multiplying the utilization rates by county for males and females ages 0-9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and 85 and over for the planning target year by the estimated county population for the planning target year divided by 1,000.

(5) Total expected discharges by county of residence is the sum of the expected discharges as set forth in paragraph (4) of this subdivision.

(6) To derive the estimated number of discharges in the planning target year by county of hospitalization, the estimated number of expected discharges for the planning target year by county of residence is adjusted to reflect the migration of patients between counties in the State and for patients migrating from other states to New York as set forth in paragraphs (9) and (10) of subdivision (d) of this section.

(7) Discharges in the planning target year, by county of expected hospitalization, are distributed by Diagnostic Related Groups (DRG) and payor categories as set forth in paragraph (11) of subdivision (d) of this section.

(8) Actual average base year length of stay for discharges in the county of hospitalization for each DRG and payor group is compared to national experience in length of stay for each DRG and payor group as set forth in paragraph (12) of subdivision (d) of this section. The lowest length of stay, either the national experience or the county actual average base year length of stay for each DRG and payor group, is multiplied by the expected number of discharges for that DRG and payor group to derive expected days of hospitalization in the planning target year. Expected days of hospitalization in the planning target year by DRG and payor groups are summed to derive total expected days. (9) Days of care provided to adults and pediatric patients are separated from total expected days of hospitalization in the planning target year as set forth in paragraph (13) of subdivision (d) of this section. Medical/surgical bed need is derived from adult days and pediatric bed need is derived from pediatric days.

(10) Expected adult and pediatric days of hospitalization in the planning target year are divided by 365 to derive average daily census for each county.

(11) Estimated medical/surgical and pediatric beds needed in the planning target year for each county are calculated by dividing average daily census by the expected occupancy rate as set forth in paragraph (14) of subdivision (d) of this section.

(12) The estimates of public need for medical/surgical and pediatric beds for the planning target year for each county are adjusted, as set forth in paragraphs (15), (16) and (17) of subdivision (d) of this section, to reflect the use of these beds for alternate level of care patients and other extraordinary disease occurrences which were not adequately reflected in the historic use rate experience.

(d) The methodology for determining public need for acute care beds and the estimates of projected bed need by county for the planning target year shall be as follows:

(1) The initial data base for the base year and the year five years previous to the base year is extracted from the Statewide Planning and Research Cooperative System (SPARCS) for medical/surgical and pediatric discharges. Excluded are neonatal discharges, newborns, and discharges with non-medical/surgical DRGs of maternity, psychiatry, drug abuse, alcohol abuse, burns and medical rehabilitation. In the event other methodologies are developed by the Department of Health to project acute care bed need for extraordinary disease occurrences, these discharges also shall be removed from the base year and the year five years previous to the base year. For the purposes of this methodology, discharges with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are excluded.

(2) Counties with similar demographic and socio-economic characteristics are grouped into peer groups for purposes of this methodology:

Group 1: Bronx, Kings, New York, Queens;

2: Dutchess, Nassau, Orange, Rockland, Suffolk, Richmond, Westchester;

3: Albany, Broome, Erie, Monroe, Niagara, Oneida, Onondaga;

4: Genesee, Madison, Montgomery, Ontario, Oswego, Rensselaer, Saratoga, Schenectady, Wayne;

5: Cattaraugus, Chautauqua, Chemung, Clinton, Cortland, Jefferson, Otsego, Steuben, Tompkins, Ulster, Warren;

6: Columbia, Greene, Hamilton, Herkimer, Livingston, Orleans, Putnam, Schoharie, Schuyler, Seneca, Washington, Wyoming, Yates;

7: Allegany, Cayuga, Chenango, Delaware, Essex, Franklin, Fulton, Lewis, St. Lawrence, Sullivan; 8: Tioga.

(3) To isolate health system changes that are occurring with the growth of hospital and free-standing ambulatory-surgery programs, discharges in the initial data base for the base year and the year five years previous to the base year are further classified based on their principal procedure code in SPARCS. Discharges whose principal procedure is included in the Department of Health's Ambulatory Surgery data base are classified as appropriate for ambulatory surgery. Exceptions to this classification include obstetric and newborn cases, deaths, transfers to acute care and long term care facilities and procedures done less than five percent of the time on an ambulatory basis.

(4) The population age 0-9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and 85 and older shall be estimated by county by sex for the base year, the year five years previous to the base year and the planning target year using linear interpolation of the population projections developed by the New York State Department of Economic Development and by population categories based on U.S. Census Bureau data. If the population projections for the planning target year are based on census data collected ten years or more before the planning target year, population projections for the planning target year shall be adjusted to account for the percent difference in the most recent year's actual census and the Department of Economic Development's population projection for that same year.

(5) A normative discharge utilization rate per 1,000 population by county of patient residence, for each sex, age group, and ambulatory-surgery category is calculated by dividing the number of discharges by the population for each sex and age group and multiplying this ratio by 1,000.

(6) For each peer grouping of counties, the number of discharges in each sex, age group, and ambulatory-surgery category are summed for a group total in the base year and the year five years previous to the base year. The population projection for the base year and the year five years previous to the base year for each sex and age group are summed for all counties in a peer group for a peer group population total. (7) A normative discharge utilization rate per 1,000 population by county peer group for each sex, age group, and ambulatory-surgery category is derived by dividing the sum of county discharges by the sum of county population estimates as set forth in paragraph (6) of this subdivision and multiplying by 1,000. An average annual rate of change is calculated for each sex, age group, and ambulatory-surgery category between the year five years previous to the base year and the base year.

(8) The projected utilization rate for the planning target year is calculated by applying the county peer group's average annual rate of change for each age group, sex and ambulatory-surgery category to each county's base year utilization rate and then each year thereafter up to the planning target year. This procedure shall be performed in all county peer groups, except groups 1 and 8, to derive a county estimated utilization rate for the planning target year. For group 8, the base year actual utilization rates shall be used for the planning target year. For group 1, the lowest actual average annual rate of change between the year five years previous to the base year and the base year for each age, sex and ambulatory-surgery category shall be applied to each county's base year rate and each year thereafter up to the planning target year.

(9) To account for the migration of patients from the county of residence to the county of hospitalization, the projected number of discharges by county of residence in the planning target year will be subdivided among the counties of hospitalization according to the same proportions as experienced by discharges in the base year. For example, if 50 percent of the base year discharges residing in county A were hospitalized in county B, then 50 percent of the projected planning target year discharges residing in county A shall be assumed hospitalized in county B. Discharges in the counties of hospitalization are summed to derive a total number of discharges by county of hospitalization.

(10) To account for the estimated number of non-New York State residents hospitalized in New York State counties in the planning target year, the actual number of non-New York State residents in the base year is added to the projected number of discharges in the planning target year as calculated in paragraph (9) of this subdivision. In the event that reliable information becomes available from the health systems agencies or other sources on migration pattern changes expected either within New York State counties or from non-New York State residents, then the migration patterns from the base year may be adjusted accordingly before being applied to the planning target year.

(11) For the purposes of this methodology, the 1991 federal grouping system of DRGs, as set forth in Appendix D-1, shall be used. The following four payor categories are used:

(i) Medicare,

(ii) Medicaid,

(iii) Blue Cross plus other commercial carriers, and

(iv) all other payors including self-pay. The percent distribution of discharges by DRG and payor group in the base year is applied to the number of discharges projected for the planning target year to derive the projected number of discharges by DRG and payor group by county of hospitalization.

(12) For the purposes of this methodology, the 75th percentile of national length of stay data, as set forth in Appendix D-2, shall be used. This national data is collected from inpatient discharge records submitted by hospitals participating in the Professional Activity Study. If a DRG is excluded from the national survey because it is no longer valid, ungroupable or inappropriate for length of stay determinations, then the actual New York State average length of stay by payor group in the base year shall be used for the expected length of stay in the target year.

(13) Pediatric days are defined as days for patients ages 0-14. The actual proportion of pediatric days as a percent of total medical/surgical and pediatric days combined for the base year is calculated for each county of hospitalization based on the age of the patients discharged. This actual base year percent distribution is multiplied by the projected number of total medical/surgical and pediatric days combined for the planning target year to derive projected pediatric days.

(14) The following occupancy levels are applied to project acute care bed need by county and bed type:
Bed Type Urban Rural__________________________________________
Medical/surgical .85 .80Pediatric .70 .65Obstetric .75 .70

For purposes of this methodology, the following counties are considered urban - Albany, Broome, Dutchess, Erie, Monroe, Nassau, Niagara, Oneida, Onondaga, Orange, Rockland, Suffolk, Westchester, Bronx, Kings, New York, Queens and Richmond. The rural occupancy proportions shall be applied in all other counties in New York State. (15) Patients who no longer require acute care but stay in the hospital pending discharge are termed alternate level of care (ALC) patients. Their bed use shall be added to the acute care bed need projected for the planning target year. The number of ALC days in the base year and the year five years previous to the base year is extracted from the SPARCS case-mix file by county of hospitalization for the following age groups - 0-44, 45-64, 65-74, 75-84 and 85 and older. The statewide average annual rate of change in the number of ALC days by age group is calculated between the year five years previous to the base year and the base year. This average annual rate of change is applied to the statewide actual number of ALC days by age group in the base year and each year thereafter to the planning target year. The total number of ALC days statewide for the planning target year by age group are then distributed to eachcounty of hospitalization according to the percent distribution of ALC days by county in the base year.

(16) Projected ALC days by county of hospitalization are summed across the age groups to derive a total number of expected ALC days by county. ALC days by county are divided by 365 to calculate an average daily census which is then added to the projected number of acute care beds needed in each county.

(17) The estimates of need for acute care beds as derived in the foregoing provisions of this section do not include estimates of need for acute care beds for patients with HIV/AIDS. Need for acute care beds to serve such patients shall be in addition to the estimates of need otherwise derived in this subdivision. If there are other patients with extraordinary disease occurrences whose acute care use is not adequately represented in the base year rate or in the rate for the year five years previous to the base year, an estimate of expected additional acute care bed need for the planning target year also shall be added to account for the needs of these patients.

(e) The methodology to derive an estimate for the need for obstetrical or maternity service beds in the planning target year shall be as follows:

(1) The number of expected live births for the planning target year is calculated by applying the projected age-specific birth rate for the planning target year as estimated by the New York State Department of Economic Development to the projected female population of child-bearing age (15-44 years) for the planning target year. If the projections of births for the planning target year are based on census data collected ten years or more before the planning target year, projections of births for the planning target year shall be adjusted to account for the percent difference in the most recent year's actual births and the Department of Economic Development's projection of births for that same year.

(2) An estimated rate of spontaneous fetal deaths and induced abortions is applied to the projected female population of child-bearing age (15-44 years) for the planning target year and then added to the expected number of live births to derive total expected obstetric discharges.

(3) To derive the estimated number of discharges in the planning target year by county of hospitalization, the estimated number of expected discharges for the planning target year by county of residence shall be adjusted to reflect the migration of patients between counties in the State and for patients migrating from other states to New York for the female population ages 15-44, as set forth in paragraphs (9) and (10) of subdivision (d) of this section.

(4) The number of estimated obstetric discharges for the planning target year is adjusted to account for the number of antenatal admissions, defined as admissions to obstetric beds which, while maternity related, do not result in a delivery. Examples of antenatal services are ectopic pregnancies, threatened abortions, miscarriages, false labor and maternity-related diagnostic procedures. The same proportion of antenatal discharges by county of hospitalization, in the base year is added to the estimated number of obstetric discharges in the planning target year.

(5) Expected discharges for the planning target year by obstetric-related diagnostic related group and payor are distributed as set forth in paragraph (11) of subdivision (d) of this section.

(6) The expected number of obstetric days for the planning target year is calculated by multiplying the number of projected discharges for each obstetric-related DRG and payor group by either the actual average county length of stay or the 75th percentile of national length of stay by DRG and payor group, as set forth in Appendix D-2, whichever is lower. Total obstetric days for the planning target year shall be further adjusted to reflect an expected length of stay for cesarean deliveries estimated by the Department of Health based on an analysis of the expected frequency and length of stay of cesarean section deliveries in New York State hospitals. (7) The expected number of obstetric days of hospitalization in the planning target year is divided by 365 to derive an average daily census for each county.

(8) The estimated number of obstetric beds needed in each county in the planningtarget year is calculated by dividing the average daily census by the expected occupancy rate as set forthin paragraph (14) of subdivision (d) of this section.

(f) Periodically, but at least every five years from the base year, the Department of Health, in conjunction with the health systems agencies and the State Hospital Review and Planning Council, shall review and update the methodology and projections established pursuant to this section to project acute care bed need to a new planning target year not to exceed five years from a new base year.

(g) The county acute care bed need totals for medical/surgical, pediatric and obstetric beds determined in accordance with subdivisions (c), (d) and (e) of this section shall constitute the estimated public need for medical/surgical, pediatric and obstetric beds in each county for the planning target year. Each health systems agency may review the estimated bed need of its region and, in conjunction with the Department of Health and the State Hospital Review and Planning Council, may:

(1) make recommendations for amending the need estimates developed in accordance with subdivisions (c), (d) and (e), of this section to reflect local characteristics. Factors that may be considered in this analysis include, but are not limited to, the following: an analysis of current utilization patterns as it relates to projected trends developed pursuant to the methodology for determining public need for acute care beds in subdivisions (c), (d), and (e) of this section, health status indices of the population, high and low variation discharge composition, ambulatory care sensitive discharge experience and trends in alternate level of care.

(2) identify counties at high risk of undergoing acute care system changes due to an estimated excess of medical/surgical, pediatric and/or obstetric bed capacity for the planning target year. Acute care system changes shall refer to any or all of the following occurrences: discontinuation of acute care services, conversion of all or a portion of the acute care beds, decertification of all or a portion of the acute care beds or hospital closure. A county at high risk of acute care system changes is one that meets at least one of the following criteria:

(i) the estimated acute care bed need in the county for the planning target year is less than 85 percent of existing capacity and there is at least one hospital in the county with fewer beds than the estimated excess in medical/surgical, pediatric, and/or obstetric beds for the county; or

(ii) the county is identified as being at high risk by the local health systems agency, subject to the approval of the Commissioner, when other factors are determined to result in acute care systems changes.

(h) The Department of Health in conjunction with the health systems agencies may develop institution-specific recommendations, with the concurrence of the State Hospital Review and Planning Council, for expected service needs and capital expenditure requirements. Commencing in 1994, and no more frequently than once a year, acute care facilities in counties identified as being at high risk pursuant to subdivision (g) of this section, may be required to submit to the Commissioner, on forms prescribed by the Commissioner, a summary assessment of the facility's service needs and capital expenditure requirements for at least the following five calendar years. Based on these five year plans and the estimated need for acute care beds in the county, the department, in consultation with the local health systems agencies, shall identify the need for appropriate changes in facility utilization and services provided to achieve the projected acute care bed need.

(i) Results of the acute care bed need methodology, as set forth in subdivisions (c), (d) and (e) of this section, together with any adjustments approved by the Commissioner in consultation with the State Hospital Review and Planning Council and developed in accordance with subdivision (g) of this section, shall be used when an application proposes one of the following:

(1) an increase in the facility's medical/surgical, pediatric or obstetric bed composition;

(2) a change in the operator of a hospital that requires a need review;

(3) a capital investment which meets at least one of the following criteria:

(i) the project is a Capital Architectural and Program Alternatives (CAPA) project with total basic costs of construction, as defined in section 710.1 of this Chapter, exceeding $25,000,000 or

(ii) the total basic costs of construction is an amount which is greater than fifty percent of the net depreciated value of the facility's total fixed assets used for hospital purposes.

(j) When submitting feasibility studies in support of applications which are subject to this section, applicants shall use the same discharge utilization rate calculations and trends as used in the acute care bed need methodology set forth in subdivisions (c), (d) and (e) of this section. Feasibility studies may not incorporate changes in hospital discharges based on market share changes except in the following instances: (1) acquisition of another hospital and consolidation of inpatient activity, (2) introduction of new services unavailable to the hospital service area population, or (3) continued increases in the market share between the year five years previous to the base year and the base year.

(k) The review of, and recommendations and decisions concerning, applications subject to this section shall be based upon the following:

(1) the estimated county acute care bed need as set forth in subdivisions (c), (d), (e) and (g) of this section; and

(2) the county's expected service needs and capital expenditure requirements, and the recommendations developed and need for changes identified in accordance with subdivision (h) of this section.

Effective Date: 
Wednesday, December 29, 1993
Doc Status: 
Complete

Section 709.3 - Residential health care facility beds

709.3 Residential health care facility beds.

(a) Notwithstanding the provisions of subdivisions (a), (b), and (c) of section 709.1 of this Part, the methodology and procedures in this section will be used in the evaluation of certificate of need applications involving the construction of new or replacement residential health care facility beds, the renovation of residential health care facilities, the sale or transfer of residential health care facility beds between facilities, or the establishment of residential health care facilities, including changes of ownership subject to review by the Public Health Council.

(b)(1) For purposes of this methodology, the base year shall be 2006 and the planning target year shall be 2016. The planning area shall be the county except as otherwise provided for in this section.

(2) Notwithstanding any other provision of this section, the estimates of public need for residential health care facility beds determined under this section for the planning target year shall continue to be the estimates of public need for such beds for years subsequent to the planning target year until a new bed need methodology is promulgated.

(c) The methodology uses the following steps to estimate the need for residential health care facility beds in the planning target year:

(1) The population age 0-64 is estimated by county for the base year and planning target year in paragraph (1) of subdivision (d) of this section.

(2) The number of functionally dependent individuals in the population age 65 and older is estimated by county for the base year and the planning target year in paragraph (2) of subdivision (d) of this section.

(3) The population age 0-64 and the number of functionally dependent individuals aged 65 and older in each county for the base year is summed in paragraph (3) of subdivision (d) of this section to derive the statewide totals for each age group.

(4) Statewide normative use rates for residential health care facilities, long term community based care and supportive housing are calculated in paragraphs (4), (5) and (6) of subdivision (d) of this section for the population age 0-64 and for the functionally dependent population age 65 and older.

(5) The statewide pattern need estimates for residential health care facility beds, long term community based services and supportive housing in the planning target year are calculated in paragraph (7) of subdivision (d) of this section by county by multiplying the statewide normative use rates by the appropriate population group.

(6) The need estimates for residential health care facility beds, long term community based services and supportive housing are summed to determine total long term care need for each county in paragraph (8) of subdivision (d) of this section.

(7) Local pattern need estimates for residential health care facility beds, long term community based services and supportive housing in the planning target year are calculated based on the local pattern distribution of long term care services in the base year in paragraph (9) of subdivision (d) of this section.

(8) The statewide pattern need estimates and the local pattern need estimates are averaged in paragraph (10) of subdivision (d) of this section to derive the blended need estimate for residential health care facility beds, long term community based care and supportive housing.

(9) The blended need estimates for residential health care facility beds are adjusted to reflect a 99% occupancy rate in paragraph (11) of subdivision (d) of this section.

(10) The residential health care facility bed need estimates are adjusted to reflect migration between counties in the State, to facilities outside the State and for patients migrating from other states to New York in paragraph (12) of subdivision (d) of this section.

(11) The relationship of the need estimates for residential health care facility beds to special populations is addressed in paragraphs (13) and (14) of subdivision (d) of this section.

(12) The requirement for the department to evaluate the residential health care facility bed need methodology and the appropriateness of certain assumptions set forth in this section is addressed in paragraph (15) of subdivision (d) of this section.

(13) The development of long term care plans by the health systems agencies and the types of adjustments to the need estimates that may be recommended in these plans is addressed in subdivision (e) of this section.

(14) Subdivision (f) of this section provides that the bed need estimates for the planning target year shall constitute the public need for residential health care facility beds in the planning area.

(15) Remaining need for construction of additional residential health care facility beds is calculated by county in subdivision (g) of this section.

(16) Factors which could be considered by the department to modify the need estimates developed in accordance with subdivision (d) of this section are described in subdivision (h) of this section.

(d) The methodology for determining the public need for residential health care facility beds and the estimates of projected need by county for the planning target year shall be as follows:

(1) The population age 0-64 shall be estimated by county for the base year and the planning target year using New York State Data Center projections.

(2)(i) The population age 65-74 and 75 and older shall be estimated by county for the base year and the planning target year using New York State Data Center projections.

(ii) The total number of functionally dependent individuals age 65 and older shall be estimated by county for the base year and planning target year based on the percentage of such individuals found in the population age 65 and older derived from U.S. Census Bureau data which identified those with a self-care limitation as those who resided in the community but report having a condition that makes activities of daily living difficult, plus those who resided in residential health care facilities. Estimating the functionally dependent population age 65 and older identifies a sub-set of the population age 65 and older of which a further sub-set will need long term care services from the formal support system, such as residential health care facility beds, supportive housing and long term community based services.

(3) The population estimates for those age 0-64 derived in accordance with paragraph (1) of this subdivision in each county and the population estimates of the functionally dependent individuals age 65 and older derived in accordance with paragraph (2) of this subdivision in each county for the base year shall be summed to derive the State total for each age group.

(4) The average daily census of persons served with long term care services in the base year shall be determined by age for the 0-64 age group and for those age 65 and older. Such data shall include, but not be limited to, the following long term care services:

(i) residential health care facility patients by county of origin including New York State residents served in out-of-state facilities;

(ii) persons served in the personal care program;

(iii) persons served in adult care facilities serving the frail elderly;

(iv) persons served by certified home health agencies with a length of stay of 90 days or longer;

(v) persons served by long term home health care programs;

(vi) persons served by managed long term care plans; and

(vii) patients in general hospitals on alternate level of care status with a length of stay on such status of seven days or more.

(5) For purposes of calculating appropriate normative use rates, the number of long term care patients served in the base year shall be summed by age group for the three long term care categories of residential health care facilities, long term community based care (including long term home health care programs, certified home health agency services to long term care patients, managed long term care plans and personal care programs) and supportive housing (including adult homes and enriched housing, programs). The number of patients on alternate level of care status shall be allocated between long-term community based care services and residential health care facilities.

(6) Statewide normative use rates shall be calculated for residential health care facilities, long term community based care and supportive housing for the population age 0-64 and for the functionally dependent population age 65 and older. Such statewide normative use rates shall be calculated by dividing the total patient population for residential health care facilities, long term community based services and supportive housing determined in accordance with paragraph (5) of this subdivision by the estimated base year population age 0-64 and the number of the functionally dependent age 65 and older.

(7) The statewide normative use rates derived in paragraph (6) of this subdivision shall be multiplied by the estimated county level population age 0-64 and estimated number of the functionally dependent age 65 and older for the planning target year to derive county level estimates of the need for residential health care facility beds, persons to be served in supportive housing and long term community based services needs. These need estimates shall be referred to as the statewide pattern need estimates.

(8) The total long term care need for each county is calculated by summing the need for residential health care facility beds, long term community based care and supportive housing. This sum represents an estimate of the total number of people in need of long term care services on a daily basis as represented by the statewide normative use rates.

(9) The local pattern of distribution of long term care services shall be calculated by county using the percentage distribution of resources in the county for residential health care facility beds, supportive housing and long term community based services in the base year. These percentages are multiplied by the total long term care need for the county derived in paragraph (8) of this subdivision to calculate the local pattern need estimates for residential health care facility beds, supportive housing and long term community based care.

(10) The need for residential health care facility beds calculated using the statewide pattern and the local pattern shall be averaged to estimate the blended need for each service category in the county for the planning target year.

(11) The residential health care facility beds in each county resulting from blending the statewide pattern need and the local pattern need in paragraph (10) of this subdivision shall be adjusted to reflect a 99% occupancy rate.

(12) The residential health care facility beds in each county resulting from the occupancy adjustment in paragraph (11) of this subdivision shall be adjusted to reflect migration between counties and to and from other states. In general, migration is estimated to be 50% voluntary and likely to continue regardless of the availability of resources in the county of origin and 50% involuntary resulting from the unavailability of resources in the county of origin. Migration adjustments shall be based on base year data and shall include:

(i) Migration from the county of origin to other New York State counties. Such migration adjustment shall be equal to 50% of the number of residential health care facility beds that would be required in the planning target year for residents who have migrated from another county for residential health care facility services calculated based on the proportion of county of origin patients migrating to the county of destination in the base year multiplied by the planning target year county of origin residential health care facility need.

(ii) Migration to facilities outside New York State. Such migration adjustment shall be equal to 50% of the Medicaid patients served outside New York State calculated based upon Medicaid claims data concerning out of state placements in the base year.

(iii) Out-of-state migration to New York State facilities. Such migration adjustment shall be equal to 100% of the patients reported by residential health care facilities in the base year.

(13) The estimates of need for residential health care facility beds determined in accordance with this subdivision do not include estimates of need for residential health care facility beds for special pediatric beds, ventilator beds, patients with acquired immune deficiency syndrome or those in need of long term rehabilitation for head injury. Need for residential health care facility beds to serve such patients shall be in addition to the estimates of need determined in accordance with paragraphs (1) through (12) of this subdivision.

(14) The estimates of need for residential health care facility beds determined in accordance with this subdivision include beds needed for dementia patients, e.g. Alzheimers disease and related disorders.

(15) The department shall conduct an evaluation of the residential health care facility bed need methodology set forth in this section by December 31, 2013.

(e)(1) The estimates of need for residential health care facility beds, supportive housing and long term community based services developed in accordance with subdivision (d) of this section shall serve as the basis for development of long term care plans by the health systems agencies that are operational. These need estimates may be modified in accordance with paragraph (4) of this subdivision.

(2) The long term care plans shall describe the steps that will be taken on a regional basis to develop the long term care system to meet the needs for residential health care facilities, long term community based services and supportive housing. These plans should be developed by the health systems agency in consultation with providers, consumers, local governments and other entities within the health systems agency region having an interest in long term care services. To be used by the department in reviewing certificate of need applications, the long term care plan must be approved by the Commissioner of Health with the advice of the State Hospital Review and Planning Council, provided, however, that if a long term care plan has not been developed by the health systems agency and approved by the Commissioner of Health with the advice of the State Hospital Review and Planning Council at the time an application is considered by the department, the need estimates shall be determined in accordance with subdivision (d) of this section without a long term care plan adjustment.

(3) The long term care plans developed by the health systems agencies shall include but need not be limited to:

(i) designation of long term care planning areas. Long term care planning areas may include a single county or two or more counties grouped together but may not include portions of a county. The criteria for establishing long term care planning areas shall be reflective of at least the following:

(a) voluntary patient migration patterns;

(b) travel patterns including driving time.

(4) The health systems agency long term care plans may make recommendation for amending the need estimates developed in accordance with subdivision (d) of this section to reflect local characteristics. Factors that may be considered in this analysis include, but are not limited to, the following:

(i) Adjustments for additional migration between health systems agency regions that is documented and agreed upon in writing by the affected health systems agencies;

(ii) Adjustments to the allocation of long term care services between components of the long term care service system - residential health care facilities, long term community based services and supportive housing. Factors that may be considered in reallocation of the need between components of the long term care service system may include issues related to geographic considerations or manpower availability. All such recommendations should clearly demonstrate why these adjustments are necessary and how they will benefit the planning area.

(f)(1) The bed need estimates developed pursuant to subdivision (d) of this section, together with any approved adjustments developed in accordance with subdivision (e) of this section, shall constitute the public need for residential health care facility beds in the planning areas defined subject to further adjustments in accordance with subdivision (h) of this section.

(2) For purposes of determining public need for residential health care facility beds in the City of New York, the public need estimates for each county in the City of New York, determined in accordance with this section, shall be summed. For the purposes of determining public need for residential health care facility beds in the counties in Nassau and Suffolk, the public need estimates for each of these two counties, determined in accordance with this section, shall be summed.

(3) Notwithstanding that there is an indication of need in a planning area for additional residential health care facility beds as determined in accordance with subdivisions (d) or (e) of this section, there shall be a rebuttable presumption that there is no need for any additional residential health care facility beds in such planning area if the overall occupancy rate for existing residential health care facility beds in such planning area is less than 97% based on the most recently available data. It shall be the responsibility of an applicant in such instances to demonstrate that there is a need for additional residential health care facility beds despite the less than 97% occupancy rate in the applicant's planning area utilizing the factors set forth in subdivision (h) of this section.

(g) The evaluative procedure for determining public need for residential health care facility beds in a planning area for the planning target year shall include, but not be limited to:

(1) identification of existing residential health care facility beds in the planning area;

(2) identification of residential health care facility beds that have been approved for construction but are not in operation in the planning area;

(3) identification of resulting total residential health care facility beds that will be available in the planning area;

(4) identification of remaining need in the planning area, based upon public need for residential health care facility beds in the planning area determined in accordance with subdivision (d) or (e) of this section or adjusted in accordance with subdivision (h) of this section.

(h
) Notwithstanding any other provision of this section, when the estimates of need for residential health care facility beds developed in accordance with subdivision (d) or (e) of this section indicate the need for additional residential health care facility beds, such estimates of additional need may be modified, based on information and data gathered from relevant sources relating to significant local factors pertaining to an applicant's service/planning area, or on statewide factors, where relevant, which factors may include, but not necessarily be limited to, those set forth in paragraphs (1) through (7) of this subdivision. When making recommendations to the State Hospital Review and Planning Council and Public Health Council concerning the impact of the factors set forth in this subdivision, the department shall, to the extent practicable, indicate the relative priority of such factors.

(1) the impact of requirements pertaining to placing persons with disabilities into the most integrated setting appropriate so as to enable persons with disabilities to interact with non-disabled persons to the fullest extent possible;

(2) the growth, availability and cost-effectiveness of long-term home and community-based services, other non-institutional residential programs and of other programs and services that may serve as a substitute for or prevent the need for residential health care facility placement;

(3) occupancy rates, and the trend of those rates of existing residential health care facilities in the planning area and in contiguous counties;

(4) patient migration patterns that vary from those included in the methodology set forth in subdivision (d) of this section;

(5) the health status of residents of the planning area or the state, as applicable;

(6) recommendations made by the local health systems agency, if applicable;

(7) documented evidence of the unduplicated number of patients on waiting lists who are appropriate for and desire admission to a residential health care facility who experience a long waiting time for placement and who cannot be served adequately in other settings.

(i) An applicant for residential health care facility beds should anticipate that the review of the certificate of need application will be on a competitive basis. Therefore, all information and factors that the applicant deems relevant to the Department's determination of public need must be included in the applicant's certificate of need submission. Review of the proposal as submitted by the applicant shall include:

(1) the proposal's responses to and consistency with priority considerations specified in any requests for proposals issued by the Department or the health systems agency;

(2) the relationship of the residential health care facility beds being proposed to any applicable regional or statewide plans;

(3) the proposal's consistency with the provisions of subdivision (d) of section 709.1 of this Part;

(4) the availability of less costly or more effective alternative methods of providing the residential health care facility beds being reviewed;

(5) whether the proposed residential health care facility beds would provide improvements or innovations in the financing and delivery of health services and serve to promote quality assurance and cost effectiveness;

(6) the quality of care provided by the residential health care facility in the past;

(7) in cases involving the reduction or elimination of residential health care facility beds including those cases involving the relocation of a facility or service, the extent to which need will be met adequately and the effect of the reduction, elimination, or relocation of the facility on the ability of low income persons, racial and ethnic minorities, and other underserved groups, to obtain needed long term care services;

(8) in cases involving a proposed service area which includes a neighboring planning area, the ability of residents of such neighboring planning area to access the residential health care facility beds proposed;

(9) the contribution the proposed residential health care facility would make in meeting the health needs of members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to residential health care facility beds (for example, low- income persons, racial and ethnic minorities, and patients on alternate level of care status in general hospitals). For the purpose of determining the extent to which the proposed facility will be accessible to such persons, the following shall be considered:

(i) the extent to which medically underserved populations currently use the applicant's services, where the applicant currently provides residential health care facility services, in comparison to the percentage of all users of the service in the applicant's planning area or to which they are found in the population in general, and the extent to which medically underserved populations are expected to use the proposed residential health care facility beds if approved;

(ii) the performance of the applicant, where the applicant currently provides residential health care facility services, in meeting its obligation under the applicable civil rights statutes prohibiting discrimination on the basis of race, color, national origin, handicap, sex and age; and

(iii) the extent to which Medicaid and medically indigent patients are or would be served by the applicant.

(10) When the remaining public need identified in subdivision (g) of this section is not sufficient to permit the approval of all applications for residential health care facility beds which are considered in the batch under consideration which otherwise meet all statutory and regulatory criteria specified under the Public Health Law, the proposals will be competitively reviewed. In the competitive review process consideration will be given to those proposals which meet any or all of the following:

(i) make a commitment to admit a percentage of patients who are Medicaid eligible or Medicare/Medicaid eligible in excess of that required under subdivision (m) of this section;

(ii) make a commitment to admit a percentage of patients who have been on alternate level of care status in a general hospital for more than 90 days. Additional consideration will be given to applications that:

(a) identify and agree to meet special program requirements for such patients; and

(b) demonstrate that they have written agreements with general hospitals for admission of alternate level of care patients;

(iii) agree in writing to participate in available local long term care case management programs. Existing written agreements with local case management programs should be documented in the application;

(iv) propose to establish or expand adult care facility beds or other supportive housing programs;

(v) provide an architectural design, as demonstrated through room-by-room single line drawings and project narrative, that offers innovative designs and other factors (such as interior finishes, lighting, decorating and furnishings) to enhance quality of life in the facility.

(j) Notwithstanding any inconsistent provision of this section, the applicant may propose a service area that includes a long term care planning area outside of that in which the facility or proposed facility is located. If any application is approved on this basis, the number of residential health care facility bed resources available in the external planning area determined in accordance with subdivision (g) of this section will be adjusted to reflect that portion of the facility's bed complement which will serve residents of the external planning area.

(k) Any application for construction wherein a determination of public need is made pursuant to this section shall be subject to he provisions of subdivision (e) of section 709.1 of this Part.

(l) Notwithstanding any other provision of this section to the contrary, up to 300 additional residential health care facility beds for the State as a whole may be approved, which shall be in addition to the total statewide number of residential health care facility beds otherwise estimated to be needed under this section. Such additional beds may be approved in response to applications to add a single bed or multiple beds to an existing facility, to add an extension unit to an existing facility or to construct a new facility. Such additional beds may be approved only to meet emergency situations or other unanticipated circumstances, which shall include, but not necessarily be limited to, the following:

(1) natural disasters, such as floods, fires and disease outbreaks,

(2) unanticipated changes in population migration patterns or census growth,

(3) unanticipated reduction in availability of alternative placement settings,

(4) unanticipated changes in population health or age group characteristics.

(m) Any residential health care facility or general hospital filing an application to add residential health care facility beds shall be subject to the following requirements which shall apply to all of the facility's existing and proposed certified residential health care beds:

(1) In determining the need for residential health care facilities, beds and services, consideration shall be given to the needs of persons who receive or are eligible to receive medical assistance benefits at the time of admission to a facility pursuant to title XIX of the Federal Social Security Act and title 11 of article 5 of the Social Services Law, hereafter referred to as Medicaid patients, and the extent to which the applicant serves or proposes to serve such persons, as reflected by factors including, but not necessarily limited to, the applicant's admissions policies and practices. An application by an applicant that is or will be a provider that participates in the medical assistance (Medicaid) program shall not be approved unless the applicant agrees to comply with the requirements of this subdivision. An applicant that, at the time of consideration of its application by the commissioner, proposes not to participate in the Medicaid program may be approved, provided all other review criteria have been met, upon the condition that if, in the future, it does participate in the Medicaid program, it would comply fully with the requirements of this subdivision.

(2) To ensure that the needs of Medicaid patients in an applicant's service area are met and that such patients have adequate access to appropriate residential health care facilities, beds and services, applicants shall be required to accept and admit at least a reasonable percentage of Medicaid patients as determined pursuant to this subdivision. Such reasonable percentage of Medicaid patient admissions, also referred to herein as the Medicaid patient admissions standard, shall be equal to 75 percent of the annual percentage of all residential health care facility admissions, in the long-term care planning area in which the applicant facility is located, that are Medicaid patients. The calculation of such planning area percentage shall not include admissions to residential health care facilities that have an average length of stay of 30 days or less. If there are four or fewer residential health care facilities in a planning area, the applicable Medicaid patient admissions standard for such planning area shall be equal to 75 percent of the planning area annual percentage of all residential health care facility admissions that are Medicaid patients or 75 percent of the annual percentage of all residential health care facility admissions, in the health systems agency area in which the facility is located, that are Medicaid patients, whichever is less. In calculating such percentages, the department will use the most current admissions data which have been received and analyzed by the department. An applicant will be required to make appropriate adjustments in its admissions policies and practices so that the proportion of its own annual Medicaid patient admissions is at least equal to 75 percent of the planning area percentage or health systems agency area percentage, whichever is applicable.

(3) The proportion of an applicant's admissions that must be Medicaid patients, as calculated under paragraph (2) of this subdivision, may be increased or decreased based on the following factors:

(i) the number of individuals within the planning area currently awaiting placement to a residential health care facility and the proportion of total individuals awaiting such placement that are Medicaid patients, provided that patients awaiting placement include, but need not be limited to, alternate level of care patients in general hospitals;

(ii) the proportion of the facility's total patient days that are Medicaid patient days and the length of time that the facility's patients who are admitted as private paying patients remain such before becoming Medicaid eligible;

(iii) the proportion of the facility's admissions who are Medicare patients or patients whose services are paid for under provisions of the Federal Veterans' Benefit Law;

(iv) the facility's patient case mix based on the intensity of care required by the facility's patients or the extent to which the facility provides services to patients with unique or specialized needs; and

(v) the financial impact on the facility due to an increase in Medicaid patient admissions.

(4)(i) An applicant shall submit a written plan, subject to the approval of the department, for reaching the Medicaid patient admissions standard required by this subdivision. The plan shall provide for reaching the standard within no longer than a two-year period and the facility shall give preference, as necessary, to Medicaid patients in order to reach the admissions standard within the prescribed time period.

(ii) Once the Medicaid patient admissions standard is reached, the facility shall not reduce its proportion of Medicaid patient admissions so as to go below the standard unless and until the applicant, in writing, requests the approval of the department to adjust the standard and the department's written approval is obtained. In reviewing requests to adjust a facility's Medicaid patient admissions standard, the department shall consider factors which may include, but need not be limited to, those factors set forth in paragraphs (2) and (3) of this subdivision.

(iii) After a facility's initial Medicaid patient admissions standard has been reached, the department may increase such facility's Medicaid patient admissions standard, based on the criteria set forth in this subdivision, if the percentage of Medicaid patients admitted by residential health care facilities in the facility's planning area or health systems agency area, as appropriate, increases due to factors other than an increase in Medicaid patient admissions by the applicant.

(5)(i) Subject to the provisions of subparagraph (ii) of this paragraph, after the phase-in period provided for in paragraph (4) of this subdivision, a facility shall be prohibited from failing, refusing or neglecting to accept or admit a Medicaid patient for whom it is otherwise able to provide care, regardless of whether the level of reimbursement received for such patient is less than the rate the facility charges private pay patients, unless the facility has reached and is maintaining compliance with the Medicaid patient admissions standard imposed by this subdivision. Compliance with the requirements of this subdivision shall be determined on the basis of a facility's total annual admissions, so that a facility may exercise its discretion in determining when during a year it will admit a sufficient number of Medicaid patients to maintain its Medicaid patient admissions standard.

(ii) A facility may be exempt from the requirement of admitting a Medicaid patient in order to meet or maintain its Medicaid patient admissions standard if it can demonstrate in writing to the satisfaction of the commissioner that the Medicaid patient was denied admission solely in order to admit another patient who had a greater need of residential health care facility services, as determined by the intensity of care anticipated to be required by such patient, and that there was only one bed available in the facility at the time of the admission decision to accommodate a new admission. Facilities shall not be required to obtain prior department approval in order to accept a non-Medicaid patient in place of a Medicaid patient pursuant to this subparagraph, but shall maintain sufficient documentation including, but not necessarily limited to, a copy of the patient review instrument for the patient admitted and the Medicaid patient denied admission in order to justify the admission decision. Copies of such documentation shall be provided to the department upon request.

(6) If any provision of this subdivision or the application thereof is held invalid, the remainder of this subdivision and the application thereof to other circumstances shall not be affected by such holding and shall remain in full force and effect.

Effective Date: 
Wednesday, July 21, 2010
Doc Status: 
Complete

Section 709.4 - End stage renal dialysis service

709.4 End stage renal dialysis service. (a) This methodology will be utilized in the evaluation of certificate of need applications involving the construction or establishment of new or replacement dialysis stations used in the treatment of End Stage Renal Disease. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of basic principles and planning/decision making tools for guiding and directing the development of dialysis stations for End Stage Renal Disease services throughout the state. Additionally, it is intended that the methodology will provide the health systems agencies and potential applicants with sufficient flexibility to consider the unique characteristics of their respective areas in determining need. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate supply of dialysis stations are available to provide access to care to all those in need of in-facility dialysis.

(b) The factors to be considered in determining the public need for dialysis stations shall include, but not be limited to, the following:

(1) evidence that the proposed dialysis services capacity proposed will be utilized sufficiently to be financially feasible as demonstrated by a five year analysis of projected costs and revenues associated with the program;

(2) evidence that the proposed service or additional capacity will enhance access to services by patients including members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to health services (for example, low-income persons, racial and ethnic minorities, women, and handicapped persons), and/or appropriate rural populations;

(3) evidence that the facility's hours of operation and admission policies will promote the availability of services which are acceptable to those in need of such services, in particular, operational hours that permit individuals in dialysis to continue employment.

(4) the facility's willingness and ability safely to serve dialysis patients; and

(5) when an existing provider proposes to add twelve or more stations, evidence, derived from analysis of factors including but not necessarily limited to both existing patient referral and use patterns and projected referral and use patterns which would result from addition of the proposed stations, indicating that approval of such stations will not jeopardize the quality of service provided at or the financial viability of other existing dialysis facilities or services within the applicant's planning area. However, a finding that the proposed facility would jeopardize the financial viability of such existing facilities will not, of itself, require a recommendation of disapproval of the application.

(c) Public need for a proposed facility or station shall be deemed to exist when review and consideration of evidence concerning each of the five factors set forth in subdivision (b) of this section results in an affirmative finding.
 

Effective Date: 
Wednesday, December 28, 1994
Doc Status: 
Complete

Section 709.5 - Ambulatory surgery services

709.5 Ambulatory surgery services. (a) This methodology will be utilized to evaluate certificate of need applications involving the construction or establishment of new ambulatory surgery centers or services or extension clinics of existing centers. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1(a) of this Title, become a statement of basic priniciples and planning/decision-making tools for guiding and directing the development of ambulatory surgery services and facilities throughout the state. This methodology is intended to promote the development of ambulatory surgery programs as a cost-effective alternative to inpatient surgery where appropriate. It is also intended that this methodology will provide potential applicants with sufficient flexibility to consider the unique characteristics of their prospective projects in determining need.

(b) Terms defined.

(1) Ambulatory surgery service, as set forth in section 755.1 of this Title, is a service organized to provide those surgical procedures which need to be performed for safety reasons in an operating room on anesthetized patients requiring a stay of less than 24 hours. A list of procedures appropriate for ambulatory surgery is set forth in section 86-4.40 of this Title. Ambulatory surgery services may be provided in a free-standing ambulatory surgery facility or a hospital-based ambulatory surgery facility. Ambulatory surgery facilities may be either single or multi-specialty.

(2) Hospital-based ambulatory surgery services, as set forth in section 405.20(d) of this Title, may be located at the same site as the hospital (on-site) or apart from the hospital (off-site).

(3) Free-standing ambulatory surgery services and facilities are certified to operate as diagnostic and treatment centers as set forth in section 600.8 of this Title.

(4) Extension clinics shall mean an extension clinic as defined in section 401.1 of this Title.

(c) Minimum requirements for ambulatory surgery services and facilities. Applicants for free-standing ambulatory surgery services or applicants for hospital-based off-site ambulatory surgery facilities must meet the following minimum requirements:

(1) all facilities must meet the minimum operating standards of free-standing ambulatory surgery services under Article 28 of the Public Health Law as set forth in Part 755 of this Title; and

(2) all facilities must meet the minimum construction standards of a diagnostic and treatment center under Article 28 of the Public Health Law as set forth in section 715.16 of this Title.

(d) Determination of public need in certificate of need applications. Factors to be considered in determining the public need for ambulatory surgery services and facilities shall include, but not be limited to, the following factors:

(1) written documentation that the proposed capacity of the ambulatory surgery service or facility will be utilized sufficiently to be financially feasible as demonstrated by a three year analysis of projected costs and revenues associated with the program. Written documentation of financial feasibility shall also include, but not be limited to, an analysis of expected demand for ambulatory surgery services and an explanation of how current and expected patient referral and use patterns will make the project financially feasible;

(2) written documentation that the proposed service or facility will enhance access to services by patients, including members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to health services (for example, low income persons, racial and ethnic minorities, women and handicapped persons) and/or rural populations;

(3) written documentation that the facility's hours of operation and admission policies will promote the availability of services to those in need of such services regardless of their ability to pay. This shall include, but not be limited to, a written policy to provide charity care and to promote access to services regardless of an individual's ability to pay. Charity care shall mean care provided at no charge or reduced charge for the services the facility is certified to provide to patients who are unable to pay full charges, are not eligible for covered benefits under Title XVIII or XIX of the Social Security Act or are not covered by private insurance; and

(4) written documentation of the facility's willingness and ability to safely serve ambulatory surgery patients including, but not limited to, such factors as control of infection, quality assessment and improvement, patient transfer, emergency care, credentialing and medical record keeping as set forth in Part 755 of this Title.

(e) Public need for a proposed facility shall be deemed to exist when review and consideration of evidence concerning each of the factors set forth in subdivision (d) of this section results in an affirmative finding.

(f) Determination of need for ambulatory surgery services in a health maintenance organization (HMO). Notwithstanding anything to the contrary in this section, the addition of ambulatory surgery services to be provided directly to an HMO-enrolled population shall be approved when the HMO can demonstrate to the satisfaction of the commissioner that the provision of services shall be cost-effective and accessible to plan enrollees.

Effective Date: 
Wednesday, March 11, 1998
Doc Status: 
Complete

Section 709.6 - Extracorporeal shockwave lithotripters

709.6 Extracorporeal shockwave lithotripters. (a) This methodology will be utilized to evaluate certificate of need applications involving the acquisition of extracorporeal shockwave lithotripters (ESWL). It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of extracorporeal shockwave lithotripters. The goals and objectives of the methodology expressed herein are expected to insure that an adequate number of ESWL units are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors and methodology for determining the public need for ESWL units shall include, but not be limited to the following:

(1) There shall be one ESWL unit of each 2.5 million residents within a health system agency's geographic area with a minimum of one unit in each health systems agency's geographic area.

(2) Each applicant must present evidence that an annual minimum utilization of 750 procedures shall be achieved within two years of initial operation, except those applicants located in a health systems agency whose geographic area contains less than 2.5 million residents.

(3) In addition, each applicant applying to acquire an ESWL unit must meet the following standards:

(i) Each applicant must demonstrate the availability of urologists who meet the definition of a qualified specialist. The applicant must also have competence in the provision of diagnostic, metabolic, and surgical services to patients with kidney stone disease. This shall include experience in the performance of renal surgery, percutaneous procedures and ureteroscopy for the removal of urinary calculi.

(ii) Each applicant must submit a plan to develop referral agreements with all facilities in the relevant service area.

(iii) Each applicant must submit a plan to evaluate ESWL compared to alternative therapeutic modalities in terms of clinical efficacy, utilization and costs.

(iv) Where public need is established herein, priority consideration will be given to applicants that agree to serve the medically indigent and patients regardless of source of payment.
 

Doc Status: 
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Section 709.7 - Liver transplantation services

709.7 Liver transplantation services. (a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of liver transplantation services. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of liver transplantation services. The goals and objectives of the methodology expressed herein are expected to insure that an adequate number of liver transplantation services are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors and methodology for determining the public need for liver transplantation services shall include, but not be limited to, the following:

(1) The need for liver transplantation services will be planned for on a statewide basis based on an incidence rate of candidates for liver transplantation of 10 persons per one million population per year.

(2) There shall be one liver transplantation service center per five million population.

(3) Each applicant for a liver transplantation service must present evidence that a minimum of 20 transplants per year shall be achieved within two years of initial operation.

(4) There shall be no additional liver transplantation services approved until each existing transplantation service is performing 50 transplantations per year.

(5) Priority consideration will be given to applicants that propose to provide this service within the facility's current capacity.

(6) Where public need is established herein, priority consideration will be given to applicants that agree to serve the medically indigent and patients regardless of the source of payment.

(7) In addition, each applicant applying to initiate a liver transplantation service must meet the following standards:

(i) Each applicant must demonstrate the availability of a liver transplantation surgeon with board certification in general surgery or have equivalent experience and demonstrate the ability to perform liver transplantation as evidenced by clinical experience in an existing liver transplantation program.

(ii) Each applicant must demonstrate the availability of a liver transplantation team that includes qualified specialists in gastroenterology, hepatology, infectious disease, pulmonary medicine, immunology, hematology, pediatrics, neurology, neurosurgery and nephrology.

(iii) Each applicant must demonstrate its participation in a donor organ procurement system, or a donor organ harvesting program, or a written affiliation agreement with an existing approved or registered donor organ procurement or harvesting agency.
 

Doc Status: 
Complete

Section 709.8 - Bone marrow transplantation (BMT) services

709.8 Bone marrow transplantation (BMT) services. (a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of allogeneic bone marrow transplantation services. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of bone marrow transplantation services. The goals and objectives of the methodology expressed herein are expected to insure that an adequate number of BMT services are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors and methodology for determining the public need for allogeneic BMT services shall include, but not be limited to, the following:

(1) The need for BMT services shall be planned on a statewide basis.

(2) Based on the current status of BMT technology, the number of people expected to be candidates for BMT therapy is 13.2 per million population per year. This will be reviewed on an annual basis to determine if any adjustment is indicated.

(3) The capacity of each BMT bed is six patients/year.

(4) A BMT service shall have a minimum of four beds.

(5) Priority consideration will be given to applicants that propose to provide this service within the facility's current capacity.

(6) Where public need is established herein, priority consideration will be given to applicants that agree to serve the medically indigent and patients regardless of the source of payment.

(7) In addition, each applicant applying to initiate a BMT service must meet the following standards:

(i) Each applicant must demonstrate the availability of a bone marrow transplant team under the direction of a full-time medical director with training in immunology or hematology who had advanced training and experience in bone marrow transplantation.

(ii) The bone marrow transplant team shall include specialists in the following areas: chemotherapy, radiation therapy, social work, nursing, infectious disease control, immunology, oncology, hematology, and expertise in intensive cardiopulmonary medicine.

(iii) The transplant program shall be supported by a blood bank with a capacity to support four to six patients/day. This requires the availability of a blood separator, a central blood repository, and an irradiator for blood products.

(iv) The bone marrow transplantation program shall provide or make arrangements for the harvesting of bone marrow.

(v) The services of an immunogeneticist and a cytogeneticist shall be available to the transplant program.

(vi) The transplant program shall have available clinical laboratories possessing permits issued under article 5, title 5 of the Public Health Law, in the categories of: virology, diagnostic immunology, bacteriology, mycology, mycobacteriology, parasitology, cytogenetics, cellular immunology and histocompatibility.

(vii) There shall be an organized follow-up program for transplant patients following discharge, including data management resources to maintain records on the long-term survival of transplant patients.

(viii) Each facility providing BMT services shall agree to provide annual reports to the Department of Health on utilization levels and patient origin data.
 

Doc Status: 
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Section 709.9 - Human heart transplantation services

709.9 Human heart transplantation services. (a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of human heart transplantation services. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of human heart transplantation services. The goals and objectives of the methodology expressed herein are expected to insure that an adequate number of human heart transplantation services are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors and methodology for determining the public need for human heart transplantation services shall include, but not be limited to the following:

(1) The need for human heart transplantation services will be planned initially on a statewide basis, based upon the need for two human heart transplantation centers.

(2) Each applicant for a human heart transplantation service must present evidence that a minimum of 14 transplants per year shall be achieved within two years of initial operation.

(3) There shall be no additional human heart transplantation services approved until each existing transplantation service is performing at least 30 transplantations per year at which time additional applications will be accepted and reviewed by the department.

(4) Priority consideration will be given to applicants that propose to provide this service within the facility's current capacity.

(5) Where public need is established herein, priority consideration will be given to applicants that agree to serve the medically indigent and patients regardless of the source of payment.

(6) In addition, each applicant applying to initiate a heart transplantation service must meet the following standards:

(i) Each applicant must demonstrate the availability of a heart transplantation surgeon with the ability to perform heart transplantation as evidenced by clinical experience in an existing heart transplantation program.

(ii) Each applicant must demonstrate the availability of a heart transplantation team that includes qualified specialists in cardiology, cardiovascular surgery, infectious disease, pulmonary medicine, pediatrics, neurosurgery, anesthesiology, psychiatry, immunologist, and pathologist.

(iii) Each applicant must demonstrate its participation in a donor organ procurement system, or a donor organ harvesting program, or a written affiliation agreement with an existing approved or registered donor organ procurement or harvesting agency.
 

Doc Status: 
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Section 709.10 Reserved

Section 709.11 - Inpatient rehabilitation programs for traumatic brain-injured patients

709.11 Inpatient rehabilitation programs for traumatic brain-injured patients. (a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of inpatient rehabilitation programs for traumatic brain-injured patients. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decision making tools for directing the distribution of inpatient rehabilitation program for traumatic brain-injured patients. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of inpatient traumatic brain-injured rehabilitation programs and beds are available to provide access to care and avoid the unnecessary duplication of resources.

(b) Inpatient rehabilitation programs for traumatic brain-injured patients are intensive rehabilitation programs designed to prevent and/or minimize chronic disabilities while restoring the individual to the optimal level of physical, cognitive, and behavioral functioning. These programs are applicable to those individuals who have severe disabling impairments of recent onset and are able to participate daily (at least five days per week) in multi-disciplinary programs for a minimum of three hours per day.

(c) The factors and methodology for determining the public need for inpatient rehabilitation programs for traumatic brain-injured patients shall include, but not be limited to, the following:

(1) The service area for determining the public need for inpatient rehabilitation programs for traumatic brain-injured patients shall be the designated health systems agency regions.

(2) The maximum number of inpatient rehabilitation beds for traumatic brain-injured patients in each health systems agency region required to meet the public need shall be determined by dividing the projected annual patient days for the service by three-hundred and sixty-five (365), and dividing the result by 0.90 to allow for ninety percent occupancy. The projected inpatient rehabilitation patient days for traumatic brain-injured patients used in this calculation shall be determined as follows:

(i) The diagnostic categories used in computing the need for inpatient rehabilitation beds for traumatic brain-injured patients shall be: brain dysfunction, traumatic brain dysfunction, and skull fracture.

(ii) The annual number of potential candidates for inpatient rehabilitation programs for the traumatic brain-injured shall be determined by calculating the total numbers of annual general hospital discharges from the categories considered, plus an additional ten percent, and multiplying the resulting figure by 0.155.

(iii) The number of potential candidates for inpatient rehabilitation programs for the traumatic brain-injured shall be multiplied by an 85-day rehabilitation length-of-stay to project the annual number of inpatient rehabilitation days for traumatic brain-injured patients.

(iv) A traumatic brain-injured rehabilitation program that is organized as a specialized unit within a comprehensive inpatient physical medicine and rehabilitation program shall have a minimum of ten beds. A traumatic brain-injury rehabilitation program that is organized as a freestanding inpatient rehabilitation program shall have a minimum of twenty beds.

(v) The Health Systems Agencies may make adjustments to these bed need estimates to address patient migration patterns and other regional planning issues.

(3) Where public need is established herein, and in addition to meeting the operating requirements of either subdivision 405.18(e) of this Title (traumatic head-injury programs of general hospitals) or section 415.36 of this Title (long term inpatient rehabilitiation program for head-injured residents in nursing homes), priority consideration will be given to applicants that:

(i) Demonstrate a commitment to developing and participating in an area-wide network of service organizations which provide and coordinate a full array of rehabilitation, support, education, vocational rehabilitation, recreation, housing, case management and social services for persons with traumatic brain-injuries.

(ii) Have a coma recovery care program for brain-injured patients who are unable to participate in an active rehabilitation program or have a transfer agreement with a facility that has a coma recovery care program for traumatic brain-injured patients. The number of coma recovery care beds needed in each health systems agency region shall be determined by the ratio of six (6) beds per 1.5 million population.

(iii) Have an extended care program for traumatic brain-injured patients who are unable to participate in an active rehabilitation program or a transfer agreement with a facility that has an extended care program for traumatic brain-injured patients. (iv) Will provide access to New York State Medicaid recipients or to patients or residents who are likely to become Medicaid-eligible.

(v) Demonstrate a commitment to serve the medically indigent and patients regardless of the source of payment.
 

Effective Date: 
Wednesday, May 5, 1993
Doc Status: 
Complete

Section 709.12 - Need methodology for acquisition of magnetic resonance imagers

709.12 Need methodology for acquisition of magnetic resonance imagers.

(a) This methodology will be utilized to evaluate certificate of need applications, submitted by facilities other than general hospitals, involving the acquisition of magnetic resonance imagers (MRI). It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decision making tools for directing the distribution of magnetic resonance imagers. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of MRI units are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors and methodology for determining the public need for MRI units shall include, but not be limited to the following:

(1) The need for MRI units will be planned for on a Health Systems Agency (HSA) region basis using a formula based on the number of CT scans performed in the region as follows:

(i) the total CT scans performed in an HSA region is reduced by fifteen percent to account for patients that are not suitable for MRI studies due to the presence of pacemakers and motion problems;

(ii) of the remaining number of CT scans, sixty percent will be deemed to be studies of the central nervous system (CNS);

(iii) fifty-five percent of the patients that receive CT scans of the CNS will be deemed to be candidates for an MRI scan;

(iv) the resulting number is increased by thirty percent to account for MRI studies of areas other than the CNS;

(v) each MRI has an annual capacity for 3,200 scans; and

(vi) the estimated number of MRI scans for the HSA region is divided by 3,200 to determine the number of MRI units which are needed.

(2) In addition, each applicant applying to acquire an MRI unit must meet the following standards:

(i) each applicant must demonstrate the availability of appropriate equipment in the areas of computed tomography, ultrasound, angiography, conventional radiography and nuclear medicine;

(ii) each applicant must demonstrate the availability of neurologists, neurosurgeons, orthopedists, oncologists and radiologists who meet the definition of qualified specialists;and

(iii) each applicant must submit a plan to develop referral agreements with all facilities in the relevant service area.

(3) When public need is established, priority consideration will be given to applicants who agree to serve the medically indigent and patients regardless of source of payment.
 

Effective Date: 
Wednesday, July 7, 2010
Doc Status: 
Complete

Section 709.13 - Adult day health-care programs

709.13 Adult day health-care programs. (a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of adult day health-care programs. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of adult day health-care programs. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of adult day health-care programs are available to provide access to care and avoid the unnecessary duplication of resources. Additionally it is intended that the methodology provide sufficient flexibility to consider additional circumstances that reflect on the need for adult day health care.

(b) The factors and methodology for determining the public need for adult day health care services in each county shall include, but not be limited to:

(1) An estimate of the capacity needed in adult day health-care programs to serve adult day health-care registrants. For purposes of this section, capacity means the number of registrants that an adult day health-care program can accommodate at one time based on factors such as availability of staff, furniture and equipment and the number and size of the rooms used for the program. This capacity is calculated using population estimates for each county projected five years in the future. This capacity shall be calculated using the following age cohorts and capacity measures:

(i) capacity for 0.04 registrants per 1,000 population aged 20-64;

(ii) capacity for 2.5 registrants per 1,000 population aged 65-74; and

(iii) capacity for 3.65 registrants per 1,000 population aged 75 and over.

(2) The estimates for each of the age cohorts shall be summed to derive the total capacity needed for adult day health-care services in a county.

(3) (i) To determine unmet need for adult day health-care program capacity in a county, capacity of the approved programs in such county shall be subtracted from the total capacity needed for such county.

(ii) The capacity of approved adult day health-care programs shall be deter mined as follows:

(a) for a program that was approved with a specific capacity, such approved capacity shall be utilized;

(b) for a program that was approved for a total number of registrants without a specific capacity, such number shall be divided by two to determine the program's capacity;

(c) for a program that was not approved with a specific capacity or for a total number of registrants, the department will determine, based on the most recently received and processed data, the total number of current registrants of such program and such number shall be divided by two to determine the program's capacity.

(iii) The number of registrants is divided by two in order to determine an approved program's capacity under clauses (ii) (b) and (c) of this paragraph, since it is estimated that each unit of adult day health-care program capacity will serve two registrants.

(4) In counties where the total capacity needed for adult day health-care services is less than the minimum capacity required in order to be approved under the operational standards set forth in Part 425 of this Title, one program may be approved despite such minimum capacity requirement, provided that all other criteria for approval are met.

(5) Notwithstanding that need may otherwise have been determined to be met under this section, additional adult day health-care program capacity may be ap proved within a county if:

(i) all existing programs within the county are operating at their approved capacities; and

(ii) there is evidence of further need for adult day health-care services as demonstrated by factors which include, but need not be limited to:

(a) waiting lists for adult day health-care services; and

(b) the number of people on alternate level of care in the county who could benefit from adult day health-care services.
 

Doc Status: 
Complete

Section 709.14 - Cardiac services

709.14 Cardiac services. (a) These standards will be used to evaluate certificate of need applications for Cardiac Catheterization Laboratory Center services and Cardiac Surgery Center services. All need determinations are hospital site specific.It is the intent of the State Hospital Review and Planning Council that these standards, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decision making tools for directing the distribution of Cardiac Catheterization Laboratory Center services and Cardiac Surgery Center services. These planning principles and decision making tools build on the existing regional resources that have been developed through the regulatory planning process. The goals and objectives of the standards expressed herein are expected to promote access to Cardiac Catheterization Laboratory Center services and Cardiac Surgery Center services, maintain provider volumes associated with high quality care, and avoid the unnecessary duplication of resources while addressing the geographic distribution of services necessary to meet the needs of patients in need of emergency percutaneous coronary interventional (PCI) procedures. Additionally, it is intended that the methodology provide sufficient flexibility to consider additional circumstances that reflect on the need for cardiac services.

(b) Cardiac Surgery Centers. The factors for determining the public need for Cardiac Surgery Center services shall include, but not be limited to the following:

(1) The planning area for determining the public need for Cardiac Surgery Center services shall include the applicant's designated Health Systems Agency (HSA) region and the use area of the applicant facility. For purposes of determining Cardiac Surgery Center services need, the use area of a facility is defined as the area within a 100 mile radius of the applicant facility.

(2) Planning for Cardiac Surgery Center services shall ensure that, to the extent possible, eighty percent of the total population of each HSA region resides within 100 miles of a facility providing cardiac surgical services.

(3) A facility proposing to initiate an Adult Cardiac Surgery Center must document a cardiac patient base and current cardiac interventional referrals sufficient to support a projected annual volume of at least 500 cardiac surgery cases and a projected annual volume of at least 300 PCI cases within two years of approval. The criteria for evaluating the need for additional Adult Cardiac Surgery Centers within the planning area shall include consideration of appropriate access and utilization, and the ability of existing services within the planning area to provide such services. Approval of additional Adult Cardiac Surgery Center services may be considered when each existing Adult Cardiac Surgery Center in the planning area is operating and expected to continue to operate at a level of at least 500 cardiac surgical procedures per year. Waiver of this planning area volume requirement may be considered if:

(i) the HSA region's age adjusted, population based use rate is less than the statewide average use rate; and

(ii) existing Adult Cardiac Surgery Centers in the applicant facility's planning area do not have the capacity or cannot adequately address the need for additional cardiac surgical procedures, such determinations to be based on factors including but not necessarily limited to analyses of recent volume trends, analyses of Cardiac Reporting System data, and review by the area Health Systems Agency(s); and

(iii) existing cardiac surgical referral patterns within the planning area indicate that approval of an additional service at the applicant facility will not jeopardize the minimum volume required at other existing cardiac surgical programs.

(4) No finding of need for the addition of Pediatric Cardiac Surgery Center services will be made unless each existing Pediatric Cardiac Surgery Center service in the planning area is operating and expected to continue to operate at a level of at least 200 pediatric cardiac surgical procedures per year, and unless such existing Pediatric Cardiac Surgery Center services do not have the further capacity to meet projected need for additional pediatric cardiac surgical procedures. Where public need is established herein, a facility proposing to provide pediatric cardiac surgical services must demonstrate the ability to perform a minimum of 200 pediatric cardiac surgical procedures per year by the end of the second full calendar year of operation or demonstrate the ability to perform a minimum of 50 cases a year on-site and operate as part of a coordinated program based on a fully executed written agreement, approved by the Commissioner, with another pediatric cardiac surgery program in accordance with standards at 405.29(d)(5)(ii). For hospitals seeking approval as part of a coordinated program, the agreement must be submitted with the certificate of need application and must be approved by the Department prior to initiation of the service.

(5) A facility proposing to provide Adult and or Pediatric Cardiac Surgery Center services shall:

(i) submit a written plan to the Department of Health which, when implemented, will ensure access to cardiac surgical services for all segments of the HSA region's population. Such plan shall provide a detailed plan to reach patients not currently served within the planning area, ensure continuity of care for patients transferred between facilities, and shall otherwise promote planning for cardiac services within the region; and

(ii) propose a hospital based heart disease prevention program that, when implemented, shall include:

(a) Treatment plans for cardiac inpatients with a principal diagnosis of ischemic heart disease. These patients are at high risk for development of adverse cardiovascular events and the program shall provide for the following in a comprehensive, systematic way:

(1) protocols shall be developed and implemented for the assessment of risk factors including lipid disorders, hypertension, diabetes, obesity, cigarette smoking, and sedentary lifestyle. Such protocols shall be in keeping with generally accepted standards;

(2) The hospital shall provide patient education that shall include, but not be limited to, information on the importance of assessing risk factors for heart disease in first-degree relatives, and the importance of cardiopulmonary (CPR) training for family members and care givers;

(3) Discharge plans must include:

(i) a request for consent to allow patient medical information to be shared with the patient’s primary care providers;

(ii) patient referral to their primary care provider with documentation of treatments provided by the hospital and follow-up care recommended by the hospital; and

(iii) patient referral to cardiac rehabilitation programs appropriate to their needs.

(b) professional education:

(1) The hospital shall sponsor or co-sponsor at least three professional education programs per year related to heart disease risk assessment and control and that are open to local community based health professionals.

(c) hospital-based heart health promotion:

(1) The program shall implement policies and health programs in the hospital and establish environments that promote heart-healthy behaviors among hospital staff, employees and visitors, including:

(i) prohibiting the sale and use of tobacco products on hospital premises;

(ii) offering and promoting, on a regular basis, healthful choices in hospital cafeterias and patient menus; and

(iii) offering employee wellness and fitness programs that provide opportunities for employees to make healthy choices.

(d) community based heart health promotion:

(1) The hospital shall organize or participate in a consortium of existing community-based organizations and key community leaders to engage in activities to improve cardiac health in the community; and

(2) organize or participate in at least one major community based campaign (not including health fairs) each year related to major heart disease risk factors.

(e) program administration:

(1) Hospitals shall identify a team within their organization to coordinate heart disease prevention activities. Members of the team shall include a broad range of expertise, including but not limited to: community organization, planning, and social marketing, public health skills and health education.

(6) When considering an application to meet public need for Adult and or Pediatric Cardiac Surgery Center services, priority consideration shall be given to the expansion of an existing service as opposed to the initiation of a new Cardiac Surgery Center.

(7) Where public need is established herein, priority consideration will be given to applicants that agree to serve the medically indigent and patients regardless of the source of payment.

(8) Applicants proposing to initiate an Adult and or Pediatric Cardiac Surgery Center service must:

(i) demonstrate the ability to comply with standards set forth in 405.29 (c), 405.29(d), and 711.4(h) of this Title; and

(ii) in addition, a facility providing Pediatric Cardiac Surgery Center services also must comply with the requirements specified in section 711.4(f) of this Title.

(9) All hospitals approved as Adult Cardiac Surgery Centers shall be approved as PCI Capable Cardiac Catheterization Laboratory Centers and must meet standards in Sections 405.29(c), 405.29(e)(1), and 405.29(e)(2) of this Title. All hospitals approved as Pediatric Cardiac Surgery Centers shall be approved as Pediatric Cardiac Catheterization Laboratory centers and must meet the standards at 405.29(c), 405.29(e)(1) and 405.29(e)(4) of this Title.

(c) For the purposes of this section the terms Cardiac Catheterization Laboratory Center, Percutaneous Coronary Intervention (PCI) Capable Cardiac Catheterization Laboratory Center, Cardiac Electrophysiology (EP) Laboratory Program and Pediatric Cardiac Catheterization Laboratory Center shall have the same meanings as in section 405.29 (a)(4) of this Title.

(d) Public need for Cardiac Catheterization Laboratory Centers:

(1) PCI Capable Cardiac Catheterization Laboratory Centers. The factors and methodology for determining the public need for PCI Capable Cardiac Laboratory Centers shall include, but not be limited to the following:

(i) PCI Capable Cardiac Catheterization Laboratory Centers at hospitals with a Cardiac Surgery Center on site. Applicants approved as Cardiac Surgery Centers are approved PCI Capable Cardiac Catheterization Laboratory Centers as provided under section 709.14 (b)(9) of this Part and must meet standards at Sections 405.29(c), 405.29(e)(1) and 405.29(e)(2) of this Title.

(ii) PCI Capable Cardiac Catheterization Laboratory Centers at hospitals with no cardiac surgery on site. Factors for determining public need for PCI Capable Cardiac Catheterization Laboratory Centers at hospitals with no cardiac surgery on-site include, but are not limited to:

(a) The planning area for determining the public need for PCI Capable Cardiac Catheterization Laboratory Centers at hospitals with no cardiac surgery on-site shall be the area within a 1 hour average surface travel time, as determined by the department of transportation and adjusted for typical weather conditions, of the applicant facility, unless otherwise determined by the Commissioner in accordance with section 709.1(c) of this title;

(b) Evidence that existing PCI Capable Cardiac Catheterization Laboratory Centers within the planning area cannot adequately meet the needs of patients in need of emergency percutaneous coronary interventions due to conditions such as capacity, geography, and or EMS limitations;

(c) Documentation by the applicant must demonstrate the hospital’s ability to provide high quality appropriate care that would yield a minimum of 36 emergency PCI procedures per year within the first year of operation and would yield a minimum of 200 total PCI cases per year within two years of start-up.

(1) Documentation of the number of cardiologists on staff at the proposed site who currently perform percutaneous coronary interventions at other hospital sites and a summary of experience (including the most recent 3 years of volume and outcomes) for each.

(2) Documentation in support of volume projections must include, at a minimum: discharge data indicating the number of patients with a diagnosis of acute myocardial infarction (AMI) and/or other diagnoses associated with PCI, the number of doses of thrombolytic therapy ordered for acute MI patients in the applicant hospital’s emergency department (as documented through hospital pharmacy records), and documentation of transfers to existing PCI Capable Cardiac Catheterization Laboratory Centers for PCI.

(3) Additional documentation that may be submitted in support of projected volume and need for a proposed PCI Capable Cardiac Catheterization Laboratory Center include:

(i) The number of acute care beds at the applicant hospital and the range of acute care services provided;

(ii) Documentation by the applicant of barriers that impact care experienced by specific population groups within the planning area and demonstration of cultural competency at the applicant site specific to the proposed populations to be served by the applicant;

(iii) Documentation by the applicant demonstrating outreach to underserved populations that identifies potential new PCI cases within the service area;

(iv) Emergency department discharge data;

(v) Documentation by the applicant of regional demographics and transport patterns within the applicant's Emergency Medical Service (EMS) Region that impact the provision of cardiac care;

(vi) The geographic distribution of PCI Capable Cardiac Catheterization Laboratory Center services and the ability of such existing centers to serve the patients in the applicant's service area;

(vii) Letters from local physicians quantifying the number of PCI referrals from their practice and the portion of those that would have been treated at the applicant facility if PCI had been available;

(viii) Additional information that may be considered in projecting volume for an applicant from an established Article 28 network, or multi-site facility as defined at section 401.1 of this Title, with an approved Cardiac Surgery Center within its system that is seeking to add a PCI Capable Cardiac Catheterization Laboratory Center at a non-cardiac surgery hospital site within the system and for a co- applicant proposing to operate a PCI Capable Cardiac Catheterization Laboratory Center without surgery onsite, under a co-operator agreement, approved by the department, with an existing Cardiac Surgery Center. Such additional volume projection criteria include documentation by the applicant of the number of patients residing in the service area of the proposed site who have received percutaneous coronary interventions at the Cardiac Surgery Center site and who would have been candidates to receive their procedures at the proposed non-surgery site.

(d) Existing referral patterns indicate that approval of an additional service at the applicant facility will not jeopardize the minimum volume required at other existing PCI Capable Cardiac Catheterization Laboratory Centers and one of the following conditions exists:

(1) The proposed PCI Capable Cardiac Catheterization Laboratory Center is located more than one hour average surface travel time, as determined by the department of transportation and adjusted for typical weather and traffic conditions, from the nearest existing PCI Capable Cardiac Catheterization Laboratory Center; or

(2) All existing PCI Capable Cardiac Catheterization Laboratory Centers within one hour average surface travel time of the applicant facility, as determined by the department of transportation and adjusted for typical weather and traffic conditions, perform and are expected to continue to perform at a level of at least 300 PCI procedures per year after the addition of the proposed new program. Evidence for evaluating this expectation shall include, but not be limited to:

(i) Data indicating the number of patients residing in the applicant’s primary service area who are currently receiving percutaneous coronary intervention procedures at existing centers and the location of the centers where patients are receiving that care;

(ii) Volume at existing PCI Capable Cardiac Catheterization Laboratory Centers within one hour of the applicant hospital;

(iii) Analysis provided by the applicant evaluating the portion of its proposed patient case load that would result in a redistribution of cases from existing centers and the portion that would represent new cases from currently under served populations. Such analysis shall include documentation of any outreach programs by the applicant facility that would support projections of new cases.

(e) A written plan submitted by the applicant that demonstrates the hospital’s ability to comply with standards for PCI Capable Cardiac Catheterization Laboratory Centers at sections 405.29(c), 405.29(e)(1) and 405.29(e)(2) of this Title;

(f) A written plan submitted by the applicant that outlines staff training and demonstrates the hospital’s readiness to accommodate the needs of the PCI patients;

(g) A written plan has been submitted by the applicant which would promote access to Cardiac Catheterization Laboratory Center services for all segments of the hospital service area's population. The document shall include:

(1) a description of current and proposed initiatives for improving outcomes for patients with heart disease,

(2) a plan documenting the hospital's ability to maintain a comprehensive program in which high quality interventional procedures are provided as a component of a broad range of cardiovascular care within the hospital and within the community, to include an emphasis on processes of care and a description of how a patient will traverse through the system of care to be offered,

(3) a plan for ensuring continuity of care for patients transferred between facilities,

(4) documentation of outreach to regional EMS councils served by the applicant,

(5) documentation that EMS system capabilities have been taken into consideration in the delivery of cardiac services;

(6) a description of activities that promote planning for cardiac services within the region; and

(7) a description of current and proposed initiatives and strategies for reaching patients not currently served within the area.

(h) Comments and recommendations received from community organizations;

(i) The hospital shall propose and implement a hospital heart disease prevention program as set forth at section 709.14(b)(5)(ii) of this Part;

(j) Where public need is established herein, priority consideration shall be given to applicants that agree to serve the medically indigent and patients regardless of payment and can document a history of the provision of services to populations that experience health disparities.

(k) Where public need is established herein, priority consideration shall be given to applicants that can demonstrate projected volume in excess of 300 PCI cases a year.

(l) Where public need is established herein, priority consideration will be given to the expansion of an existing service as opposed to the initiation of a new service.

(m) A written and signed affiliation agreement with a New York State Cardiac Surgery Center, acceptable to the department, has been submitted in accordance with standards at Section 405.29(c)(8)(i) of this title.

(n) In addition, hospital applicants proposing to jointly operate a PCI Capable Cardiac Catheterization Laboratory Center at a hospital without cardiac surgery on-site under a co-operator agreement with a Cardiac Surgery Center must:

(1) Submit a written and signed operational agreement between the applicant Cardiac Surgery Center and the applicant hospital without cardiac surgery on site that demonstrates there will be an integration of expertise and resources from the Cardiac Surgery Center that would support a high quality program at the proposed site and that is acceptable to the department. The agreement must specify that the department shall be provided 60 day prior written notification of any proposed change, termination or expiration of the agreement, and any changes must be found acceptable to the Department prior to implementation. The agreement shall further provide that the parties agree that termination or expiration of the agreement shall result in closure of the co-operated Cardiac Catheterization Laboratory Center.

(2) Submit documentation that demonstrates high quality cardiac care is provided at the applicant Cardiac Surgery Center site and that expanding the service to the proposed site would serve as a benefit to patients and the community.

(3) Submit written documentation of governing body approval of the co-operator contract.

(2) Cardiac EP Laboratory Programs. Factors for determining public need for Cardiac EP Laboratory Programs shall include but not be limited to the following:

(i) Each applicant for a Cardiac EP Laboratory Program shall be an approved PCI Capable Cardiac Catheterization Laboratory Center or an approved Diagnostic Cardiac Catheterization Service operating in compliance with standards at sections 405.29(c) and 405.29(e). Applicants for EP laboratory programs will also be considered in conjunction with requests for approval of PCI Capable Cardiac Catheterization Laboratory Center services.

(ii) Each applicant shall submit documentation, describing how the hospital will comply with standards at 405.29(e)(5) of this Title.

(iii) Each applicant shall submit documentation of existing referrals for cardiac electrophysiology patients treated by cardiologists on staff at the hospital.

(iv) Applicants for cardiac EP Laboratory Programs at hospitals with no Cardiac Surgery Center on-site must submit a copy of the patient selection criteria for the proposed program in accordance with the standards at section 405.29(e)(5)(iii) of this Title.

(v) Hospitals approved as Cardiac Surgery Centers shall be deemed to have demonstrated public need to perform cardiac electrophysiology.

(3) Pediatric Cardiac Catheterization Laboratory Centers. Public need for a Pediatric Cardiac Catheterization Laboratory Center shall be determined only in conjunction with an application for a Pediatric Cardiac Surgery Center and when need has been demonstrated for Pediatric Cardiac Surgery Centers in accordance with standards at Section 709.14(b) of this Part.

Effective Date: 
Wednesday, November 4, 2009
Doc Status: 
Complete

Section 709.15 REPEALED

Effective Date: 
Wednesday, July 7, 2010

Section 709.16 - Therapeutic radiology or radiation oncology

709.16 Therapeutic radiology or radiation oncology.

(a) This methodology will be utilized to evaluate certificate of need applications involving the acquisition of megavoltage (MEV) devices used in therapeutic radiology. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decision making tools for directing the distribution of MEV devices. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of therapeutic radiology units are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors for determining the public need for MEV devices used in therapeutic radiology shall include, but not be limited to, the following:

(1) No equipment other than four or more MEV or cobalt teletherapy units with a source axis distance of 80 or more centimeters and rotational capabilities will be considered appropriate as the primary unit in a multi-unit radiotherapy service or as the sole unit in a smaller radiotherapeutic unit.

(2) Ninety-five percent of the total population of each health region is within a one-hour mean travel time, adjusted for weather conditions, of a facility providing therapeutic radiology services.

(3) The expected volume of utilization sufficient to support the need for an MEV machine shall be calculated as follows:

(i) Each applicant and MEV machine shall provide a minimum of 5,000 treatments per year and have the capacity to provide 6,500 treatments per year. These volumes may be adjusted for the expected case-mix of a specific facility.

(ii) Sixty percent of the annual incidence of cancer cases in a service area will be candidates for radiation therapy.

(iii) Fifty percent of radiation therapy patients will be treated for cure with an average course of treatment of 35 treatments and fifty percent of patients will be treated for palliation with an average course of treatment of 15 treatments. These estimates may be adjusted based on the case-mix of a specific facility.

Effective Date: 
Wednesday, October 5, 2005
Doc Status: 
Complete

Section 709.17 - Long-term ventilator beds

709.17 Long-term ventilator beds.

(a) This methodology will be utilized to evaluate certificate of need applications for the certification of long-term ventilator beds, which are operated in residential health care facilities for individuals experiencing respiratory failure who can be treated through mechanical ventilation. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decision making tools for directing the distribution of long-term ventilator beds. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of long-term ventilator beds are available to provide access to care and avoid the unnecessary duplication of resources.

(b) The factors for determining the public need for long-term ventilator beds shall include, but not be limited to, the following:

(1) The planning areas for determining the public need for long-term ventilator beds shall be the designated health systems regions.

(2) The number of long-term ventilator beds in each health systems region required to meet the public need shall be determined by dividing the projected annual patient days for the service by three hundred and sixty-five (365), and dividing the result by 0.95 to allow for a ninety-five percent occupancy rate. The projected long-term ventilator patient days used in this calculation shall be determined as follows:

(i) The annual number of potential candidates for long-term ventilator beds shall be determined by calculating the total number of annual general hospital discharges in the planning area for DRG 475 (respiratory system diagnosis with ventilator support), plus an additional ten percent, and multiplying the resulting figure by 0.32.

(ii) The number of potential candidates for long-term ventilator beds shall be multiplied by a 125-day length-of-stay to project the annual number of patient days for long-term ventilator patients.

(3) The review of certificate of need applications will consider the documented referral patterns in the planning area, the expected length-of-stay based on the case-mix of long-term and short-term patients, the ability of the applicant to successfully wean ventilator patients, and the ability and commitment of the applicant to accept the difficult-to-place ventilator patients (e.g. ventilator patients with hemodialysis needs or patients with bacterial infections).

(4) The long-term ventilator bed need methodology will be reviewed within three years from the effective date of this section.

(c) (1) The bed need estimates developed pursuant to subdivision (b) of this section shall constitute the public need for ventilator beds in the planning area subject to further adjustments in accordance with subdivision (d) of this section.

(2) Notwithstanding that there is an indication of need in a planning area for additional long-term ventilator beds as determined in accordance with subdivision (b) of this section, there shall be a rebuttable presumption that there is no need for any additional long-term ventilator beds in such planning area if the overall occupancy rate for existing long-term ventilator beds in such planning area is less than 95 percent based on the most recently available data. It shall be the responsibility of an applicant in such instances to demonstrate that there is a need for additional long-term ventilator beds despite the less than 95 percent occupancy rate in the planning area utilizing the factors set forth in subdivision (d) of this section.

(3) The Department shall evaluate the appropriateness of the 95 percent occupancy threshold criterion in this section, based on the most recent data available, within three years of the effective date of this section.

(d) Notwithstanding any other provision of this section, when the estimates of need for long-term ventilator beds developed in accordance with subdivision (b) of this section indicate the need for additional beds, such estimates of additional need may be modified, based on information and data gathered from relevant sources relating to significant local factors pertaining to the planning area, or on statewide factors, where relevant, which factors may include, but not necessarily be limited to, those set forth in paragraphs (1) through (3) of this subdivision. When making recommendations to the State Hospital Review and Planning Council and the Public Health Council concerning the impact of the factors set forth in this subdivision, the department shall, to the extent practicable, indicate the relative priority of such factors.

(1) the impact of requirements pertaining to placing persons with disabilities into the most integrated setting appropriate so as to enable persons with disabilities to interact with non-disabled persons to the fullest extent possible;

(2) recommendations made by the local health systems agency, if applicable;

(3) documented evidence of the unduplicated number of patients on waiting lists who are appropriate for admission to long-term ventilator care who experience a long stay in acute care facilities awaiting discharge to a residential health care facility for long-term ventilator care.

Effective Date: 
Wednesday, October 5, 2005
Doc Status: 
Complete

Appendix 709 - Diagnosis Related Groups

APPENDIX D-1 is available for inspection and/or copying at the NYS Department of Health, Bureau of Health Facility Planning, Hedley Building, 6th Floor, Troy, NY (518) 402-0966.

Doc Status: 
Complete

Appendix 709 - National Length of Stay by DRG and Payment Source, Average and 75th Percentile, 1991-1992

APPENDIX D-2 is available for inspection and/or copying at the NYS Department of Health, Bureau of Health Facility Planning, Hedley Building, 6th Floor, Troy, NY (518) 402-0966.

Doc Status: 
Complete

Article 2 - Medical Facility Construction

Effective Date: 
Wednesday, September 6, 2017
Doc Status: 
Complete

Part 710 - Approval of Medical Facility Construction

Effective Date: 
Wednesday, September 6, 2017
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Secs. 2803, 2901, 2904

Section 710.1 - General provisions

Section 710.1 General provisions. (a) Medical facilities shall be planned to achieve efficiency and economy of operation and care of high quality.

(b)(1) For purposes of this Part, total project cost(s) means total costs for construction, including but not limited to costs for demolition work, site preparation, design and construction contingencies, total costs for real property, for fixed and movable equipment, architectural and/or engineering fees, construction manager and/or consultant fees, construction loan interest costs, and other financing, professional and ancillary fees, charges and allowances. Such costs shall include the cost of all capital items associated with an acquisition, lease arrangement and/or construction. If any acquisition is to be financed through a leasing arrangement, the relevant cost shall be the cost of the asset, not the lease amount.

(2) For purposes of this Part, total basic cost(s) of construction means total project cost(s) less capitalized amounts of construction loan interest cost(s), and other financing fees and charges.

(3) For purposes of this Part, “general hospital” means a general hospital as defined in subdivision 10 of section 2801 of the public health law.

(4) Reserved

(5) For purposes of this Part, Cardiac Catheterization Laboratory Center, PCI Capable Cardiac Catheterization Laboratory Center, Diagnostic Cardiac Catheterization Service, and Cardiac Electrophysiology (EP) Laboratory Program shall have the same meanings as in section 405.29(a)(4) of this Title.

(c) The erection, building, acquisition, alteration, reconstruction, improvement, extension or modification of a medical facility, including its equipment and services shall be governed by the following:

(1) Proposals requiring a certificate of need application. Any proposal which involves any of the following shall be the subject of an application submitted for review pursuant to the requirements of this Part and Article 28 of the Public Health Law:

(i) the addition, modification or decertification of a licensed service, other than the addition of a service or a decertification of a facility's services as provided for in paragraph (5) of this subdivision, or the addition or deletion of approval to operate part-time clinics, regardless of costs. The addition or deletion of part-time clinic services operated by the State Department of Health (other than as an extension of an Article 28 hospital operated by the State Department of Health) or by the health department of a city or county as such terms are defined in section 614 of the Public Health Law shall not be subject to approval pursuant to this Part;

(ii) a change in the method of delivery of a licensed service, regardless of cost;

(iii) the initial acquisition or addition of any equipment, regardless of cost, utilized in the provision of a service listed in paragraph (2) of this subdivision, other than the acquisition or addition of equipment subject to paragraph (6) of this subdivision. A proposal for the replacement of existing equipment, regardless of cost, which meets the criteria contained therein, shall not require an application but shall be processed pursuant to paragraph (4) of this subdivision;

(iv) Reserved

(v) a conversion of beds, except as provided in paragraph (5) of this subdivision or a change in the certified bed capacity of a facility, regardless of cost, other than a decertification of a facility's beds as provided for in paragraph (5) of this subdivision; or

(vi) any other construction, addition or replacement proposal involving a total project cost in excess of $15,000,000 for a general hospital or $6,000,000 for all other facilities, except non-clinical and health information technology projects subject to paragraph 4 of this subdivision.

(2) Proposals requiring a full review, including a recommendation of the State Hospital Review and Planning Council.

(i) Any proposal involving any of the activities set forth in paragraph (1) of this subdivision that falls within any of the following categories shall require a full review pursuant to the requirements of this Part and Article 28 of the Public Health Law:

(a) the addition of beds, other than beds designated for patients with acquired immune deficiency syndrome (AIDS) which are eligible for administrative review under paragraph (3) of this subdivision, or the conversion of beds which establish a different level of care, regardless of cost;

(b) any proposal for the addition, modification or change in the method of delivery of the following services, including the initial acquisition of any equipment relating thereto, regardless of cost;

(1) therapeutic radiology other than the replacement of a cobalt unit with a linear accelerator by a facility which has been deemed appropriate to provide therapeutic radiology or radiation oncology pursuant to Section 708.5 of this Title which may be eligible for administrative review under paragraph (3) of this subdivision;

(2) adult or pediatric cardiac surgery;

(3) cardiac catheterization, including the relocation of any Cardiac Catheterization Laboratory Center service within a network or to another site in a multi-site facility, as defined in Section 401.1 of this Title, and the addition of a PCI Capable Cardiac Catheterization Laboratory Center at a facility that is not already approved to provide cardiac catheterization services; provided however that the addition of a PCI Capable Cardiac Catheterization Laboratory Center or Cardiac EP Laboratory Program at a facility approved to provide cardiac catheterization services shall be reviewed pursuant to paragraph (3) of this subdivision, and the addition of a Cardiac EP Laboratory Program services at a facility approved to provide cardiac surgery shall be reviewed pursuant to paragraph (6) of this subdivision;

(4) kidney, heart, liver and bone marrow transplantation;

(5) burns care;

(6) acquired immune deficiency syndrome (AIDS) centers except as provided in paragraph (3) of this subdivision; and

(7) epilepsy service.

(c) any proposal involving total project cost in excess of $30,000,000 for a general hospital or $15,000,000 for all other facilities, except as otherwise provided under paragraph (3) of this subdivision;

(d) any other proposal not eligible for administrative review under this section;

(e) any proposal which would otherwise be eligible for administrative review but which exceeds a facility's administrative review limitation; or

(f) any proposal which would otherwise be eligible for administrative review but which is recommended for disapproval.

(ii) The addition of equipment utilized in the provision of a service set forth in subparagraph (i) of this paragraph by a medical facility already approved to provide such service shall be reviewed as follows:

(a) The addition of equipment utilized in the provision of Cardiac Catheterization Laboratory Center services shall be eligible for limited review pursuant to paragraph (6) of this subdivision, to the extent that it does not otherwise require an administrative or a full review under this Part;

(b) The addition of equipment utilized in the provision of all other services set forth in subparagraph (i) shall be eligible for administrative review pursuant to paragraph (3) of this subdivision, to the extent that it does not otherwise require a full review under this Part;

(iii) For any application subject to full review for which the total basic cost of construction does not exceed $15,000,000, the commissioner may, in lieu of requiring some or all of the architectural information and documentation required by this Part, accept a written certification by an architect or engineer licensed by the State of New York that such project complies with Part 711 of this Title. The certification shall be attached to and made a part of the application. The costs of any subsequent corrections necessary to achieve compliance with the requirements of Part 711 of this Title, when the prior work was not completed properly and was not accurately certified, shall not be considered allowable costs for reimbursement under Part 86 of this Title. This subparagraph does not waive any of the requirements of section 5-1.22 of this Title.

(3) Proposals eligible for administrative review.

(i) The commissioner may administratively approve applications submitted pursuant to Article 28 of the Public Health Law and this Part without the recommendation of the Public Health and Health Planning Council when an application has not been recommended for disapproval by the health systems agency having jurisdiction, and where the total project cost does not exceed $30,000,000 for a general hospital or $15,000,000 for all other facilities. An application shall be eligible for administrative review even though total project costs exceed $30,000,000 for a general hospital or $15,000,000 for all other facilities, if: (a) total project costs do not exceed 10% of the total operating costs of the facility for the fiscal year ended two years prior to the submission of the application; and (b) total project costs do not exceed $100,000,000; for a general hospital or $25,000,000 for all other facilities. Notwithstanding anything in this Part to the contrary, any cost increase of a project in excess of $30,000,000 for general hospitals or $15,000,000 for all other facilities that is administratively reviewed under the subparagraph, resulting in total project costs in excess of the $100,000,000 for general hospitals or $25,000,000 for all other facilities, or in excess of 10% of the total operating costs of the facility for the fiscal year ended two years prior to the submission of the application, shall subject the application to full review. The following types of proposals are eligible for administrative review:

(a) the addition of a licensed service or the modification or change in the method of delivery of a licensed service, other than those set forth in paragraph (2) of this subdivision which require full review;

(b) the conversion of a Diagnostic Cardiac Catheterization Service as described in section 405.29(a)(4)(ii) of this Title into a PCI Capable Cardiac Catheterization Laboratory Center as described in section 405.29(a)(4)(i) of this Title; and the addition of Cardiac EP Laboratory Program services at a facility approved to provide Cardiac Catheterization Laboratory Center services that is not also approved to provide cardiac surgery services;

(c) the conversion of beds other than a conversion which would establish a different level of care which proposal would require a full review, including the approval of the Public Health Council, and except as provided for in paragraph (5) of this subdivision;

(d) additions to existing services not involving an additional site or beds;

(e) the correction of patient safety deficiencies, ordinary repairs and maintenance, energy conservation measures, or modernization in a medical facility or portion of a medical facility. Projects for the modernization (which may include new construction and/or renovation) of a medical facility or portion of a medical facility will be eligible for administrative review only if it will not substantively change the capacity or type of the service(s) involved and does not involve issues of public need.

(f) the addition, updating or modification of equipment utilized in the provision of a service listed in paragraph (2) of this subdivision, by a medical facility already approved to provide such service, except for the addition of equipment utilized in cardiac catheterization laboratory center services by a facility already approved to provide such service, which shall be subject to limited review pursuant to paragraph (6) of this subdivision;

(g) the addition or deletion of approval to operate part-time clinic services;

(h) the operation or relocation of an extension clinic as defined in section 401.1 of this Title, when such relocation is to a site outside the current service area of the extension clinic, as defined in paragraph (5) of this subdivision, and does not entail an increase in scope of services or clinical capacity;

(i) the expansion or the modernization of an emergency room;

(j) reserved;

(k) a change in bed capacity of an acquired immune deficiency syndrome (AIDS) center which does not result in a net increase in the certified bed capacity of the facility;

(l) the acquisition of magnetic resonance imagers (MRIs), provided that acquisitions of MRIs by a general hospital as defined in section 2801 of the Public Health Law may be reviewed under paragraph (5) of this subdivision;

(m) the addition of adult day health care services provided either in a residential health care facility or offsite by a residential health care facility that has been approved to provide the services onsite or the expansion of an existing adult day health care service; or

(n) the addition of skilled nursing facility beds specifically designated for persons suffering with acquired immune deficiency syndrome (AIDS) by a residential health care facility without any limitation of total project cost as set forth above.

(o) the addition of a methadone maintenance treatment program at either the main site or an extension clinic;

(p) the acquisition of CT scanners, provided that acquisitions of CT scanners by a general hospital as defined in Article 28 of the Public Health Law may be reviewed under paragraph (5) of this subdivision;

(q) Reserved;

(r) the replacement of a cobalt unit with a linear accelerator by a facility which has been deemed appropriate to provide therapeutic radiology and radiation oncology pursuant to Section 708.5(a) of this Title;

(s) the temporary addition of beds to a facility's certified capacity, for a period of time not to exceed one year, required to address high priority health care needs for which there is a demonstrated acute shortage;

(t) the addition of ventilator dependent service;

(u) swing bed demonstration program;

(v) the addition of chronic renal dialysis stations by a facility approved and operating dialysis stations. A facility approved to provide only chronic renal dialysis shall be deemed approved to provide:

(1) all modalities of chronic renal dialysis; and

(2) chronic renal dialysis services to patients at home, provided that a facility shall give the appropriate area office of the department at least 15 days' written notice prior to commencing or terminating the facility's program for the provision of chronic renal dialysis services to patients at home; and

(w) the addition of primary care sites meeting the following criteria:

(1) primary care services are comprehensive in nature and are developed consistent with section 85.44 of this Title; and

(2) total project costs do not exceed $15,000,000; and

(3) the proposed location is designated by the department and the health systems agency having jurisdictgion as a low access to primary care area and access to primary care by residents will be enhanced. The local health systems agency, however, may provide the department with other relevant information addressing the unmet need for additional primary are capacity; and

(4) the number of projected new visits represents residents who are not currently receiving primary health care services from an existing designated preferred primary care provider (PPCP); and

(5) the proposed addition would not substantially adversely impact existing PPCPs relative to duplication of services and proximity of the proposed site; and

(6) existing PPCPs have achieved optimal utilization based on their physical plant and ability to retain an appropriate supply of practitioners; and

(7) neither the facility nor any part thereof, nor the project is currently or is proposed to be financed by bonds or other debt instruments insured, enhanced or guaranteed by any state or municipal agency or public benefit corporation. Notwithstanding anything in this Part to the contrary, any cost increase of a primary care services project resulting in total project costs in excess of the $30,000,000 threshold for general hospitals or the $15,000,000 threshold for all other facilities shall subject the application or amendment, as the case may be, to full review.

(ii)(a) Each medical facility shall be limited in the total amount of, or extent to which, applications may be approved administratively, and such limit shall be based on the anticipated annual operating costs, including capital costs, generated by the activities which are the subject of the applications. Except with respect to an application under clause (a),(c),(h) or (j) of subparagraph (i) of this paragraph, or clause (b) of this subparagraph, a medical facility's application shall not be eligible for administrative review if, for any calendar year, the total anticipated annual increase in total operating costs, including capital costs, generated by the facility's applications that have already been approved administratively in the current calendar year exceeds or, including the subject application under review, would exceed an amount equal to one percent of the total allowable operating and capital costs of the base year used trended to determine the facility's Medicaid reimbursement rate pursuant to Part 86 of this Title for the year in which the application is expected to be acted on. For facilities which do not participate in the Medicaid program, the limitation imposed herein shall be an amount equal to one half of one percent of the facility's total annual operating and capital costs, incurred during the fiscal year utilized by Part 86 for participating facilities. Any unused portion of a facility's administrative review cap for any calendar year shall be carried forward to the following calendar year to be applied to any application(s) eligible for administrative review which has not been acted on, which is deemed complete and which was submitted on or before October 1st of the preceding year.

(b) Notwithstanding the administrative review limitation imposed by clause (a) of this subparagraph, the commissioner may, pursuant to the requirements and limitation of this clause, administratively approve an application for the correction of nonwaiverable requirements of construction under this Title or the replacement of existing equipment which has not exhausted at least 90 percent of the higher of its useful life pursuant to Part 86 of this Title or its estimated useful life according to the tables of estimated useful lives in the American Hospital Association's Estimated Useful Lives of Depreciable Hospital Assets 2008 edition, as incorporated by reference below, the total project cost of which does not exceed $15,000,000, when such correction or replacement proposal is essential for the continued operation of the facility in compliance with the requirements of this Title or the provision of necessary medical care and services. Equipment replacement proposals involving equipment which no longer meets the generally accepted operational standards for such equipment or has exhausted at least 90 percent of the higher of its useful life reported pursuant to Part 86 of this Title or its estimated useful life according to the tables of estimated useful lives in the American Hospital Association's Estimated Useful Lives of Depreciable Hospital Assets, 2008 edition, may be processed under paragraph (4) of this subdivision. Copies of the foregoing publication are available from the American Hospital Association, One North Franklin, Chicago, Illinois 60606-3421, www.aha.org, and a copy is available for inspection and copying at the Regulatory Affairs Unit of the Department of Health, Empire State Plaza, Corning Tower, Albany, NY 12237. The anticipated annual increase in total operating costs, including capital costs, generated by an application eligible for administrative review under this clause, shall be charged against any unused portion of the applicant's administrative review limitation imposed by clause (a) of this subparagraph; however, an application eligible for administrative review under this clause may be processed administratively despite the fact that the administrative review limitation has been exhausted or may be exceeded as a result of approving the subject application.

(iii) Where an application is being processed administratively and consistency with applicable statutes, codes, rules and regulations relating to the structural, architectural, engineering, environmental, safety and sanitary requirements of a licensed medical facility is required:

(a) the applicant shall submit to the Bureau of Architectural and Engineering Review such information and documentation as is required under this Part to determine the acceptability of the proposal; or

(b) the commissioner may, as an alternative to the above, accept a written certification by an architect or engineer licensed by the State of New York that such project complies with Part 711 of this Title. The certification will be made available for review at the next onsite survey conducted by the department in accordance with Article 28 of the Public Health Law. The costs of any subsequent corrections necessary to achieve compliance with the requirements of Part 711 of this Title when the prior work was not completed properly and was not accurately certified shall not be considered allowable costs for reimbursement under Part 86 of this Title. This clause does not waive any of the requirements of section 5-1.22 of this Title.

(4) Proposals not requiring an application.

(i) The following types of construction projects shall not require prior approval under this Part, regardless of cost, provided that a written notice has been submitted to the Department prior to commencement of construction, together with, where indicated in this paragraph, a written certification by a New York State licensed architect or engineer that the project meets all applicable statutes, codes and regulations; and provided that the hospital shall implement a plan to protect patient safety during construction projects that implicate patient safety, consistent with section 711.2 of this part and other applicable standards, and as otherwise required by the department:
(a) Any proposal for the correction of cited deficiencies, consistent with a plan of correction approved by the department; provided that the construction is limited to the correction of the deficiencies.

(b) Any proposal for the repair or maintenance of a medical facility, including routine purchases and the acquisition of minor equipment undertaken in the course of a medical facility's inventory control functions, provided that for proposals under this clause with a total cost of up to six million dollars, including separate proposals which are programmatically related, no written notice shall be required. This subparagraph shall not apply to activities requiring a limited review under Article 28 of the Public Health Law pursuant to paragraph (5) of this subdivision.

(c) Any proposal to discontinue a part-time clinic site of a medical facility already authorized to operate part-time clinics pursuant to this Part shall not require the submission of an application pursuant to this Part, but compliance is required with the applicable notice provisions of section 703.6 of this Title.

(d) Any proposal for the replacement of existing equipment, regardless of cost, with another piece of equipment used for similar purposes but employing substantially equivalent current technology which, if subject to approval by the U.S. Food and Drug Administration, has received such approval. The facility's written notice to the department shall include a written certification by a New York State licensed architect or engineer that the project meets the applicable statutes, codes and regulations; and a plan to protect patient safety during replacement projects that implicate patient safety, consistent with section 711.2 of this part and other applicable standards, and as otherwise required by the department. Upon completion of the project, the facility shall, where applicable, submit written certification by a New York State licensed architect, engineer and/or physicist that the replacement equipment as installed meets applicable statutes, codes and regulations; and such other close-out documents as may be required by the department.

(e) Subject to clause (d) of subparagraph (ii) of paragraph 5 of this subdivision, any proposal for a nonclinical infrastructure project with total project costs in excess of $6,000,000, including but not limited to replacement of heating, ventilating and air conditioning, fire alarm and call bell systems or components thereof, roofs, elevators, parking lots and garages, dietary, and solid waste and/or sewage disposal and upgrades of the exterior building envelope. The facility’s written notice to the department shall include a written certification by a New York State licensed architect or engineer that the project meets the applicable statutes, codes and regulations; and shall include a plan to protect patient safety during construction consistent with section 711.2 of this part and other applicable standards, and as otherwise required by the department. Upon completion of the project, the facility shall, where applicable, submit written certification by a New York State licensed architect, engineer and/or physicist that the project as constructed or installed meets applicable statutes, codes and regulations; and such other close-out documents as may be specified by the department.

(f) Notwithstanding anything in this section to the contrary, from time to time the commissioner may, at the commissioner's discretion, approve capital expenditures that may be required in response to new state, municipal, or federal code requirements. Such approval may only be considered when such code changes affect large numbers of hospitals (as such term is defined in Article 28 of the Public Health Law) and where the commissioner finds that the capital expenditure is unlikely to create any risk to patient safety. Upon such determination, the commissioner shall notify affected hospitals of the opportunity to proceed with such capital expenditures based on a letter of notice to the department. The commissioner may impose a cap on anticipated individual project capital expenditures for such a waiver.

(g) Any proposal that relates to health information technology regardless of cost.  For health information technology proposals involving the implementation of clinical information systems, electronic medical records, computerized physician order entry, radiology systems, lab ordering systems or other health information systems impacting patient care, the facility’s written notice to the department shall include a certification of the technology's interoperability with other systems and conformance with state and federal guidelines and regulations governing the use and exchange of information, including privacy and security, that is acceptable to the department.

(ii)  Proposals for a nonclinical infrastructure project, including but not limited to replacement of heating, ventilating and air conditioning, fire alarm and call bell systems or components thereof, roofs, elevators, parking lots and garages, dietary, and solid waste and/or sewage disposal and upgrades of the exterior building envelope, where total project costs do not exceed $6,000,000, shall not require prior approval or written notice to the department under this Part, except as required by clause (d) of subparagraph (ii) of paragraph (5) of this subdivision.

(5) Proposals requiring a limited review. Proposals where total project cost does not exceed $15,000,000 for a general hospital or $6,000,000 for all other facilities, and for which a certificate of need is not otherwise required under this Part, shall be reviewed under this paragraph, except for proposals covered by paragraph (4) of this subdivision.

(i)(a) Applicants shall submit all such requests for approval of proposals described in this paragraph through the electronic application submission process at the address posted on the Department's website, including such information and documentation as the Department requires to determine whether the proposal is acceptable.

(b) If the proposal involves the addition or decertification of a service or the conversion or decertification of beds subject to review under subparagraph (iv) of this paragraph, a copy shall also be sent to the health systems agency (HSA) having jurisdiction, if any. The HSA will have 10 days to respond to the department.

(c) If the Department determines that the proposal complies with all pertinent statutory and regulatory requirements, the Department shall notify the applicant, in writing, that the proposal is acceptable and, if applicable, an amended operating certificate will be issued.

(d) If the Department determines that the proposal is not acceptable, the applicant shall be notified in writing of such determination and the bases thereof. If the applicant disagrees with the commissioner's determination, the applicant may submit a certificate of need application to be processed for full review in accordance with this Part.

(e) Applicants that submit proposals subject to review under clause (e) of subparagraph (ii) of this paragraph, or under subparagraph (iv) of this paragraph that do not require an architecture and engineering certification, shall be notified of the Department’s determination within 30 days of submission of all necessary information.

(ii) A review shall be conducted of the proposal’s compliance with applicable statutes, codes, rules and regulations relating to the structural, architectural, engineering, environmental, safety and sanitary requirement of licensed medical facilities, where the proposal relates to the acquisition, relocation, installation or modification of:

(a) medical equipment involving ionizing radiation or magnetic resonance, including magnetic resonance imagers (MRIs) and CT scanners by a general hospital as defined in Article 28 of the Public Health Law;

(b) facility areas relating to clinical services or surgical or other invasive procedures, not otherwise requiring approval under this section;

(c) inpatient units, including resident rooms in a residential health care facility and other spaces used by residents of residential health care facilities on a daily basis, relating to other than routine maintenance and repairs or routine purchase of equipment;

(d) heating, ventilating, air conditioning, plumbing, electrical, water supply, and fire protection systems that involve modification or alteration of clinical space, services or equipment such as operating rooms, treatment and procedure rooms, and intensive care, cardiac care and other special care units (such as airborne infection isolation rooms and protective environment rooms), laboratories and special procedure rooms, and patient or resident rooms or other spaces used by residents of residential health care facilities on a daily basis. Projects involving routine maintenance or repairs or routine purchases affecting such systems shall not be subject to this subparagraph.

(e) the relocation of an extension clinic within the same service area, defined as (1) one or more postal zip code areas in each of which twenty-five (25) percent or more of the extension clinic's patients reside, or (2) the area within one mile of the current location of such extension clinic, which does not entail an increase in services or clinical capacity; and

(f) Notwithstanding anything in this Title to the contrary, the reallocation, relocation or redistribution of linear accelerators as replacements for cobalt units and related services from one hospital to another hospital within the same established Article 28 network.

(iii) The commissioner may, as an alternative to the submission of architectural and engineering documentation referenced above, accept a written certification by an architect or engineer licensed by the State of New York that such project complies with Part 711 of this Title. The certification will be made available for review at the next onsite survey conducted by the department in accordance with article 28 of the Public Health Law. The costs of any subsequent corrections necessary to achieve compliance with the requirements of Part 711 of this Title, when the prior work was not completed properly and was not accurately certified, shall not be considered allowable costs for reimbursement under Part 86 of this Title. This subparagraph does not waive any of the requirements of section 5-1.22 of this Title.

(iv) The following proposals shall also be subject to limited review under this paragraph for programmatic and/or public need purposes:

(a) Any proposal to decertify a facility's beds, for which a certificate of need application is not otherwise required under this Part. The applicant shall submit information indicating the number of beds to be decertified, where the beds to be decertified are physically located in the facility and what, if any, alternate use will be made of the space. Such proposed alternate use may require review pursuant to subparagraph (ii) of this paragraph.

(b) Any proposal solely to decertify services, other than those set forth in clause (2)(i)(b) of this subdivision. The applicant shall submit information indicating the services to be decertified, where the services to be decertified are physically provided in the facility and what, if any, alternate use will be made of the space. Such alternate use may require review pursuant to subparagraph (ii) of this paragraph.

(c) Any proposal to add services, other than those set forth in paragraphs (2)(i)(b) and (3)(i) of this subdivision, for which a certificate of need application is not otherwise required under this Part. The applicant shall submit information indicating the services to be certified, the additional staffing requirement, if any, where the services to be certified are physically provided in the facility and what, if any, construction will be required in the facility. If construction is required, the request may require review pursuant to subparagraph (ii) of this paragraph.

(d) Any proposal to convert beds from one category to another in the categories listed in this clause and for which the acute care inpatient facility is already a certified provider. The applicant shall submit information indicating the number of beds to be converted and the categories from which and to which the beds will be converted.

This clause applies to beds in the following categories:

(1) medical/surgical;

(2) intensive care;

(3) coronary care;

(4) pediatric;

(5) pediatric intensive care;

(6) neonatal intensive care;

(7) neonatal intermediate care;

(8) neonatal continuing care;

(9) maternity; and

(10) chemical dependence - detoxification.

(e) Any proposal to operate, change services offered, change hours of operation, or relocate a part-time clinic site. Requests for approval shall be consistent with the provisions of section 703.6(b) of this Title. Notwithstanding any inconsistent provision of this section, if the proposal is acceptable to the department, the applicant shall be notified in writing within 45 days of acknowledgement of receipt of the request. If the proposal is not acceptable, the applicant shall be notified in writing within 45 days of such determination and the bases thereof. If the applicant disagrees with the commissioner's determination, the applicant may submit a certificate of need application to be processed for full review in accordance with this Part. If a proposal requests approval for an arrangement or services that are not permissible for a part-time clinic, the proposal will not be accepted for processing under this section.

(f) Notwithstanding anything in this Title to the contrary, any proposal for the reallocation, relocation or redistribution of acute care beds from one general hospital to another general hospital within the same established Article 28 network shall be subject to a limited review under this section. The applicant shall submit information indicating the current and proposed certified bed capacity for each service and facility for which the reallocation, relocation or redistribution of beds is proposed.

(g) Reserved.

(6) Cardiac Catheterization Proposals Requiring a Limited Review.

(i) The following proposals related to the expansion or modification of Cardiac Catheterization Laboratory Center services and equipment shall be subject to review pursuant to this paragraph, provided that they do not involve a total project cost in excess of the amount set forth in paragraph (5) of this subdivision or otherwise require a certificate of need under this Part:

(a) Any proposal to add or modify cardiac catheterization laboratories, facility areas or equipment to be utilized in the provision of approved Cardiac Catheterization Laboratory Center services by a facility already approved to provide PCI Capable Cardiac Catheterization Laboratory Center services;

(b) Any proposal to add or modify equipment in approved space by a facility already approved to provide Diagnostic Cardiac Catheterization Services; and

(c) Any proposal to add Cardiac EP Laboratory Program services at a facility that is already approved to provide cardiac surgery services.

(ii) (a) Reviews under this paragraph shall include, but not be limited to, the proposal's compliance with applicable statutes, codes and rules and regulations relating to the structural, architectural, engineering, environmental, safety and sanitary requirements of licensed medical facilities and with Part 405.29 of this Title.

(b) Requests for approval of proposals described in this subparagraph shall be made through the electronic application submission process at the address posted on the department's website or any other means approved by the department, including information indicating the services to be provided, the facility areas to be utilized, and such other information as the Department may require. If construction is required, the request should include the cost of such construction and other information required by the Bureau of Architectural and Engineering Facility Planning under this Part. If the proposal involves the addition of Cardiac EP Laboratory Program Services, the applicant shall also submit a copy to the local health systems agency (HSA) having jurisdiction, if any. The HSA shall have 10 days to make a recommendation to the department.

(c) If the proposal is acceptable to the department, the applicant will be notified in writing and, if appropriate, an amended operating certificate will be issued. If the proposal is not acceptable, the applicant shall be notified in writing of such determination and the basis thereof. If the applicant has not submitted an acceptable proposal within 30 days of such determination, then the proposal shall be deemed an application subject to full or administrative review pursuant to section 2802 of the Public Health Law.

(7) Medical facilities which will undertake during their fiscal year a number of construction and/or acquisition projects related programmatically, the aggregate total project cost of which during said period will exceed $6,000,000, shall submit for review a single application encompassing all such projects pursuant to the requirements of this part and Article 28 of the Public Health Law. If a subsequent audit reveals that during any such period a medical facility has undertaken several projects or submitted several proposals or applications, related programmatically, the total aggregate project cost of which exceeds $6,000,000, the facility's reimbursement rate may not reflect, or may be reduced to the extent it includes, the cost of the related projects. For the purposes of this paragraph, no such audit shall consider costs incurred in proposals or applications acknowledged or received prior to the effective date of this subdivision.

(8) Medical facilities shall maintain a record of all additions to property, plant and equipment made during the appropriate 12-month period reflected in their capital budget. Each addition, which is subject to paragraph (1) of this subdivision, must be supported by an application approved pursuant to Article 28 of the Public Health Law and this Part. Each medical facility shall, as a matter of routine, submit with the annual certified cost reimbursement reporting forms required by the Office of Health Systems Management, beginning with the effective date of this section, identification of its annual capital expenditures, as provided for in the section entitled "Changes in financial positions," indicating separately the total amounts thereof involving projects in the following categories: below $6,000,000 and over $6,000,000, which have received appropriate approvals pursuant to this Part, and the nature of each approval. The facilities shall also provide to the department annually, on forms provided by the department, a list of projects between $1,000,000 and $6,000,000, which have been undertaken by the facility, although such projects do not require certificate of need approval.

(d) All drawings and specifications shall bear the seal and signature of an architect or engineer licensed to practice in New York State. The commissioner, at his discretion, may waive the above requirement when the construction is less than $10,000 in value, unless otherwise provided for in this Part.

(e) All construction in or of a medical facility shall have competent and adequate architectural and/or engineering inspection at the construction site to ensure that the completed work conforms to the approved plans and specifications.

(f) As a part of the application required for approval of the project, the applicant shall give the following assurances:

(1) that the applicant has or will have a fee simple or such other estate or interest in the site, including necessary easements and rights-of-way sufficient to assure use and possession for the purpose of the construction and operation of the facility;

(2) that the applicant will obtain the approval of the commissioner of all required submissions, which shall conform to the standards of construction and equipment of this Subchapter;

(3) that the applicant will submit to the commissioner final working drawings and specifications, which shall conform to the standards of construction and equipmentof this Subchapter, prior to contracting for construction, unless otherwise provided for in section 710.7 of this Part;

(4) that the applicant will cause the project to be completed in accordance with the application and approved plans and specifications;

(5) that the applicant will provide and maintain competent and adequate architectural and/or engineering inspection at the construction site to insure that the completed work conforms with the approved plans and specifications;

(6) that if the project is an addition to a facility already in existence, upon completion of construction all patients shall be removed from areas of the facility which are not in compliance with sections 711.4 through 711.8 of this Title, or other pertinent provisions of this Subchapter, unless a waiver is granted to specific provisions by the commissioner, under section 711.9 of this Title;

(7) that the facility will be operated and maintained in accordance with the standards prescribed by law; and

(8) that the applicant will comply with the provisions of the Public Health Law and the applicable provisions of this Title with respect to the operation of all established, existing medical facilities in which the applicant has a controlling interest.

(g) The applicant shall be required to adequately equip the facility to assure its proper operation.

Effective Date: 
Wednesday, September 6, 2017
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2803(2)(a)

Section 710.2 - Application; project scope and concept

710.2 Application; project scope and concept.

(a)(1) The applicant shall transmit to the project management unit, at the department's central office in Albany, nine copies of the application in a format determined by the commissioner setting forth the scope and concept of the project. A copy of the application shall be transmitted by the department to the health systems agency having geographic jurisdiction over the area in which the applicant's facility is located:

(i) Except as provided for under subparagraph (ii) of this paragraph with respect to facility leases, any expenditure to effect construction and/or commencement of construction, other than those costs directly attributable to the preparation of the application, prior to the issuance of approval of the application pursuant to this Part shall not be considered an allowable cost for reimbursement pursuant to any of the provisions of Part 86 of this Title, even if the application eventually is approved.

(ii) Notwithstanding the provisions of subparagraph (i) of this paragraph, if an applicant, prior to obtaining approval for the application, entered into an arms-length lease with an unrelated party for space in an existing facility or building, which space is the subject of the application and which has an asset value that does not exceed $4,000,000, the capital costs associated with the leased space which are approved under the application and which costs are attributable in accordance with generally accepted accounting principles to the time period subsequent to the approval of the application, shall be eligible for reimbursement in accordance with the applicable provisions of Part 86 of this Title. Any capital costs associated with such leased space which are attributable to the time period prior to the approval of the application shall not be reimbursable pursuant to any of the provisions of Part 86 of this Title.

(2) Those applicants that have indicated in their service and capital needs inventory problems whose projected solutions exceed $15 million in total basic cost of construction should, before filing a certificate of need application, have received a site visit report prepared by the Department of Health and have completed the Capital Architectural and Program Alternatives review process. As a result of this alternative review process, a preferred solution will be identified by the department and, if agreed to by the applicant and incorporated into an application, will expedite processing of the application to the commissioner and/or the Public Health Council for action. In the event the applicant has not agreed to the department's designation of the preferred solution, the applicant shall, when filing its application, indicate the preferred solution as well as the solution it is seeking approval for.

(b) The application setting forth the scope and concept of the project shall include the following if applicable:

(1) identifying information setting forth the location, type of the proposed construction, and disclosing any interest in the operation and any interest in the ownership of the property interests of the proposed construction;

(2) a description of the site, including a topographic map, United States Geological Survey, published by the United States Department of Interior Geological Survey, 7-1/2 minute series, unless not published for such site, in which case 15-minute series shall be acceptable;

(3) an outline of the construction proposal, including a description of the program and the bed capacity by type of service to be provided;

(4) an estimate of the total basic cost of construction predicated upon a construction start date that coincides with the filing date of the application and a projection of such total basic cost of construction together with a projection of the total project costs to the completion of the proposed construction schedule;

(5) a proposed time period for construction which shall state a time to commence and complete construction, including a time period for each distinct phase. An acceptable time frame shall be determined by the department after consultation with the applicant and shall be made a condition of any approval or contingent approval. If, after consultation, an acceptable time period cannot be agreed upon, the commissioner shall establish a time period as a condition of approval;

(6) an outline of the proposed financing of the total project costs, including the source of any Federal or State financial support;

(7) a statement whether the project is consistent with the institution's long-range capital plan;

(8) a narrative description of the programmatic and/or architectural solution of each functionally discrete component of the project, including the following when relevant to the proposal: (i) justification of the need for the proposed change, and a determination of its relative priority when compared with the applicant's other needed services and programs;

(ii) how the solution has taken advantage of opportunities for the efficient and economic reuse and recycling of existing physical plant resources, where feasible and appropriate;

(iii) how the solution could be adapted to accommodate changes in emerging technology;

(iv) the proposed plan for the organization and operation of the facility; .tx (v) the number and types of personnel to be employed as a result of the project; and

(vi) any special or unusual services, programs or equipment to be provided, including a description of health professional teaching programs associated with the solution;

(9) an architectural program for the project;

(10) architectural drawings, including if applicable:

(i)(a) schematic architectural and engineering design drawings, including site plan, room-by-room layouts of each floor in an appropriate scale, showing the relationship of the various departments or services to each other. The major exit corridors, exit stair locations and pedestrian and service circulation patterns shall be indicated along with existing buildings, if additions or alterations are part of the project. In addition, applications shall include typical sections and elevations, single-line diagrams of proposed building systems if applicable, or outline descriptions of heating, ventilation and air conditioning, electrical power, lighting and communications systems, plumbing, fire protection, materials handling and transportation systems, dietary, water supply and sewage systems and preliminary layouts of mechanical equipment rooms and riser diagrams and outline specifications; and

(b) a functional stack diagram which includes square footages, type of construction and estimated cost of equipment for each functional area displayed and, where appropriate, the relative cost of each area as well as the total construction cost for each discrete physical structure involved and a set of single-line freehand sketches of each floor in an appropriate scale, showing the relationship of the various departments or services to each other. The major exit corridors, exit stair locations and pedestrian and service circulation patterns shall be indicated, along with existing buildings if additions or alterations are part of the project;

(ii) a list in outline form of functional project components, including the enumeration of primary treatment spaces and the area to be included in each component;

(iii) a description of the functional and locational relationships among each related but discrete component;

(iv) the current and proposed bed capacity of the facility by the type of bed, indicating the total number of existing and proposed beds and nursing units and the type of room distribution (e.g., single or multi-bed rooms), the number of each, and the patient or resident capacity of the institution upon completion of construction;

(v) a description of proposed alterations or additions to existing structures;

(vi) a description of the energy sources, type and location of engineering systems which will be used for heating, cooling, ventilation and electrical distribution;

(vii) a description of the proposed method of transport of clean and soiled materials and wastes;

(viii) a description of the intended dietary systems; and

(ix) a description of methods intended for water supply and sewage.

(c) Such other information pertinent to the project as the commissioner, State Hospital Review and Planning Council, Public Health Council or health systems agency may require.

(d) All applications transmitted pursuant to this section shall be:

(1) subscribed by the chief executive officer or other officer so authorized by the board of a corporate applicant, a general partner or proprietor of a medical facility, or, where an application is to be submitted by a municipal medical facility, the president or chairman of the board of the facility, or the chief executive officer if there is no board; and

(2) with respect to applications involving full review or the reduction or deletion of licensed beds and/or services, the application shall be accompanied by a certified copy of a resolution of the board of a corporate applicant authorizing the undertaking which is the subject of the application and the subscribing and submission thereof by an appropriate designated individual.

(e) (1) After receipt and review of the application setting forth the scope and concept of the project, the commissioner, after considering the recommendations of the local health systems agency and the State Hospital Review and Planning Council, shall make a determination. If the application is approved, the applicant shall be notified of such approval together with any contingencies or conditions therein. The applicant, upon receipt of such approval, may proceed with the application pursuant to section 710.4 of this Part. (2) If the commissioner proposes to disapprove a project or make a determination contrary to the recommendation of the local health systems agency, the opportunity to request a hearing shall be afforded to the appropriate party before a decision is made.

(3) (i) The commissioner may, during the processing of an application, propose to disapprove the application solely on the basis that the facility is not currently in substantial compliance with all applicable codes, rules and regulations or that the adequacy of financial resources and sources of future revenue has not been demonstrated in advance of his consideration of the other criteria under Public Health Law, section 2802 without, however, waiving his right to consider such criteria at a later date.

(ii) In the event the commissioner, upon the recommendation of the State Hospital Review and Planning Council, proposes to disapprove an application solely on the basis that the facility is not currently in substantial compliance with all applicable codes, rules and regulations or that the adequacy of financial resources and sources of future revenue has not been demonstrated and the applicant then requests a hearing, the commissioner may direct the completion of the other reviews required by Public Health Law, section 2802, the results of which shall be presented to State Hospital Review and Planning Council for its recommendation, which reviews may then be considered at the hearing. If the commissioner directs the completion of such reviews, a copy of the report containing the results of the reviews shall be mailed to the applicant at least 60 days prior to the date set for hearing.

(iii) In the event the commissioner proposes to disapprove an application solely on the basis that the facility is not currently in substantial compliance with all applicable codes, rules and regulations or that the adequacy of financial resources and sources of future revenue has not been demonstrated and the State Hospital Review and Planning Council does not concur with such proposed disapproval, the application shall be returned to the department without a formal recommendation. The commissioner shall then direct the completion of the other reviews required by Public Health Law, section 2802, and shall return the application to the State Hospital Review and Planning Council for its formal recommendations.

(4) Before a health systems agency may make a recommendation to the commissioner relative to an application, it must have first provided notice to all interested parties of the receipt of such application, together with a brief description thereof. For purposes of this paragraph, interested parties shall mean all persons, entities, agencies or other organizations, located within the health systems agency's geographic area, that have requested, in writing to such agency, notification of the applications pending review by the agency.
 

Effective Date: 
Wednesday, February 12, 1997
Doc Status: 
Complete

Section 710.3 - Review of application; project scope and concept

710.3 Review of application; project scope and concept. (a) The department may request the applicant in writing to submit additional documentation and information in order to complete the review of the application, project scope and concept. Except as provided for in subdivision (c) of this section, if the applicant does not submit the additional documentation or information to the department within the time specified in the request, or as extended by the department in writing, the application shall be deemed abandoned and withdrawn upon written notice to the applicant.

(b) If an application includes a proposal to correct a violation of any provision of the Public Health Law or this Title, which violation, as determined by the commissioner, directly affects or threatens to directly affect the health, safety or welfare of any patient or resident, the application shall not be deemed abandoned or withdrawn due solely to the failure by the applicant to submit the requested documentation and information within the prescribed time. The provisions of this subdivision shall not affect the authority of the department to institute any action or proceeding with respect to the facility concerning the violation of any provision of the Public Health Law or this Title.
 

Effective Date: 
Wednesday, January 29, 1997
Doc Status: 
Complete

Section 710.4 - Additional information to be submitted

710.4 Additional information to be submitted. (a) After the issuance of the approval of the application by the commissioner, the applicant shall submit, to the Bureau of Architectural and Engineering Review, with a copy of the transmittal letter to the project management unit for information, the following:

(1) one set of design development drawings which has been reviewed and approved by the applicant's chief executive officer or equivalent person. Such drawings shall be in sufficient detail to ensure consistency with the detailed functional and operational requirements of this Title and the National Fire Protection Association's codes and standards set forth in Part 711 of this Title. The applicant shall advise the department one month in advance of its intent to file such drawings;

(2) an updated functional stack diagram which includes square footages, type of construction and estimated cost of equipment and construction for each functional area displayed and, where appropriate, the relative cost of each area as well as the total construction cost for each discrete physical structure involved; and

(3) draft contracts relating to construction costs included in the total basic cost of construction as defined in section 710.1 of this Part.

(b) In addition to those items specified in subdivision (a) of this section, the applicant must submit to the project management unit eight copies of the following information:

(1) any financial information which may have an impact on the feasibility of the project;

(2) any information that may have an impact on quality of care issues;

(3) the method and terms of any permanent financing for the project; and

(4) the updated total project costs as defined in section 710.1 of this Part in a format prescribed by the commissioner if different than previously approved by the commissioner.
 

Doc Status: 
Complete

Section 710.5 - Amendments

710.5 Amendments. (a) Subsequent to an approval or contingent approval of an application under this Part, any change, as set forth in paragraphs (b)(1) through (3) of this section, shall constitute an amendment to the application, and the applicant shall submit appropriate documentation as may be required by the commissioner pursuant to this Part in support of such amendment. The amended application shall be referred to the health systems agency having jurisdiction and the Public Health and Health Planning Council for their reevaluation and recommendations. The approval of the commissioner shall be obtained for any such amended application.

(b) Any of the following shall constitute an amendment:

(1) a change in the number and/or types of beds and/or services, other than a reduction of service which would be subject to administrative review;

(2) a change in the location of the site of the construction if outside the facility's planning area as identified in Part 709. If the change in site, within the facility's planning area, impacts geographic accessibility in such planning area, the commissioner may before making any finding that such change is in the best interest of the planning area seek the recommendation of the Public Health and Health Planning Council and the health systems agency having geographical jurisdiction. In addition, for applications to establish diagnostic and treatment centers which were not reviewed competitively within a batch, a change of site within a planning area shall not constitute an amendment pursuant to the provisions of this section and shall require only the prior approval of the commissioner; or

(3) any change in the applicant.

(c)(1) If the the commissioner determines that increases in total project costs or total basic costs of construction are due to factors of an emergency nature such as labor strikes, fires, floods or other natural disasters, or factors beyond the control of the applicant, or modifications to the architectural aspects of the application which are made on the recommendation of the department, the commissioner may permit review of the application to proceed without the need for the application to be referred back to the health systems agency and the council pursuant to this Part. However, failure of the applicant to obtain financing or appropriate environmental and zoning permits or approvals shall not be deemed to be beyond the control of the applicant.

(2) If the applicant can document by evidence acceptable to the commissioner that increases in total project costs or total basic costs of construction were caused by delays in obtaining zoning or planning approvals which were beyond its control, the commissioner may permit review of the application to proceed without the need for the application to be referred back to the health systems agency and the council pursuant to this part. The evidence should clearly demonstrate that the applicant had timely pursued the zoning or planning permits and in addition that the applicant has now obtained all such required permits and approvals and is prepared to proceed with the project. (3) If the applicant can document, by evidence acceptable to the commissioner, that increases in the total basic cost of construction were caused by inflation in excess of that estimated and approved in the application and that such inflation has affected the total basic cost of construction as a result of delays which were beyond the applicant's control, the commissioner may permit review of the application to proceed without the need for the application to be referred back to the health systems agency and the Public Health and Health Planning Council pursuant to this Part. The evidence shall demonstrate clearly that the increase in inflation exceeds that estimated and approved in the application, and that any delays resulting in such inflationary cost increases were beyond the applicant's control.

(d) The applicant must obtain the prior approval of the commissioner for any change relating to the program scope or functional space concept of the project, total project costs or increase in total basic costs of construction, a change in the ownership interest in the land, building or equipment relating to the proposal, a change in the location of the site of the construction, or interest rates relating to the financing of any aspect of the project, regardless of whether such change constitutes an amendment under this section.

Effective Date: 
Wednesday, March 25, 2015
Doc Status: 
Complete

Section 710.6 - Determination by the commissioner

710.6 Determination by the commissioner. (a) After receipt of all the documentation and recommendations required in sections 710.4 and 710.5 of this Part, and the satisfaction of all applicable outstanding contingencies imposed on the approval relating to the project, the commissioner shall make a determination. If the commissioner proposes to disapprove an application or an amendment or issue a determination contrary to the recommendation of the local health systems agency, the opportunity to request a hearing shall be afforded to the applicant or the health systems agency, as appropriate, prior to a final decision. If the application is approved, the applicant may proceed to apply for approval to start construction of the project or specific project phases, if any, pursuant to section 710.7 of this Part.

(b) Any project cost incurred which exceeds a cost already approved under this Part shall not be considered an allowable cost for reimbursement pursuant to any of the provisions of Part 86 of this Title unless, prior to incurring such cost or entering into a contract to incur such cost, the applicant has requested, in a format prescribed by the department, and obtained, the written approval of the commissioner for such increased cost.
 

Doc Status: 
Complete

Section 710.7 - Approval to start construction

710.7 Approval to start construction. (a) The applicant may seek approval to start construction of the project, or one or more phases thereof, upon the filing with the department completed contract documents consistent with all previous approvals.

(b) If documents are not completed, the applicant may request approval to start construction upon submission of a certification by the applicant, construction manager or contractor, and the architect that completed working drawings and specifications shall be submitted within a time period specified in the applicant's request, that such construction shall be undertaken at the applicant's risk and that approval is understood to be contingent upon submission of the completed documents as a no-cost change order.

(c) A request by the applicant pursuant to subdivision (a) or (b) of this section shall include an affidavit by the applicant's architect or engineer that the drawings:

(1) are consistent with schematic and design development drawings previously approved and, if not, the affidavit shall identify the changes and reasons for such changes; and

(2) are in compliance with the applicable provisions of this Title and all applicable local codes, statutes and regulations. In addition, the applicant shall submit an up-dated functional stack diagram consistent with section 710.2(b)(10)(i)(b) of this Part.

(d) When the submission under subdivision (a) or (b) of this section is deemed complete by the department, the applicant shall be advised in writing to commence construction pursuant to this Part.
 

Doc Status: 
Complete

Section 710.8 - Requirements during construction

710.8 Requirements during construction. (a) The applicant shall request and must obtain the prior approval of the commissioner for any changes proposed during construction relating to the description of the program scope or functional space concept of the project, total project costs, total basic costs of construction, increased interest rates relating to the financing of any aspect of the project, or major items of equipment as approved. The commissioner shall respond in writing within 30 days of the receipt of such a request, unless the change constitutes an amendment to the application, in which event the provisions of section 710.5 of this Part shall apply.

(b) The applicant may authorize change orders to the construction contract which contribute to the necessary coordination and orderly completion of the project without the need for prior approval of the commissioner if such change orders can be funded within the approved construction contingency and the changes do not relate to changes in the program scope or functional space concept of the project. Any change order relating to changes in program scope or functional space concept must be submitted for prior approval. If the total value of change orders exceeds the budgeted construction contingency, which may constitute an amendment pursuant to the provisions of section 710.5 of this Part, then all change orders, including those previously authorized by the applicant, will be reviewed by the commissioner as to acceptability for reimbursement. In such event, only those change orders that have been given prior approval under subdivision (a) of this section, those change orders which are deemed necessary by the commissioner for prudent coordination and continuation of the project, and those change orders which are related to unforeseen conditions or which can demonstrate positive financial impact on the project may be considered reimbursable. The costs associated with change orders, in excess of those effectuated under the approved design and/or construction contingency, made by the applicant, its architects, contractors or agents, will be eligible for reimbursement pursuant to the provisions of Part 86 of this Title only to the extent that the applicant has not been able to recover such costs from a responsible party, if any, insurance carrier or bonding agency.

(c) For projects exceeding $15 million in total basic cost of construction, an updated functional stack diagram which includes square footages, type of construction and estimated cost of construction and equipment for each functional area displayed and, where appropriate, the relative cost of each area as well as the total construction cost for each discrete physical structure involved, and indicating the percentage of completion for each functional area, shall be submitted every six months during construction in accordance with section 710.2(b)(10)(i)(b) of this Part.
 

Doc Status: 
Complete

Section 710.9 - Onsite inspection

710.9 Onsite inspection. Upon completion of the project or each phase of a mega-project as set forth in the commissioner's letter of approval, an onsite inspection of the construction and equipment will be made to assure that such are in accordance with the prior approval of the commissioner. The applicant shall notify the area administrator requesting such inspection two months prior to the anticipated completion date. Based upon the final onsite inspection report of the Bureau of Architectural and Engineering Review indicating that the construction is acceptable as completed, a preopening survey shall be conducted by the area office. After the completion of the preopening survey, the area administrator shall, by writing, advise the applicant, if the results of the survey are acceptable, that the premises so inspected may be occupied. In addition, if applicable, the department shall issue an operating certificate consistent with the findings of the preopening survey.
 

Doc Status: 
Complete

Section 710.10 - Cancellation, withdrawal and annulment of approvals

710.10 Cancellation, withdrawal and annulment of approvals. The failure, neglect or refusal of the applicant, in manner and detail as required by this Subchapter, to conform to the requirements hereinbelow set forth shall result in the cancellation, withdrawal or annulment of any or all prior approvals issued to the applicant concerning the subject application:

(a) Failure to commence and complete construction, within the time period determined under section 710.2 of this Title, which time period shall commence on the date of approval or contingent approval of the application, project scope and concept, shall constitute an abandonment of the application and any such approval or contingent approval shall be deemed cancelled, withdrawn and annulled without further action of the commissioner.

(b) Any applicant, regardless of reason, requesting to change the date on which construction is to begin or end shall file a request with the commissioner setting forth the change in date and the reasons for the change. The approval of the commissioner must be obtained for any such change. A change in the date of commencement or completion of construction is not an amendment to an application pursuant to section 710.5 of this Title.

(c)(1) The failure, neglect or refusal of an applicant to submit documentation or information, within the stated time frame, to satisfy a contingency imposed by the commissioner in conjunction with the proposal to approve an application shall constitute and be deemed abandonment or withdrawal of the application by the applicant without the need for further action by the commissioner.

(2) When an applicant submits documentation or information, within the stated time frame, in an attempt to satisfy a contingency imposed by the commissioner, but the department does not consider the documentation or information sufficient to satisfy the contingency, the department will so notify the applicant in writing and inform the applicant of the reasons why the documentation or information is not considered sufficient to satisfy the contingency. The applicant shall have 30 days from the date of receipt of the department's notice to submit to the department additional or amended documentation or information to correct the deficiencies and satisfy the contingency. The failure to submit such documentation or information within the 30-day time period shall constitute and be deemed an abandonment or withdrawal of the application by the applicant without the need for further action by the commissioner. If additional or amended documentation or information is submitted within the 30-day time period but the department does not consider it sufficient to satisfy the contingency, the applicant will be so notified in writing, the application shall be proposed for disapproval, and the applicant shall be afforded the opportunity to requesst a hearing.
 

Effective Date: 
Wednesday, January 17, 1996
Doc Status: 
Complete

Section 710.11 - Schedule for construction applications

710.11 Schedule for construction applications. The commissioner, after consultation with the health systems agencies, shall establish a schedule for the review of project scope and concept construction applications by the health systems agencies, the department and the council. Such schedule shall require that:

(a) review periods will be established by the commissioner with the agreement of the health systems agencies for the consideration of applications proposing similar types of construction and services; each review period for similar types of construction and services will occur not less than once each year;

(b)(1) beginning on January 1, 1994, applications received between January 1 and June 30 of each year shall be reviewed by the health systems agencies and the department and presented to the council for its consideration prior to June 30 of the following year and applications received between July 1 and December 31 of each year shall be reviewed by the health systems agencies and the department and presented to the council for consideration prior to December 31 of the following year; and

(2) applications which the Commissioner has determined address high priority health care needs for which there is a demonstrated acute shortage of particular equipment and/or services or as may be indicated by the application of existing need regulations in Part 709 of this Subchapter for specific services and equipment, may be processed more quickly than the 6 month batch provided for in paragraph (1) of this subdivision, as an expedited batch; provided, however, that the Department shall advise the health care industry, and all specific parties known to be interested or who have requested such notification in writing, at least three months in advance of the date on which it intends to commence a particular expedited batch.

(c) to qualify for review during the appropriate review period, an application shall meet criteria established by the commissioner to assure the application is complete in order to permit substantive review;

(d) applications requesting emergency construction resulting from unforeseen circumstances necessary to protect patient care and safety or primary care applications proposed to be funded by State grant money or primary care applications for freestanding facilities proposed to be funded under Federal Public Law 95-210, 93-222 or 89-4, as amended, or proposed by an organization authorized to operate pursuant to article 44 of the Public Health Law, as amended, shall be reviewed promptly;

(e) the commissioner after consultation with the health systems agencies shall establish procedures to be followed by health systems agencies when making recommendations to the department; such procedures shall include a relative priority of applications;

(f) a health systems agency recommendation that is inconsistent with the provisions of Article 1 of the State Hospital Code on the determination of public need for medical facility construction shall be explained and documented by the agency; when the department makes a decision contrary to the recommendation of the health systems agency, the department shall document the reason for such decision.
 

Effective Date: 
Wednesday, February 12, 1997
Doc Status: 
Complete

Part 711 - General Standards of Construction

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2803

Section 711.1 - Applicability

Section 711.1 Applicability. (a) This Part sets forth minimum construction and physical environment standards applicable to all health facilities subject to Public Health Law Article 28, including but not limited to, general hospitals, nursing homes and ambulatory care facilities.

(b) An applicant seeking approval to construct a new health facility or alter or renovate an existing health facility shall submit to the department a completed application and functional program. The applicant shall ensure that all terms and acronyms are clearly defined and consistently used in the application and functional program. The functional program, which is a detailed architectural and design plan for the health facility, shall include a description of the following:

(1) the scope and purpose of the proposed construction project and other basic information relating to fulfillment of the applicant's objectives;

(2) the services necessary for the complete operation of the health facility, the size and function of each space, any special design features, the projected occupant load, and numbers and types of staff, patients, residents, visitors and vendors;

(3) the types and projected numbers of procedures to be performed in each treatment area and circulation patterns for staff, patients or residents, and the public;

(4) the projected demand or utilization, staffing patterns, departmental relationships, space requirements, and circulation patterns that are a function of infection control requirements and for clean and soiled materials;

(5) equipment requirements, including building service equipment and fixed and moveable equipment; and,

(6) potential future expansion that may be needed to accommodate increased demand.

(c) Once approved by the department, the functional program and the approved plans and specifications developed from it shall be used in the development, design and construction of the project and serve as the basis for all subsequent construction approvals regarding the specific project. The applicant or health facility operator shall retain and make available to the department, upon the department's request, the functional program, all government approved plans and specifications developed from it and any other design data to facilitate alterations, and program changes.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 711.2 - Pertinent technical standards

711.2 Pertinent technical standards. All health facilities shall comply with the pertinent provisions of the standards and codes referred to in this section and with local laws relating to zoning, sanitation, fire safety and construction, where such local laws represent standards in addition to those required by this Part. Reference throughout this chapter to codes and standards shall be those editions listed in this section. If a conflict occurs between the following codes and standards or between them and regulations elsewhere in this chapter, then compliance with the more restrictive regulation is required. If federal regulatory requirements conflict with the codes and standards referred to in this section, the department may waive compliance with such standards and codes, provided that a health facility fully complies with said federal regulatory requirements.

(a) The following National Fire Protection Association (NFPA) Codes and Standards are hereby incorporated by reference, with the same force and effect as if fully set forth at length herein. These codes and standards are available for public inspection and copying at the Regulatory Affairs Unit, New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237. The codes and standards are published by the National Fire Protection Association, and copies are also available from the National Fire Protection Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101, 1-800-344-3555 or www.nfpa.org. The various codes and standards are available from the NFPA either as individual publications or as contained within the Compilation of NFPA National Fire Codes, 1999 edition.

(1) NFPA 101, Life Safety Code, 2000 edition.

(2) NFPA 101A, Guide on Alternative Approaches to Life Safety, 1998 edition.

(3) NFPA 10, Standard for Portable Fire Extinguishers, 1998 edition.

(4) NFPA 13, Standard for the Installation of Sprinkler Systems, 1999 edition.

(5) NFPA 14, Standard for the Installation of Standpipe, Private Hydrants and Hose Systems, 2000 edition.

(6) NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 1998 edition.

(7) NFPA 30-1996--Flammable and Combustible Liquids Code.

(8) NFPA 31, Standard for the Installation of Oil-Burning Equipment, 1997 edition.

(9) NFPA 45-1996-Standard on Fire Protection for Laboratories Using Chemicals.

(10) NFPA 54, National Fuel Gas Code, 1999 edition.

(11) NFPA 58, Liquefied Petroleum Gases Code, 1998 edition.

(12) NFPA 70, National Electrical Code, 1999 edition.

(13) NFPA 72, National Fire Alarm Code, 1999 edition.

(14) NFPA 80, Standard for Fire Doors and Fire Windows, 1999 edition.

(15) NFPA 82, Standard on Incinerators and Waste and Linen Handling Systems and Equipment, 1999 edition.

(16) NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 1999 edition.

(17) NFPA 90B, Standard for the Installation of Warm Air Heating and Air-Conditioning Systems, 1999 edition.

(18) NFPA 91, Standards for Exhaust Systems for Air Conveying of Vapors, Gases, Mists and Noncombustible Particulate Solids, 1999 edition.

(19) NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 1998 edition.

(20) NFPA 99, Standard for Health Care Facilities, 1999 edition.

(21) NFPA 110, Standard for Emergency and Standby Power Systems, 1999 edition.

(22) NFPA 111, Standard on Stored Electrical Energy Emergency and Standby Power Systems, 1996 edition.

(23) NFPA 211, Standard for Chimneys, Fireplaces, Vents, and Solid Fuel-Burning Appliances, 2000 edition.

(24) NFPA 220, Standard on Types of Building Construction, 1999 edition.

(25) NFPA 221, Standard for Fire Walls and Fire Barrier Walls, 1997 edition.

(26) NFPA 241-1996--Standard for Safeguarding Construction, Alteration, and Demolition Operations.

(27) NFPA 251, Standard Methods of Tests of Fire Endurance of Building Construction and Materials, 1999 edition.

(28) NFPA 252, Standard Methods of Fire Tests of Door Assemblies, 1999 edition.

(29) NFPA 253, Standard Method of Test for Critical Radiant Flux of Floor Covering Systems Using a Radiant Heat Energy Source, 2000 edition.

(30) NFPA 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 edition.

(31) NFPA 256, Standard Methods of Fire Tests of Roof Coverings, 1998 edition.

(32) NFPA 257, Standard on Fire Test for Windows and Glass Block Assemblies, 2000 edition.

(33) NFPA 260, Standard Methods of Tests and Classification System for Cigarette Ignition Resistance of Components of Upholstered Furniture, 1998 edition.

(34) NFPA 261, Standard Method of Tests for Determining Resistance of Mock-Up Upholstered Furniture Material Assemblies to Ignition by Smoldering Cigarettes, 1998 edition.

(35) NFPA 265, Standard Methods of Fire Tests for Evaluating Room Fire Growth Contribution of Textile Wall Coverings, 1998 edition.

(36) NFPA 266, Standard Method of Test for Fire Characteristics of Upholstered Furniture Exposed to Flaming Ignition Source, 1998 edition.

(37) NFPA 267, Standard Method of Test for Fire Characteristics of Mattresses and Bedding Assemblies Exposed to Flaming Ignition Source, 1998 edition.

(38) NFPA 286, Standard Methods of Fire Tests for Evaluating Room Fire Contribution of Wall and Ceiling Interior Finish, 2000 edition.

(39) NFPA 418, Standard for Heliports, 1995 edition.

(40) NFPA 701, Standard Methods of Fire Tests for Flame Propagation of Textiles and Films, 1999 edition.

(41) NFPA 703, Standard for Fire Retardant Impregnated Wood and Fire Retardant Coatings for Building Materials, 2000 edition.

(b) The following codes and standards are hereby incorporated by reference, with the same force and effect as if fully set forth at length herein. These codes and standards are available for public inspection and copying at the Regulatory Affairs Unit, New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237. Copies are also available from the publisher or issuing organization at the address listed.

(1) ANSI/ASHRAE Standard 52.2-1999, Method of Testing Air-Cleaning Devices for Removal Efficiency by Particle Size, 1999 edition. American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc., 1791 Tullie Circle NE, Atlanta, GA 30329.

(2) Compressed Gas Association, Inc. (CGA) Pamphlet E-10, Maintenance of Medical Gas and Vacuum Systems in Health Care Facilities, third edition, 2007. Compressed Gas Association, Inc., 4221 Walney Road, Chantilly, VA, 20151-2923, www.cganet.com.

(3) National Council on Radiation Protection and Measurements (NCRP) Report No. 102--Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50MeV (1989). National Council on Radiation Protection and Measurements, 7910 Woodmont Avenue, Bethesda, MD 20814-3095, www.ncrppublications.org.

(4) National Council on Radiation Protection and Measurements (NCRP) Report No. 147--Structural Shielding Design for Medical X-Ray Imaging Facilities, 2004 edition. National Council on Radiation Protection and Measurements, 7910 Woodmont Avenue, Bethesda, MD 20814-3095, www.ncrppublications.org.

(5) National Council on Radiation Protection and Measurements (NCRP) Report No. 144--Radiation Protection for Particle Accelerator Facilities, 2003 edition. National Council on Radiation Protection and Measurements, 7910 Woodmont Avenue, Bethesda, MD 20814-3095, www.ncrppublications.org.

(6) 1996-97 Guidelines for Design and Construction of Hospital and Health Care Facilities, 1996 edition. The American Institute of Architects Academy of Architecture for Health, with assistance from the U.S. Department of Health and Human Services, the American Institute of Architects Press, 1735 New York Avenue, N.W., Washington, D.C. 20006. The standards set forth in this paragraph are applicable to construction projects completed pursuant to Subparts 712-2 and 713-2 and other applicable provisions in this Chapter. Such projects must, at minimum, maintain compliance with these standards.

(7) Guidelines for Design and Construction of Health Care Facilities, 2010 edition. The American Society for Healthcare Engineering, with assistance from the U.S. Department of Health and Human Services, One North Franklin Street, Chicago, Illinois, 60606, and at www.ashe.org.

(c) Design standards for the disabled. The Americans with Disabilities Act of 1990 (ADA) extends comprehensive civil rights protection to persons with disabilities. Health care facilities must comply with the ADA and the regulations which implement it. Title 28 of the Code of Federal regulations, Public Health Parts 35, Non-Discrimination on the Basis of Disability in State and Local Government Services, and Part 36, Non-Discrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities, including Appendix A, "Standard for Accessible Design", 2004 edition. These regulations are published by the Office of the Federal Register National Archives and Records Administration. Copies may be obtained from the Superintendent of Documents, United States Government Printing Office, Washington D.C. 20402.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 711.3 - Site requirements

711.3 Site requirements. (a) Each health facility shall be easily accessible to patients or residents, staff and visitors and to service vehicles such as fire protection apparatus. Health facility grounds shall have paved roads and walkways to provide access to all public and service entrances, including loading docks. Emergency department entrances shall be conspicuously marked to facilitate access from public roads and streets. Access to emergency entrances shall not conflict with other vehicular or pedestrian traffic.

(b) Health facilities shall be located with due regard to the accessibility by public transportation for patients, staff and visitors and the availability of competent medical and surgical consultation.

(c) Off-street parking shall be made available for patients, staff and visitors. In urban areas where a health facility is accessible by public transportation, the commissioner may waive the requirement for off-street parking, if compliance with this requirement is burdensome or unnecessary because adequate parking exists to accommodate patients, staff and visitors.

(d) In earthquake prone regions, health facilities that are subdivided into separate structural units by seismic joints, each unit shall be provided with an exit stairway to permit evacuation from the building without traversing the seismic joints. Special care shall be taken to anchor fixed equipment, suspended ceilings, light fixtures and similar items to minimize hazard to occupants and damage to the equipment and building during an earthquake. Storage shelves and racks holding breakable or fragile supplies shall be designed to retain their contents when subject to the lateral forces of an earthquake.

(e) If a health facility is located in a flood plain, the commissioner may require that the health facility comply with any, or all, of the following:

(1) Health facility footings, foundations, and structural frame shall be designed to be stable under flood conditions.

(2) A helicopter landing pad shall be located on the facility roof and shall be structurally sound and suitable for safe helicopter evacuations of patients and staff.

(3) The health facility shall be designed and capable of providing services necessary to maintain the life and safety of patients and staff if floodwaters reach the one-hundred year flood crest level and shall include the following:

(i) electrical service, emergency power supply, heating, ventilating and sterilizers;

(ii) main internal communication capability, including nurses' call systems and the fire alarm system;

(iii) dietary service;

(iv) an acceptable alternate to the normal water supply system;

(v) an acceptable emergency means of storage and/or disposal of sewage, biological waste, and garbage;

(vi) emergency department service; and,

(vii) x-ray service.

(4) No floor level or basement shall be located below the 100-year flood crest level, unless specifically approved by the commissioner. On those floor levels or basements that the commissioner approves to be below the 100-year flood crest level:

(i) all new partitions shall be constructed without void such as solid concrete, solid concrete block, or other solid material;

(ii) no new carpeting shall be installed; and

(iii) the following services and equipment shall not be provided or located in such area:

(a) medical records storage area;

(b) medical records library;

(c) surgical suite; and

(d) such other services and fixed equipment that the commissioner may determine, taking into consideration patient safety and cost of replacement.

(5) Storage of available building plans of the existing buildings shall be above the 100-year flood crest level.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 711.4 RESERVED

Effective Date: 
Wednesday, December 29, 2010

Section 711.5 RESERVED

Effective Date: 
Wednesday, December 29, 2010

Section 711.6 RESERVED

Section 711.7 RESERVED

Effective Date: 
Wednesday, December 29, 2010

Section 711.8 RESERVED

Effective Date: 
Wednesday, December 29, 2010

Section 711.9 - Waivers and approvals of equivalent or innovative construction standards