N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-1.13 - Certified home health agency rates
(a) Effective January 1, 1988, reported costs
and statistics for a facility's annual fiscal period ending two years prior to
the rate period, trended pursuant to section
86-1.58 of
this Subpart, shall be used in computing Medicaid rates for care provided by
community-based home health agencies. No amount may be included in a rate that
is in excess of the agency charges or in excess of 110 percent of the weighted
average cost of all community-based agencies in their group. For hospital-based
home health agencies, no amount may be included in a rate that is in excess of
110 percent of the weighted average cost of community-based agencies in their
area.
(b) The commissioner shall
establish separate payment rates for home care nursing services provided by
Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs
(LTHHCPs) to patients diagnosed with Acquired Immune Deficiency Syndrome (AIDS)
as defined by ICD-9 codes 042, 043 and 044. Such rates shall be regional
service prices increased by a case mix adjustment factor to reflect the
additional resource utilization needed in home care treatment of AIDS patients
in excess of resource utilization needed for an average mix of home care
patients.
(1) Regional nursing service prices
shall be computed based upon average nursing costs per visit calculated by
aggregating the base year allowable costs and statistics reported by community
based certified home health agencies located within each of four regions;
provided, however, that effective with rate periods commencing January 1, 1990,
the calculation of regional nursing service prices pursuant to this paragraph
shall also incorporate base year allowable costs and statistics for LTHHCPs.
The regions shall be New York City Region which is comprised of New York,
Kings, Queens, Richmond, Bronx, Westchester, Rockland and Putnam Counties;
Nassau-Suffolk Region which is comprised of Nassau and Suffolk Counties; Rural
Region which is comprised of all Non-Standard Metropolitan Statistical Area
counties; All Other Metropolitan Region which is comprised of all counties not
included in the other regions.
(2)
For agencies in the All Other Metropolitan Region group only, the base price
will be adjusted by Wage Index Factors. Wage Index Factors shall be calculated
for and applied to each of the Standard Metropolitan Statistical Areas (SMSA)
within the All Other Metropolitan Region. The SMSA's are:
(i) Albany-Schenectady-Troy;
(ii) Syracuse;
(iii) Binghamton;
(iv) Buffalo;
(v) Elmira;
(vi) Glens Falls;
(vii) Niagara Falls;
(viii) Orange County;
(ix) Poughkeepsie;
(x) Rochester;
(xi) Utica-Rome;
The wage index factor shall be determined by weighting the registered nurse, licensed practical nurse and nurse's aide salary categories based upon the proportion of skilled and aide visits. The labor portion of the base price shall be multiplied by the respective wage index factor for each of the eleven SMSA's in the All Other Metropolitan Region group.
(3) The
base regional service prices computed in accordance with this subdivision shall
be increased by a trend factor developed in accordance with section
86-1.58 of
this Subpart.
(4) The trended
regional nursing service prices shall be increased by an AIDS case mix
adjustment factor of 1.2988 to arrive at regional nursing service rates for
homecare services provided by CHHAs and LTHHCPs to patients diagnosed with
AIDS.
(5) Adjustments to regional
nursing service prices established by this subdivision shall be limited to
annual adjustments made pursuant to paragraphs (1) and (3) of subdivision (b)
of this section.
(c) The
department shall establish a cap on reimbursable base year administrative and
general costs equal to 30% of total reimbursable base year operational costs of
a provider of services, excluding a provider of services reimbursed on an
initial budget basis, and a new provider, excluding changes in ownership or
changes in name, who begins operations in the year prior to the year which is
used as a base year in determining rates of payment. The cap on administrative
and general costs shall be applied after the application of the weighted
average cost of all community-based agencies in their group area, described in
this section.
Notes
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