Computation of basic rates for day health care services
provided by freestanding ambulatory care facilities to patients with acquired
immune deficiency syndrome (AIDS), other human immunodeficiency virus (HIV)
related illnesses and other high-need populations that, regardless of their HIV
status and in the discretion of the commissioner, would benefit from receiving
adult day health care services. Effective April 1, 1994 and thereafter,
reimbursement for adult day health care services that are provided to
registrants with acquired immune deficiency syndrome (AIDS), other human
immunodeficiency virus (HIV) related illnesses and, effective April 1, 2017,
that are provided to registrants who are otherwise considered at the discretion
of the commissioner to be part of a high-need population that, regardless of
their HIV status, would benefit from receiving these adult day health care
services shall be established pursuant to this section.
(a) For payments made pursuant to this
section for day health care services rendered to patients who have AIDS or
HIV-related illness and other high-need registrants, reimbursement shall be a
single price per visit, with not more than one reimbursable visit per day per
patient. For 1993 an initial price shall be determined taking into
consideration reasonable projections of necessary costs, and the costs and
statistics contained in proposed annual budgets for this service as defined in
section
759.1(d)
of this Title, including, but not limited to, utilization, staffing and
salaries. For subsequent rate periods the price established pursuant to this
section shall be adjusted by the trend factor described in subdivision (e) of
this section after considering the actual allowable expenditures and statistics
for the year which ended 15 months prior to the rate period.
(b) To be eligible to receive reimbursement
pursuant to this section, a free-standing ambulatory care facility must be
certified to provide general medical services and day health care services for
AIDS/HIV patients and, effective April 1, 2017, to other high-need
registrants.
(c) The price
established pursuant to this section shall be full reimbursement for the
following:
(1) physician services, nursing
services, and other related professional expenses directly incurred by the
licensed facility, including the provision of triage or sick call
services;
(2) space occupancy and
plant overhead costs;
(3)
administrative personnel, business office, data processing, recordkeeping,
housekeeping, food services, transportation, and other related facility
overhead expenses;
(4) all
ancillary services described in section
759.8 of this
Title and laboratory tests and diagnostic X-ray services appropriate to the
level of primary medical care required by the patient;
(5) all medical supplies, immunizations, and
drugs directly related to the provision of services.
(d) Components of the price may be adjusted
for service capacity, urban or rural location, and for regional differences in
wage levels, space occupancy, and facility overhead costs, by comparing
anticipated utilization and costs with actual experiences. The downstate region
shall be defined as the counties of Putnam, Rockland, Westchester, Bronx,
Kings, New York, Queens, Richmond, Nassau, and Suffolk and the upstate region
shall be defined as all remaining counties in the State.
(e) The commissioner shall establish trend
factors to project increases in prices for the effective period of the
reimbursement rates. The trend factors shall be developed using available price
indices including elements of the United States Department of Labor consumer
and producer price indices and special price indices developed by the
Commissioner for this purpose. The projected trend factors shall be updated on
an annual basis, based upon current and available data.