N.Y. Comp. Codes R. & Regs. Tit. 10 § 86-4.13 - Groupings
(a) For the purpose
of establishing reimbursable operating costs, facilities shall be compared on
the basis of the following general criteria:
(1) similarity of services; and
(2) regional economic factors.
(b) Comparisons using similarity
of services shall be based on the following:
(1) Comprehensive primary medical care
services shall mean those health care services organized to provide basic
medical care to the general population without regard to patient category or
characteristics such as health status, diagnosis, age or sex. Such primary
medical care services shall be provided by staff sufficient in number and
capable of delivering comprehensive primary medical care services. A facility
providing comprehensive primary medical care services as its principal mission
shall be categorized as a comprehensive primary medical care
facility.
(2) Limited primary
medical care services shall mean those health care services organized to
provide basic medical care to a population of individuals with a specific
medical condition or dysfunction. Such primary medical care services focus on
the medical care needs of this population that are incidental to, interrelated
with or a consequence of the specific primary medical diagnosis/disease
process. When limited primary medical care services are not the principal
mission of a facility, the facility providing limited primary medical care
services shall be categorized based on the services, as defined in this
section, which it provides as its principal mission and shall not be
categorized as a comprehensive primary medical care facility.
(3) Family planning services shall mean those
services organized to provide reproductive and/or gynecological related health
care services to men and women of reproductive age. A facility providing family
planning services as its principal mission shall be categorized as a family
planning facility.
(4) Abortion
services shall mean those services related to the termination of pregnancy
including services associated with verification of the pregnancy, abortion
counseling services and post-procedure examinations. Sterilization procedures
done as outpatient surgery shall be included in this category as well. A
facility providing abortion services as its principal mission shall be
categorized as an abortion facility.
(5) Developmentally disabled services shall
mean those services organized to provide ongoing/long-term rehabilitation
therapy services to individuals with developmentally related physical
disabilities. A facility providing developmentally disabled services as its
principal mission shall be categorized as a developmentally disabled services
facility.
(6) Rehabilitation
therapy services shall mean those services organized to provide episodic or
short-term restorative therapy services to individuals physically disabled from
causes that are predominantly other than developmentally related. A facility
providing such rehabilitation therapy services as its principal mission shall
be categorized as a rehabilitation therapy facility.
(7) Speech and hearing services shall mean
speech/language pathology and audiology services. A facility providing speech
and hearing services as its principal mission shall be categorized as a speech
and hearing facility.
(8) Dental
services shall mean those services organized to provide basic dental care to
the general population. A facility providing dental services as its principal
mission shall be categorized as a dental facility.
(9) Dialysis services shall mean
hemodialysis, peritoneal dialysis and home dialysis services provided to
patients with chronic renal disease. A facility providing dialysis services as
its principal mission shall be categorized as a dialysis facility.
(10) Optometric services shall mean optometry
and services related to eye and vision care. A facility providing optometric
services as its principal mission shall be categorized as an optometric
facility.
(11) Methadone
maintenance treatment services shall mean drug detoxification and drug
dependency counseling and rehabilitation services which include chemical
management of the patient with methadone. A facility providing methadone
maintenance treatment services as its principal mission and certified by the
Office of Alcoholism and Substance Abuse Services shall be categorized as a
methadone maintenance treatment program (MMTP) facility.
(12) Drug free services shall mean drug
dependency counseling and rehabilitation services, including incidental and
interrelated medical care services, provided in a drug free environment. A
facility providing drug free services as its principal mission shall be
categorized as a drug free facility.
(13) Child health services shall mean acute,
episodic, preventive and well child care services, including immunizations,
provided to the pediatric population. A facility providing child health
services as its principal mission shall be categorized as a child health
facility.
(14) A county sponsored
facility which does not provide comprehensive primary medical care services but
provides health care services such as dental, well child care, immunizations,
TB services, STD services, and prenatal and/or other reproductive related
health care services shall be categorized as a county sponsored multiservice
facility.
(c) Regional
economic factors shall be defined to mean significant differences in labor cost
experienced by facilities that are due to their geographic location and which
impact on the delivery of patient care services.
(d) For the purpose of comparison, when there
are fewer than three facilities defining a particular category of service as
their principal mission, the facilities will be treated as ungrouped until such
time as there are at least two other similar facilities.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.