Home » 2016 Issues » April 13, 2016 » HLT-16-15-00014-A Rate Rationalization—Prevocational Services, Respite, Supported Employment and Residential Habilitation
HLT-16-15-00014-A Rate Rationalization—Prevocational Services, Respite, Supported Employment and Residential Habilitation
4/13/16 N.Y. St. Reg. HLT-16-15-00014-A
NEW YORK STATE REGISTER
VOLUME XXXVIII, ISSUE 15
April 13, 2016
RULE MAKING ACTIVITIES
DEPARTMENT OF HEALTH
NOTICE OF ADOPTION
I.D No. HLT-16-15-00014-A
Filing No. 352
Filing Date. Mar. 25, 2016
Effective Date. Apr. 13, 2016
Rate Rationalization—Prevocational Services, Respite, Supported Employment and Residential Habilitation
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Addition of Subpart 86-13 to Title 10 NYCRR.
Statutory authority:
Public Health Law, section 201
Subject:
Rate Rationalization—Prevocational Services, Respite, Supported Employment and Residential Habilitation
Purpose:
To establish new rate methodology effective July 1, 2015.
Substance of final rule:
This regulation establishes a new reimbursement methodology for Prevocational (Site-based and Community-based), Respite (Hourly and Free-standing), Supported Employment Services, and Residential Habilitation (Family Care) programs, which will be effective July 1, 2015.
For Prevocational (Site-based) and Respite (Hourly and Free-standing) programs, the methodology will include the following elements:
1) The use of a base period Consolidated Fiscal Report (CFR) for the period of January 1, 2013 – December 31, 2013 for calendar year filers or the period of July 1, 2012 –June 30, 2013 for fiscal year filers.
2) The assignment of geographic location, based on CFR information and consistent with Department of Health (DOH) regions.
3) Operating, facility and capital components.
• The operating component recognizes a blend of actual provider costs and average regional costs.
• The facility component recognizes actual provider costs.
• The methodology for the capital component has not been significantly changed from that of the previous reimbursement methodology, except that the initial reimbursement will remain in the rate for only two years from the date of site certification unless actual costs are verified with the Department of Health.
4) Wage equalization factors.
5) A budget neutrality factor.
6) A two year phase-in period for transition to the methodology.
For Prevocational (Community-based) Services, Supported Employment Services and Residential Habilitation (Family Care) programs, the methodology will include the following elements:
1) The use of a base period Consolidated Fiscal Report (CFR) for the period of January 1, 2013 – December 31, 2013 for calendar year filers or the period of July 1, 2012 –June 30, 2013 for fiscal year filers to calculate a fee reimbursement schedule.
2) The assignment of geographic location, based on CFR information.
• For Residential Habilitation (Family Care), the geographic location will be consistent with DOH regions.
• For Prevocational (Community-based) Services and Supported Employment Services, the geographic location will be consistent with Office for People With Developmental Disabilities (OPWDD) regions.
Final rule as compared with last published rule:
Nonsubstantive changes were made in section 86-13.3.
Text of rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, (518) 473-7488, email: regsqna@health.ny.gov
Revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement
Changes made to the last published rule do not necessitate revision to the previously published RIS, RFA, RAFA and JIS.
Assessment of Public Comment
The Department of Health (DOH) received one set of comments during the public comment period from the Cerebral Palsy Associations of New York State.
Comment:
DOH recognized the fact that the 7/1/15 pre-vocational service fees for specialized template populations, as calculated and presented in the proposed regulation, need to be revised to incorporate compensation funding increases for direct support professionals that were effective 1/1/15 and 4/1/15 for clinical employees.
To be consistent, DOH must also recognize the need for similar revisions to the proposed 7/1/15 community pre-vocational and Supported Employment (SEMP) fees since these proposed fees also did not include either of these compensation funding increases when they were developed.
Response:
DOH will not change the regulation at this time. However, the comment will be taken under advisement for consideration when subsequent amendments are made to the regulation.
Comment:
We are asking that DOH recognize and make an appropriate adjustment in the calculation of the SEMP and pre-vocational service fees as well as in Agency respite rates to recognize the cost associated with a NYC law (called the Earned Sick Time Act) that went into effect on 4/1/14. Many of the new key provisions of the Act will have direct fiscal impact on our OPWDD funded providers that operate in New York City – resulting in increased expenses not previously incurred. Some of the key provisions of the Act are attached to the letter.
Obviously, of major concern is that now NYC providers will be required to provide sick leave to basically ALL part-time employees, substitute direct support professionals, as well as per diem professionals, and clinical staff. This is a NEW cost that is now mandated by this NYC law, so an adjustment will need to be made by DOH at least until such time as the 7/1/14-6/30/15 cost period or after is used to establish fees/rates. This also impacts other OPWDD service rates (IRA residential and day habilitation and ICF services) that are being revised effective 7/1/15.
Response:
DOH will not change the regulation as this time. However, the comment will be taken under advisement for consideration when subsequent amendments are made to the regulation.
Comment:
The DOH regulations need to be clear that the SEMP fees do not include the cost related to the generic round trip transportation of an individual with developmental disabilities between their home and their job.
Response:
DOH will not change the regulation as this time. However, the comment will be taken under advisement for consideration when subsequent amendments are made to the regulation.
Comment:
Community pre-vocation is a new OPWDD service with no prior programmatic or cost experience. The regional fees developed by DOH were developed based upon the existing community habilitation program and fees with an adjustment for noncertified site cost. The new fee schedule for Community Pre-vocational services is very much lower than those for Supported Employment in both the intensive and extended phases. People involved in pre-vocational services have been enrolled in that program because they need more supports in order to be ready to work. The supports that they will need will be more intensive and more structured due to their higher needs levels. Therefore, it is not likely that the proposed fees will be sufficient. Once sufficient program and cost experience is obtained, DOH will need to modify the fee schedule accordingly.
Response:
DOH will not change the regulation at this time. However, the comment will be taken under advisement for consideration when subsequent amendments are made to the regulation.
