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Title: Section 86-10.2 - Definitions

Effective Date

04/22/2015

86-10.2 Definitions. As used in this Subpart, the following terms shall have the following meanings:

(a) Allowable capital costs. Capital costs that are allowable under 14 NYCRR Subpart 635-6.

(b) Allowable operating costs. In the case of residential habilitation services, operating costs that are allowable under 14 NYCRR paragraph 635-10.4 (b)(1) and subdivision 686.13(b); in the case of day habilitation services, operating costs that are allowable under 14 NYCRR paragraph 635-10.4(b)(2).

(c) Acuity factor. Factor developed through a regression analysis utilizing components of Developmental Disabilities Profile (DDP) scores, average residential bed size, Willowbrook class indicators and historical utilization data to predict direct care hours needed to serve individuals.

(d) Base year. The consolidated fiscal report period from which the initial period rate will be calculated. Such period shall be January first, two thousand eleven through December thirty-first, two thousand eleven for providers reporting on a calendar year basis and July first, two thousand ten through June thirtieth, two thousand eleven for providers reporting on a fiscal year basis.

(e) Base operating rate. Reimbursement amount calculated by dividing annual reimbursement by applicable annual units of service, both in effect on June thirtieth, two thousand fourteen.

(f) Community residence. A facility operated as a community residence under 14 NYCRR Part 686, including an individualized residential alternative.

(g) Day habilitation services. Day habilitation services provided under the home and community based services waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10.

(h) Department of Health (DOH) Regions. Regions as defined by the Department, assigned to providers based upon the geographic location of the provider’s headquarters as reported on the consolidated fiscal report. Such regions are as follows:

(1) Downstate: 5 boroughs of New York City, Nassau, Suffolk, Westchester;

(2) Hudson Valley: Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster;

(3) Upstate Metro: Albany, Erie, Fulton, Genesee, Madison, Monroe, Montgomery, Niagara, Onondaga, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming;

(4) Upstate Non-Metro: Any counties not listed in paragraphs (1), (2) or (3) of this subdivision.

(i) Developmental Disabilities Profile (DDP-2). The document titled Developmental Disabilities Profile (DDP-2) dated 7/10 and issued by OPWDD. This document, the
Developmental Disabilities Profile (DDP-2) User’s Guideand another document titled
Scoring the DDPare available during business hours and by appointment at the following locations:

(1) the Department of State, Division of Administrative Rules, One Commerce Plaza, 99 Washington Avenue, Albany NY 12231-0001

(2) OPWDD, Attention Public Access Officer, 44 Holland Avenue, Albany, NY 12229.

(j) Evacuation Score (E-Score). The score for a supervised community residence that is certified under Chapters 32 or 33 of the Residential Board and Care Occupancies of the NFPA 101 Life Safety Code (2000 edition) that is provided to the Department by OPWDD once a year. The E-score is described in the NFPA 101A
Guide on Alternative Approaches to Life Safety,2001 edition. The Life Safety Code and
Guide on Alternative Approaches to LifeSafety are available from the National Fire Protection Association, One Batterymarch Park, Quincy, MA 02169-7471; or is available during business hours and by appointment at the following locations:

(1) the Department of State, Division of Administrative Rules, One Commerce Plaza, 99 Washington Avenue, Albany, NY 12231-0001

(2) OPWDD, Attention Public Access Officer, 44 Holland Avenue, Albany, NY 12229.

(k) E-Score Factor. Factor derived from analysis of Evacuation Scores to adjust staffing needs necessary to address health and safety needs.

(l) Financing expenditures. Interest expense and fees charged for financing of costs related to the purchase/acquisition, alteration, construction, rehabilitation and/or renovation of real property.

(m) Individual. Person receiving a residential or day habilitation service.

(n) Initial period. July first, two thousand fourteen through June thirtieth, two thousand fifteen.

(o) Lease/rental and ancillary payments. A provider’s annual rental payments for real property and ancillary outlays associated with the property such as utilities and maintenance.

(p) Occupancy factor. Beginning July first, two thousand fifteen such factor will be an adjustment made prospectively at the beginning of the applicable rate year, based upon the previous years’ experience. Such adjustment shall be provider specific and shall be the lower of the provider’s actual vacancy or five percent.

(q) Operating costs. Provider costs related to the provision of day habilitation and residential habilitation services provided in a community residence and identified in such provider’s cost reports. With the exception of Live-In Caregiver services, allowable operating costs shall not include the costs of board.

(r) Provider - An individual, corporation, partnership or other organization to which OPWDD has issued an operating certificate to operate a community residence, and for which the NYS Department of Health has issued a Medicaid provider agreement, or an individual, corporation, partnership or other organization to which OPWDD has issued an operating certificate or approval to operate a day habilitation program, and for which the NYS Department of Health has issued a Medicaid provider agreement.

(s) Rate sheet capacity. The number of individuals for whom a provider is certified or approved by OPWDD to provide residential habilitation.

(t) Reimbursable cost. The final allowable costs of the rate year after all audit and/or adjustments are made.

(u) Residential habilitation. Residential habilitation services provided in a community residence, under the home and community based services waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10 and 14 NYCRR 671.

(v) Room and board. Room means hotel or shelter type expenses including all property related costs such as rental or depreciation related to the purchase of real estate and furnishings; maintenance, utilities and related administrative services. Board means three meals a day or any other full nutritional regimen.

(w) Start-up costs. Those costs associated with the opening of a new program. Start-up costs include pre-operational rent, utilities, staffing, staff training, advertising for staff, travel, security services, furniture, equipment and supplies.

(x) State supplement. Amount paid to a provider to cover Room and Board costs in excess of SSI and Supplemental Nutrition Assistance Program (SNAP) payments.

(y) Target rate. The final rate in effect at the end of the transition period for each waiver service determined using the rate year final reimbursable cost for each respective provider for each respective service divided by the final total of actual units of service for all individuals, regardless of payor.

(z) Units of service. The unit of measure for the following waiver services shall be:

(1) Residential habilitation provided in a supervised community residence - daily

(2) Residential habilitation provided in a supportive community residence - monthly

(3) Day habilitation - daily

Volume

VOLUME A-2 (Title 10)

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