Section 86-13.3 - Rates for prevocational services (site-based), respite (hourly and free-standing), prevocational services (community-based), supported employment, and residential habilitation (family care)

86-13.3. Rates for prevocational services (site-based), respite (hourly and free-standing), prevocational services (community-based), supported employment, and residential habilitation (family care).

(a) There shall be one provider-wide rate for each provider of prevocational services (site-based), except that rates for prevocational services provided to individuals identified as specialized populations by OPWDD shall be determined under section 86-13.8 of this Subpart. Adjustments may be made to the rate resulting from any final audit findings or reviews.

(b) Rates shall be computed on the basis of a full twelve month base year CFR, adjusted in accordance with the methodology as provided in this section. The rate shall include operating cost components, facility cost components, and capital cost components as identified in applicable paragraphs. Such base year may be updated periodically, as determined by DOH.

(c) Prevocational (site-based).

(1) Operating component. Allowable operating costs shall include costs identified in the consolidated fiscal reports and reimbursement for such costs shall be inclusive of the following components:

(i) Regional average direct care wage, which shall mean the quotient of base year salaried direct care dollars (including production staff) for each provider in a DOH region, aggregated for all such providers in such region, divided by base year salaried direct care hours (including production staff) for each provider in a DOH region, aggregated for all such providers in such region.

(ii) Regional average employee-related component, which shall mean the quotient of the sum of vacation leave accruals and total fringe benefits for the base year for each provider in a DOH region, aggregated for all such providers in such region, divided by base year salaried direct care dollars (including production staff) for each provider in a DOH region, aggregated for all such providers in such region, and such quotient shall be multiplied by the applicable regional average direct care wage as determined by subparagraph (i) of this paragraph.

(iii) Regional average program support component, which shall mean the quotient of the sum of transportation related-participant, staff travel, participant incidentals, expensed adaptive equipment, sub-contract raw materials, participant wages-non-contract, participant wages-contract, participant fringe benefits, staff development, supplies and materials-non-household, other-OTPS, lease/rental vehicle, depreciation-vehicle, interest-vehicle, other-equipment, other than to/from transportation allocation, salaried support dollars (excluding housekeeping and maintenance staff) and salaried program administration dollars for the base year for each provider in a DOH region, aggregated by all such providers in such region, divided by the total base year salaried direct care dollars (including production staff) of all providers in a DOH region, and such quotient shall be multiplied by the applicable regional average direct care wage as determined pursuant to subparagraph (i) of this paragraph.

(iv) Regional average direct care hourly rate-excluding general and administrative costs, which shall mean the sum of the applicable regional average direct care wage as determined pursuant to subparagraph (i) of this paragraph, the applicable regional average employee-related component as determined pursuant to subparagraph (ii) of this paragraph, and the applicable regional average program support component as determined pursuant to subparagraph (iii) of this paragraph.

(v) Regional average general and administrative component, which shall mean the quotient of the sum of the insurance-general and agency administration allocation for the base year for each provider in a DOH region, aggregated for all such providers in such region, divided by (the sum of total program/site costs and other than to/from transportation allocation, less the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation equipment, total property-provider paid, housekeeping and maintenance staff, salaried clinical dollars, and contracted clinical dollars for the base year for each provider in a DOH region, aggregated for all providers in such region). The regional average direct care hourly rate-excluding general and administrative costs, as determined pursuant to subparagraph (iv) of this paragraph, shall then be divided by (one minus the applicable regional average general and administrative quotient), from which the applicable regional average direct care hourly rate-excluding general and administrative costs, as computed in subparagraph (iv) of this paragraph, shall be subtracted.

(vi) Regional average direct care hourly rate, which shall mean the sum of the applicable regional average direct care wage as determined pursuant to subparagraph (i) of this paragraph, the applicable regional average employee-related component as determined pursuant to subparagraph (ii) of this paragraph, the applicable regional average program support component as determined pursuant to subparagraph (iii) of this paragraph, and the applicable regional average general and administrative component as computed in subparagraph (v) of this paragraph.

(vii) Provider average direct care wage, which shall mean the quotient of base year salaried direct care dollars (including production staff) divided by the base year salaried direct care hours (including production staff) of a provider.

(viii) Provider average employee-related component, which shall mean the quotient of the sum of vacation leave accruals and fringe benefits for the base year for each provider, divided by base year salaried direct care dollars (including production staff) of a provider, and such quotient shall be multiplied by the provider average direct care wage as computed in subparagraph (vii) of this paragraph.

(ix) Provider average program support component, which shall mean the quotient of the sum of transportation related-participant, staff travel, participant incidentals, expensed adaptive equipment, sub-contract raw materials, participant wages-non-contract, participant wages-contract, participant fringe benefits, staff development, supplies and materials-non-household, other-OTPS, lease/rental vehicle, depreciation-vehicle, interest-vehicle, other-equipment, other than to/from transportation allocation, salaried support dollars (excluding housekeeping and maintenance staff) and salaried program administration dollars for the base year for a provider, divided by the base year salaried direct care dollars (including production staff) of such provider, and such quotient shall be multiplied by the provider average direct care wage as computed in subparagraph (vii) of this paragraph.

(x) Provider average direct care hourly rate-excluding general and administrative costs, which shall mean the sum of the provider average direct care wage as determined pursuant to subparagraph (vii) of this paragraph, the provider average employee-related component as determined pursuant to subparagraph (viii) of this paragraph, and the provider average program support component as determined pursuant to subparagraph (ix) of this paragraph for each provider.

(xi) Provider average general and administrative component, which shall mean the quotient of the sum of insurance-general and agency administration allocation for the base year for a provider, divided by (the sum of total program/site costs and other than to/from transportation allocation less the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation equipment, insurance – property and casualty, total property-provider paid, housekeeping and maintenance staff, salaried clinical dollars, and contracted clinical dollars for a provider) for the base year. The provider average direct care hourly rate-excluding general and administrative costs, as computed in subparagraph (x) of this paragraph, shall then be divided by (one minus the applicable provider average general and administrative quotient), from which the provider average direct care hourly rate-excluding general and administrative costs, as computed in subparagraph (x) of this paragraph, shall be subtracted.

(xii) Provider average direct care hourly rate, which shall mean the sum of the provider average direct care wage as determined pursuant to subparagraph (vii) of this paragraph, the provider average employee-related component as determined pursuant to subparagraph (viii) of this paragraph, the provider average program support component as determined pursuant to subparagraph (ix) of this paragraph, and the provider average general and administrative component as determined pursuant to subparagraph (xi) of this paragraph.

(xiii) Provider direct care hours, which shall mean the quotient of the sum of base year salaried direct care hours (including production staff) and base year contracted direct care hours, divided by the billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xiv) Regional average clinical hourly wage, which shall mean the quotient of base year salaried clinical dollars for each provider in a DOH region, aggregated for all such providers in such region, divided by base year salaried clinical hours for each provider in a DOH region, aggregated for all such providers in such region.

(xv) Provider average clinical hourly wage, which shall mean the quotient of base year salaried clinical dollars of a provider divided by base year salaried clinical hours of such provider.

(xvi) Provider salaried clinical hours, which shall mean the quotient of base year salaried clinical hours of a provider, divided by the billed units for the base year, and such quotient shall be multiplied by the rate sheet units for the initial period for such provider.

(xvii) Regional average contracted clinical hourly wage, which shall mean the quotient of contracted clinical dollars for each provider in a DOH region, aggregated for all such providers in such region, divided by the base year contracted clinical hours for each provider in a DOH region, aggregated for all such providers in such region.

(xviii) Provider contracted clinical hours, which shall mean the quotient of a provider’s contracted clinical hours for the base year, divided by the billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xix) Provider direct care hourly rate-adjusted for wage equalization factor, which shall mean the sum of the provider average direct care hourly rate, as determined pursuant to subparagraph (xii) of this paragraph, multiplied by seventy-five hundredths and the applicable regional average direct care hourly rate, as determined pursuant to subparagraph (vi) of this paragraph, multiplied by twenty-five hundredths.

(xx) Provider clinical hourly wage – adjusted for wage equalization factor, which shall mean the sum of the provider average clinical hourly wage, as determined pursuant to subparagraph (xv) of this paragraph, multiplied by seventy-five hundredths and the applicable regional average clinical hourly wage, as computed in subparagraph (xiv) of this paragraph, multiplied by twenty-five hundredths.

(xxi) Provider reimbursement for direct care hourly rate, which shall mean the product of the calculated provider direct care hours as determined pursuant to subparagraph (xiii) of this paragraph and the provider direct care hourly rate-adjusted for wage equalization factor as computed in subparagraph (xix) of this paragraph.

(xxii) Provider reimbursement for clinical hourly wage, which shall mean the product of the provider salaried clinical hours as determined pursuant to subparagraph (xvi) of this paragraph and the provider clinical hourly wage-adjusted for wage equalization factor as determined pursuant to subparagraph (xx) of this paragraph.

(xxiii) Provider reimbursement from contracted clinical hourly wage, which shall mean the product of the provider contracted clinical hours as determined pursuant to subparagraph (xviii) of this paragraph and the applicable regional average contracted clinical hourly wage as determined pursuant to subparagraph (xvii) of this paragraph.

(xxiv) Provider facility reimbursement, which shall mean the quotient of the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation equipment, insurance – property and casualty, housekeeping and maintenance staff, and program administration property the base year for a provider, divided by provider billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xxv) Provider to/from transportation reimbursement, which shall mean the quotient of the to/from transportation allocation for the base year, divided by the provider billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xxvi) Provider operating revenue, which shall mean the sum of provider reimbursement for direct care hourly rate, as determined pursuant to subparagraph (xxi) of this paragraph, the provider reimbursement for clinical hourly wage as determined pursuant to subparagraph (xxii) of this paragraph, the provider reimbursement from contracted clinical hourly wage as determined pursuant to subparagraph (xxiii) of this paragraph, the provider facility reimbursement as determined pursuant to subparagraph (xxiv) of this paragraph, and provider to/from transportation reimbursement as determined pursuant to subparagraph (xxv) of this paragraph.

(xxvii) Statewide budget neutrality adjustment factor for operating dollars, which shall mean the quotient of the operating revenue from all provider rate sheets in effect on June thirtieth, two thousand fifteen, divided by provider operating revenue, as determined pursuant to subparagraph (xxvi) of this paragraph, for all providers.

(xxviii) Total provider operating revenue-adjusted, which shall mean the product of the provider operating revenue as determined pursuant to subparagraph (xxvi) of this paragraph and the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (xxvii) of this paragraph. The final daily operating rate shall be determined by dividing the total provider operating revenue-adjusted, as determined by subparagraph (xxviii) of this paragraph, by the applicable provider rate sheet units for the initial period.

(2) Alternative operating component. For providers that did not submit a cost report or submitted a cost report that was incomplete for prevocational services for the base year, the final daily operating rate shall be a regional daily operating rate. This rate shall be the sum of:

(i) The product of the applicable regional average direct care hourly rate, as determined pursuant to subparagraph (vi) of paragraph (1) of this subdivision, and the applicable regional average direct care hours, which shall mean the quotient of base year salaried and contracted direct care hours (including production workers) for each provider in a DOH region, aggregated for all such providers in such region, divided by the billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region; and

(ii) the product of the applicable regional average clinical hourly wage, as determined pursuant to subparagraph (xiv) of paragraph (1) of this subdivision, and the applicable regional average clinical hours, which shall mean the quotient of base year salaried and contracted clinical hours for each provider in a DOH region, aggregated for all such providers in such region, divided by the billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region; and

(iii) the applicable regional average facility reimbursement, which shall mean the quotient of the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation, insurance – property and casualty, housekeeping and maintenance staff, and program administration property for the base year divided by the billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region; and

(iv) the applicable regional average to/from transportation reimbursement which shall mean the quotient of the to/from transportation allocation for the base year divided by the provider billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region.

Such sum shall then be multiplied by the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (xxvii) of paragraph (1) of this subdivision.

(3) Capital component.

(i) For Capital Assets Approved on or after July first, two thousand fifteen. OPWDD regulations under 14 NYCRR Subpart 635-6 establish standards and criteria for calculating provider reimbursement for the acquisition and lease of real property assets which require approval by the office for people with developmental disabilities. The regulations also address associated depreciation and related financing expenses. The rate will include costs for actual straight line depreciation, interest expense, financing expenses, and lease cost.

In no case will the total capital reimbursement associated with the capital asset exceed the total acquisition, renovation and financing cost associated with a capital asset. The asset life for building acquisitions shall be twenty-five years.

(ii) For Capital Assets Approved Prior to July first, two thousand fifteen. The State will identify each asset by provider, and provide a schedule of these assets identifying: total actual cost, reimbursable cost determined by the prior approval, total financing cost, allowable depreciation and allowable interest for the remaining useful life as determined by the prior approval, and the allowable reimbursement for each year of the remaining useful lives.

In no case will the total reimbursable depreciation or principal amortization and total interest associated with the capital asset exceed the total acquisition, renovation and financing cost associated with a capital asset.

(iii) Notification to Providers. 14 NYCRR Subpart 635-6 contains the criteria and standards associated with capital costs and reimbursement. Each provider will receive a schedule of approved reimbursable costs that is being used to establish the real property capital component of the provider’s reimbursement rate.

(iv) Rate for capital assets approved on or after July first, two thousand fifteen. The rate shall include the approved appraised costs of an acquisition or fair market value of a lease, and estimated costs for renovations, interest, soft costs and start-up expenses. Such costs shall be included in the rate as of the date when prevocational services are first provided at the site, continuing until such time as actual costs are submitted to the State. Estimated costs shall be submitted in lieu of actual costs for a period no greater than two years. If actual costs are not submitted to the State within two years from the date when prevocational services were first provided at the site, the amount of capital costs included in the rate shall be zero for each period in which actual costs are not submitted. The Department may retroactively adjust the capital component.

(v) Cost verified rates for capital assets approved on or after July first, two thousand fifteen. The provider shall submit to the State supporting documentation of actual costs. Actual costs shall be verified by the State reviewing the supporting documentation of such costs. A provider submitting such actual costs shall certify that the reimbursement requested reflects allowable capital costs and that such costs were actually expended by such provider. Under no circumstances shall the amount included in the rate under this subparagraph exceed the amount authorized in the approval process. Capital costs shall be depreciated over a twenty-five year period for acquisition of properties or the life of the lease for leased sites. Capital improvements shall be depreciated over the life of the asset. The amortization of interest shall not exceed the life of the loan taken. Amortization or depreciation shall begin upon certification by the provider of such costs. Start-up costs may be amortized over a one year period beginning with site opening. If actual costs are not submitted to the State within two years from the date when prevocational services were first provided at the site, the amount of capital costs included in the rate shall be zero for each period in which actual costs are not submitted.

(vi) Capital reimbursement schedule. Beginning with the cost reporting period ending December thirty-first, two thousand fourteen, each provider shall submit to OPWDD, as part of the annual cost report, a capital reimbursement schedule.

This schedule will specifically identify the differences, by capital reimbursement item, between the amounts reported on the certified cost report, and the reimbursable items, including depreciation, interest and lease cost from the schedule of approved reimbursable capital costs.

The provider’s independent auditor will apply procedures to verify the accuracy and completeness of the capital reimbursement schedule.

The Department will retroactively adjust capital reimbursement based on the actual cost verification process as described in subparagraph (v) of this paragraph.

(d) Respite (hourly and free-standing).

(1) Operating component. Allowable operating costs shall include costs identified in the consolidated fiscal reports and reimbursement for such costs shall be inclusive of the following components:

(i) Regional average direct care wage, which shall mean the quotient of base year salaried direct care dollars for each provider in a DOH region, aggregated for all such providers in such region, divided by base year salaried direct care hours for each provider in a DOH region, aggregated for all such providers in such region.

(ii) Regional average employee-related component, which shall mean the quotient of the sum of vacation leave accruals and total fringe benefits for the base year for each provider in a DOH region, aggregated for all such providers in such region, divided by base year salaried direct care dollars for each provider in a DOH region, aggregated for all such providers in such region, and such quotient shall be multiplied by the applicable regional average direct care wage as determined by subparagraph (i) of this paragraph.

(iii) Regional average program support component, which shall mean the quotient of the sum of transportation related-participant, staff travel, participant incidentals, expensed adaptive equipment, sub-contract raw materials, participant wages-non-contract, participant wages-contract, participant fringe benefits, staff development, supplies and materials-non-household, other-OTPS, lease/rental vehicle, depreciation-vehicle, interest-vehicle, other-equipment, other than to/from transportation allocation, salaried support dollars (excluding housekeeping and maintenance staff) and salaried program administration dollars for the base year for each provider in a DOH region, aggregated by all such providers in such region, divided by the total base year salaried direct care dollars of all providers in a DOH region, and such quotient shall be multiplied by the applicable regional average direct care wage as determined pursuant to subparagraph (i) of this paragraph.

(iv) Regional average direct care hourly rate-excluding general and administrative costs, which shall mean the sum of the applicable regional average direct care wage as determined pursuant to subparagraph (i) of this paragraph, the applicable regional average employee-related component as determined pursuant to subparagraph (ii) of this paragraph, and the applicable regional average program support component as determined pursuant to subparagraph (iii) of this paragraph.

(v) Regional average general and administrative component, which shall mean the quotient of the sum of the insurance-general and agency administration allocation for the base year for each provider in a DOH region, aggregated for all such providers in such region, divided by (the sum of total program/site costs and other than to/from transportation allocation, less the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation equipment, total property-provider paid, housekeeping and maintenance staff, salaried clinical dollars, and contracted clinical dollars for the base year for each provider in a DOH region, aggregated for all providers in such region). The regional average direct care hourly rate-excluding general and administrative costs, as determined pursuant to subparagraph (iv) of this paragraph, shall then be divided by (one minus the applicable regional average general and administrative quotient), from which the applicable regional average direct care hourly rate-excluding general and administrative costs, as computed in subparagraph (iv) of this paragraph, shall be subtracted.

(vi) Regional average direct care hourly rate, which shall mean the sum of the applicable regional average direct care wage as determined pursuant to subparagraph (i) of this paragraph, the applicable regional average employee-related component as determined pursuant to subparagraph (ii) of this paragraph, the applicable regional average program support component as determined pursuant to subparagraph (iii) of this paragraph, and the applicable regional average general and administrative component as computed in subparagraph (v) of this paragraph.

(vii) Provider average direct care wage, which shall mean the quotient of base year salaried direct care dollars divided by the base year salaried direct care hours of a provider.

(viii) Provider average employee-related component, which shall mean the quotient of the sum of vacation leave accruals and fringe benefits for the base year for each provider, divided by base year salaried direct care dollars of a provider, and such quotient shall be multiplied by the provider average direct care wage as computed in subparagraph (vii) of this paragraph.

(ix) Provider average program support component, which shall mean the quotient of the sum of transportation related-participant staff travel, participant incidentals, expensed adaptive equipment, sub-contract raw materials, participant wages-non-contract, participant wages-contract, participant fringe benefits, staff development, supplies and materials-non-household, other-OTPS, lease/rental vehicle, depreciation-vehicle, interest-vehicle, other-equipment, other than to/from transportation allocation, salaried support dollars (excluding housekeeping and maintenance staff) and salaried program administration dollars for the base year for a provider, divided by the base year salaried direct care dollars of such provider, and such quotient shall be multiplied by the provider average direct care wage as computed in subparagraph (vii) of this paragraph.

(x) Provider average direct care hourly rate-excluding general and administrative costs, which shall mean the sum of the provider average direct care wage as determined pursuant to subparagraph (vii) of this paragraph, the provider average employee-related component as determined pursuant to subparagraph (viii) of this paragraph, and the provider average program support component as determined pursuant to subparagraph (ix) of this paragraph for each provider.

(xi) Provider average general and administrative component, which shall mean the quotient of the sum of insurance-general and agency administration allocation for the base year for a provider, divided by (the sum of total program/site costs and other than to/from transportation allocation less the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation equipment, insurance – property and casualty, total property-provider paid, housekeeping and maintenance staff, salaried clinical dollars, and contracted clinical dollars for a provider) for the base year. The provider average direct care hourly rate-excluding general and administrative costs, as computed in subparagraph (x) of this paragraph, shall then be divided by (one minus the applicable provider average general and administrative quotient), from which the provider average direct care hourly rate-excluding general and administrative costs, as computed in subparagraph (x) of this paragraph, shall be subtracted.

(xii) Provider average direct care hourly rate, which shall mean the sum of the provider average direct care wage as determined pursuant to subparagraph (vii) of this paragraph, the provider average employee-related component as determined pursuant to subparagraph (viii) of this paragraph, the provider average program support component as determined pursuant to subparagraph (ix) of this paragraph, and the provider average general and administrative component as determined pursuant to subparagraph (xi) of this paragraph.

(xiii) Provider direct care hours, which shall mean the quotient of the sum of base year salaried direct care hours and base year contracted direct care hours, divided by the billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xiv) Regional average clinical hourly wage, which shall mean the quotient of base year salaried clinical dollars for each provider in a DOH region, aggregated for all such providers in such region, divided by base year salaried clinical hours for each provider in a DOH region, aggregated for all such providers in such region.

(xv) Provider average clinical hourly wage, which shall mean the quotient of base year salaried clinical dollars of a provider divided by base year salaried clinical hours of such provider.

(xvi) Provider salaried clinical hours, which shall mean the quotient of base year salaried clinical hours of a provider, divided by the billed units for the base year, and such quotient shall be multiplied by the rate sheet units for the initial period for such provider.

(xvii) Regional average contracted clinical hourly wage, which shall mean the quotient of contracted clinical dollars for each provider in a DOH region, aggregated for all such providers in such region, divided by the base year contracted clinical hours for each provider in a DOH region, aggregated for all such providers in such region.

(xviii) Provider contracted clinical hours, which shall mean the quotient of a provider’s contracted clinical hours for the base year, divided by the billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xix) Provider direct care hourly rate-adjusted for wage equalization factor, which shall mean the sum of the provider average direct care hourly rate, as determined pursuant to subparagraph (xii) of this paragraph, multiplied by seventy-five hundredths and the applicable regional average direct care hourly rate, as determined pursuant to subparagraph (vi) of this paragraph, multiplied by twenty-five hundredths.

(xx) Provider clinical hourly wage – adjusted for wage equalization factor, which shall mean the sum of the provider average clinical hourly wage, as determined pursuant to subparagraph (xv) of this paragraph, multiplied by seventy-five hundredths and the applicable regional average clinical hourly wage, as computed in subparagraph (xiv) of this paragraph, multiplied by twenty-five hundredths.

(xxi) Provider reimbursement for direct care hourly rate, which shall mean the product of the calculated provider direct care hours as determined pursuant to subparagraph (xiii) of this paragraph and the provider direct care hourly rate-adjusted for wage equalization factor as computed in subparagraph (xix) of this paragraph.

(xxii) Provider reimbursement for clinical hourly wage, which shall mean the product of the provider salaried clinical hours as determined pursuant to subparagraph (xvi) of this paragraph and the provider clinical hourly wage-adjusted for wage equalization factor as determined pursuant to subparagraph (xx) of this paragraph.

(xxiii) Provider reimbursement from contracted clinical hourly wage, which shall mean the product of the provider contracted clinical hours as determined pursuant to subparagraph (xviii) of this paragraph and the applicable regional average contracted clinical hourly wage as determined pursuant to subparagraph (xvii) of this paragraph.

(xxiv) Provider facility reimbursement, which shall mean the quotient of the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation equipment, insurance – property and casualty, housekeeping and maintenance staff, and program administration property the base year for a provider, divided by provider billed units for the base year, and such quotient shall be multiplied by rate sheet units for the initial period.

(xxv) Provider operating revenue, which shall mean the sum of provider reimbursement for direct care hourly rate as determined pursuant to subparagraph (xxi) of this paragraph, the provider reimbursement for clinical hourly wage as determined pursuant to subparagraph (xxii) of this paragraph, the provider reimbursement from contracted clinical hourly wage as determined pursuant to subparagraph (xxiii) of this paragraph, and the provider facility reimbursement as determined pursuant to subparagraph (xxiv) of this paragraph.

(xxvi) Statewide budget neutrality adjustment factor for operating dollars, which shall mean the quotient of the operating revenue from all provider rate sheets in effect on June thirtieth, two thousand fifteen, divided by provider operating revenue, as determined pursuant to subparagraph (xxv) of this paragraph, for all providers.

(xxvii) Total provider operating revenue-adjusted, which shall mean the product of the provider operating revenue as determined pursuant to subparagraph (xxv) of this paragraph and the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (xxvi) of this paragraph.

The final daily operating rate shall be determined by dividing the total provider operating revenue-adjusted, as determined by subparagraph (xxvii) of this paragraph, by the applicable provider rate sheet units for the initial period.

(2) Alternative operating component. For providers that did not submit a cost report or submitted a cost report that was incomplete for free-standing or hourly respite services for the base year, the final daily operating rate shall be a regional daily operating rate. This rate shall be the sum of:

(i) The product of the applicable regional average direct care hourly rate, as determined pursuant to subparagraph (vi) of paragraph (1) of this subdivision, and the applicable regional average direct care hours, which shall mean the quotient of base year salaried and contracted direct care hours for each provider in a DOH region, aggregated for all such providers in such region, divided by the billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region; and

(ii) the product of the applicable regional average clinical hourly wage, as determined pursuant to subparagraph (xiv) of paragraph (1) of this subdivision, and the applicable regional average clinical hours, which shall mean the quotient of base year salaried and contracted clinical hours for each provider in a DOH region, aggregated for all such providers in such region, divided by the billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region; and

(iii) the applicable regional average facility reimbursement, which shall mean the quotient of the sum of food, repairs and maintenance, utilities, expensed equipment, household supplies, telephone, lease/rental equipment, depreciation, insurance – property and casualty, housekeeping and maintenance staff, and program administration property for the base year, divided by the billed units for the base year for each provider in a DOH region, aggregated for all such providers in such region.

Such sum shall then be multiplied by the statewide budget neutrality adjustment factor for operating dollars as determined pursuant to subparagraph (xxvi) of paragraph (1) of this subdivision.

(3) Capital component.

(i) For free-standing respite sites.

A. The rate shall be determined by dividing the approved annual costs by 12. Capital costs shall be determined in accordance with 14 NYCRR Subpart 635-6.

B. The capital rate shall be paid monthly.

Note: The provisions of this paragraph do not apply to capital approved by OPWDD prior to July first, two thousand fifteen.

(ii) Initial rate for capital assets approved on or after July first, two thousand fifteen. The rate shall include the approved appraised costs of an acquisition or fair market value of a lease, and estimated costs for renovations, interest, soft costs and start-up expenses. Such costs shall be included in the rate as of the date of certification of the site, continuing until such time as actual costs are submitted to the State. Estimated costs shall be submitted in lieu of actual costs for a period no greater than two years. If actual costs are not submitted to the State within two years from the date of site certification, the amount of capital costs included in the rate shall be zero for each period in which actual costs are not submitted. The Department may retroactively adjust the capital component.

(iii) Cost verified rates for capital assets approved on or after July first, two thousand fifteen. The provider shall submit to the State supporting documentation of actual costs. Actual costs shall be verified by the State reviewing the supporting documentation of such costs. A provider submitting such actual costs shall certify that the reimbursement requested reflects allowable capital costs and that such costs were actually expended by such provider. Under no circumstances shall the amount included in the rate under this subparagraph exceed the amount authorized in the approval process. Capital costs shall be depreciated over a twenty-five year period for acquisition of properties or the life of the lease for leased sites. Capital improvements shall be depreciated over the life of the asset. The amortization of interest shall not exceed the life of the loan taken. Amortization or depreciation shall begin upon certification by the provider of such costs. Start-up costs may be amortized over a one year period beginning with site certification. If actual costs are not submitted to the State within two years from the date of site certification, the amount of capital costs included in the rate shall be zero for each period in which actual costs are not submitted.

(e) Prevocational (community-based).

(1) Fee schedule. Effective July first, two thousand fifteen, prevocational (community-based) services will be reimbursed according to the fee schedule below:

 

Prevocational (community-based)

OPWDD Region

Unit of Service

Individual (serving 1)

Group (serving 2)

Group (serving 3+)

1

Hourly

$41.57

$25.98

$20.78

2

Hourly

$43.92

$27.45

$21.96

3

Hourly

$42.90

$26.81

$21.45

 

(f) Supported employment.

(1) Fee schedule. Effective July first, two thousand fifteen, supported employment will be reimbursed according to the fee schedule below:

 

Supported employment (Intensive Phase)

OPWDD Region

Unit of Service

Intensive-1 (serving 1)

Intensive-2 (serving 2+)

1

Hourly

$67.88

$27.15

2

Hourly

$62.19

$24.88

3

Hourly

$54.98

$21.99

 

 

    Supported employment (Extended Phase)

    OPWDD Region

    Unit of Service

    Extended-1 (serving 1)

    Extended-2 (serving 2+)

    1

    Hourly

    $67.88

    $27.15

    2

    Hourly

    $62.19

    $24.88

    3

    Hourly

    $54.98

    $21.99

     

      (g) Residential habilitation (family care).

      (1) Fee schedule. Effective July first, two thousand fifteen, residential habilitation (family care) will be reimbursed according to the fee schedule below:

       

      Residential habilitation (family care) – Base Fee

      DOH Region

      Unit of Service

      Fee

      1

      Daily

      $42.06

      2

      Daily

      $43.61

      3

      Daily

      $35.58

      4

      Daily

      $41.53

       

       

        Residential habilitation (family care) – Difficulty of Care (DOC) Add-on

         

        Unit of Service

        ISPM level 1

        ISPM level 2

        ISPM level 3

        ISPM level 4

        ISPM level 5

        ISPM level 6

        Family Care

        Daily

        $5.56

        $10.87

        $11.12

        $16.43

        $32.26

        $37.57

         

        Effective Date: 
        Wednesday, April 13, 2016
        Statutory Authority: 
        Public Health Law, Section 201