Title: Section 86-13.2 - Definitions
86-13.2 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 prevocational and respite services, operating costs that are allowable under 14 NYCRR Section 635-10.4.
(c) Base year. The consolidated fiscal report period from which the initial period rate will be calculated. Such period shall be January first, two thousand thirteen through December thirty-first, two thousand thirteen for providers reporting on a calendar year basis and July first, two thousand twelve through June thirtieth, two thousand thirteen for providers reporting on a fiscal year basis.
(d) Base operating rate. Reimbursement amount calculated by dividing annual reimbursement by applicable annual units of service, both in effect on June thirtieth, two thousand fifteen.
(e) Department of Health (DOH) Regions. Regions as defined by DOH, 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: Five 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.
(f) Financing expenses. Interest expense and fees charged for financing of costs related to the purchase/acquisition, alteration, construction, rehabilitation and/or renovation of real property.
(g) Free-standing respite. Respite services provided in a free-standing respite facility under the home and community based services waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10.
(h) Hourly respite. Respite services provided outside of a free-standing respite center under the home and community based services waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10.
(i) Individual. Person receiving a service authorized by OPWDD.
(j) Initial period. July first, two thousand fifteen through June thirtieth, two thousand sixteen.
(k) Lease/rental and ancillary costs. A provider’s annual rental payments for real property and ancillary outlays associated with the property such as utilities and maintenance.
(l) Office for People With Developmental Disabilities (OPWDD) Regions. OPWDD regions are as follows:
(1) Region 1: Bronx, Kings, New York, Queens and Richmond counties.
(2) Region 2: Nassau, Putnam, Rockland, Suffolk, and Westchester counties.
(3) Region 3: All other counties in New York State.
(m) Operating costs. Provider costs related to the provision of prevocational services (site- based) and respite services (hourly and free-standing) identified in such provider’s cost reports.
(n) Prevocational services. Prevocational services provided under the home and community based services waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10 are defined as follows:
(1) Site based prevocational services are habilitation services that assist individuals to develop employment readiness skills and that are provided in non-residential facilities certified by OPWDD. The services consist of learning and work experiences that are not job-task specific but contribute to an individual’s ability to attain paid employment in the community.
(2) Community prevocational services are habilitation services that assist the individual to develop employment readiness skills and that are provided in the most integrated setting appropriate to the needs of the individual receiving such services. The services consist of learning and work experiences, including volunteer work, that are not job-task specific but contribute to an individual’s ability to attain paid employment in the community.
(o) Provider. An individual, corporation, partnership, or other organization to which OPWDD has issued an operating certificate or approval to operate a prevocational (site-based), prevocational (community-based), hourly respite, free-standing respite, residential habilitation (family care) or supported employment program, and for which DOH has issued a Medicaid provider agreement.
(p) Rate sheet units. The number of units for which OPWDD authorizes a provider to deliver services in a specific program.
(q) Reimbursable cost. The final allowable costs of the rate year after all audit and/or adjustments are made.
(r) Residential habilitation (family care). Residential habilitation (family care) services that are (1) provided under the home and community based services waiver operated by OPWDD, (2) provided pursuant to 14 NYCRR Subpart 635-10, and (3) provided by a family care home issued an operating certificate by OPWDD.
(s) 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.
(t) Supported employment services. Supported employment services provided under the home and community based services waiver operated by OPWDD and pursuant to 14 NYCRR Subpart 635-10.
(u) Target rate. The final rate in effect at the end of the transition period for prevocational services (site-based) determined using the rate year final reimbursable cost for prevocational services (site-based) for each respective provider divided by the final total of actual units of service for all individuals, regardless of payor.
(v) Units of service. The unit of measure for the following waiver services shall be:
(1) Prevocational (Site-Based) – daily.
(2) Prevocational (Community-Based) – hourly.
(3) Respite (Hourly and Free-standing) – hourly.
(4) Supported Employment – hourly.
(5) Residential habilitation (family care) – daily.
VOLUME A-2 (Title 10)