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Title: Section 86-7.1 - Definitions

Effective Date


Section 86-7.1 Definitions. As used in this Subpart, the following words shall have following meanings:

(a) "Assisted living program" shall mean an entity as defined in paragraph (a) of subdivision (1) of section 461-1 of the social services law.

(b) "Services" shall mean all services for which full payment to an assisted living program is included in the rate of payment which shall consist of the following: nursing services, personal care services, home health aide services, physical therapy, occupational therapy, speech therapy, medical supplies and equipment not requiring prior approval, personal emergency response services and adult day health care in a program approved by the commissioner and which the assisted living program shall provide directly, or arrange for the provision of, through contract(s) with a social services district, a long term home health care program or a certified home health agency, or other qualified providers.

(c) "Patient classification groups" shall mean patient categories contained in the classification system, Resources Utilization Groups-II (RUG-II), which identifies the relative resource consumption required by different types of residential health care facility (RHCF) patients as specified in Appendix 13-A of this Title.

(d) "Regions" shall mean the sixteen regions within the State into which residential health care facilities are grouped, by county, as identified in Appendix 13-A of this Title.

(e) "Rate of payment" shall mean the capitated per diem rate of reimbursement established pursuant to this Subpart for governmental agencies for services provided directly by an assisted living program or provided through contract(s) with eligible providers.

(f) "Per Diem" shall mean the unit of measure denoting services rendered to one patient between the census taking hour on two successive days. In computing per diems, the day of admission shall be counted but not the day of discharge. When a patient is admitted and discharged on the same day, this period shall be counted as one per diem.

(g) "Roll factor" shall mean the cumulative result of multiplying one year's trend (inflation) factor times one or more other year's trend factor which is used to inflate costs from a base period to a rate period.


VOLUME A-2 (Title 10)