Home » 2014 Issues » July 16, 2014 » PDD-28-14-00021-EP Supervised IRA/CR Residential Habilitation Unit of Service Change
PDD-28-14-00021-EP Supervised IRA/CR Residential Habilitation Unit of Service Change
7/16/14 N.Y. St. Reg. PDD-28-14-00021-EP
NEW YORK STATE REGISTER
VOLUME XXXVI, ISSUE 28
July 16, 2014
RULE MAKING ACTIVITIES
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
EMERGENCY/PROPOSED RULE MAKING
HEARING(S) SCHEDULED
I.D No. PDD-28-14-00021-EP
Filing No. 577
Filing Date. Jul. 01, 2014
Effective Date. Jul. 01, 2014
Supervised IRA/CR Residential Habilitation Unit of Service Change
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Proposed Action:
Amendment of sections 635-10.5(b) and 671.7 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, section 13.09(b)
Finding of necessity for emergency rule:
Preservation of public health, public safety and general welfare.
Specific reasons underlying the finding of necessity:
The emergency adoption of these amendments is necessary to protect the health, safety, and welfare of individuals receiving services in the OPWDD system.
The amendments are necessary to fully implement a new rate methodology for residential habilitation provided in non-state operated Individualized Residential Alternatives (IRAs) and Community Residences (CRs). OPWDD made commitments to the Centers for Medicare and Medicaid Services (CMS) in order to qualify for substantial federal funding, including its commitment to implement a new rate methodology in July 2014. The rate methodology includes a change in the unit of service for residential habilitation services delivered in supervised IRAs and CRs. To fulfill its commitment, OPWDD adopted proposed regulations to implement the rate setting methodology effective July, 2014 through the regular rulemaking process. However, there was not sufficient time to propose regulations concerning the implementation of the unit of service change through the regular rulemaking process.
The emergency/proposed regulations change the unit of service from a monthly to a daily unit of service and change the service documentation requirements. The regulations are necessary to enable provider agencies to receive reimbursement for residential habilitation services provided in supervised IRAs and CRs on or after July 1, 2014.
Further, if OPWDD did not promulgate these regulations on an emergency basis, OPWDD would fail to meet its commitment to CMS and would risk loss of the substantial federal funding that is contingent on this commitment. The loss of this federal funding could jeopardize the health, safety, and welfare of individuals receiving services in the OPWDD system, as without it, individuals would be at risk of receiving services that are inadequate or insufficient in meeting their needs.
Subject:
Supervised IRA/CR residential habilitation unit of service change.
Purpose:
To conform existing OPWDD regulations to the change in the unit of service from monthly to daily.
Public hearing(s) will be held at:
10:30 a.m., Sept. 2, 2014 at Office for People with Developmental Disabilities, Counsel's Office Conference Rm., 3rd Fl., 44 Holland Ave., Albany, NY; and 10:30 a.m., Sept. 3, 2014 at Office for People with Developmental Disabilities, Counsel's Office Conference Rm., 3rd Fl., 44 Holland Ave., Albany, NY.
Interpreter Service:
Interpreter services will be made available to hearing impaired persons, at no charge, upon written request submitted within reasonable time prior to the scheduled public hearing. The written request must be addressed to the agency representative designated in the paragraph below.
Accessibility:
All public hearings have been scheduled at places reasonably accessible to persons with a mobility impairment.
Text of emergency/proposed rule:
• Subdivision 635-10.5(b) is amended by the addition of a new paragraph (3) as follows and existing paragraphs (3)-(9) are renumbered to be (4)-(10):
(3) Reimbursement for residential habilitation services provided in non-state operated IRAs and CRs on or after July 1, 2014 shall be in accordance with the provisions of Subpart 641-1 of this Title. Subpart 641-1 supersedes the provisions of this subdivision for reimbursement of residential habilitation services provided in non-state operated supervised and supportive IRAs and CRs on or after July 1, 2014, except those provisions pertaining to enrollment and service days in paragraphs (9) - (13) of this subdivision.
Note: Subpart 641-1 includes a provision that changes the unit of service for residential habilitation services provided in non-state operated supervised IRAs and CRs from a monthly to a daily unit of service (See paragraphs (9) and (13) of this subdivision).
• Renumbered paragraph 635-105(b)(9) is amended as follows and existing subparagraphs (i)-(v) are renumbered to be (iii) -(vii):
(9) [Monthly] [s]Supervised IRA [price] residential habilitation (Supervised IRA RH).
(i) Reimbursement for residential habilitation services provided in non-state operated IRAs and CRs on or after July 1, 2014 shall be in accordance with the provisions of Subpart 641-1 of this Title. Subpart 641-1 supersedes the provisions of subparagraphs (iii) - (vii) of this paragraph for reimbursement of residential habilitation services provided in non-state operated supervised IRAs and CRs on and after July 1, 2014.
(ii) The unit of service for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014 shall be a daily unit of service. The requirements of this subparagraph supersede the provisions of subparagraph (v) of this paragraph for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014.
• Renumbered subparagraph 635-10.5(b)(9)(v) is amended as follows:
[(iii)](v) Countable service days.
(a) The full month supervised IRA price shall be paid for services provided to an individual who meets the enrollment requirement in subparagraph (11)[(i)](ii) of this subdivision and who receives face-to-face residential habilitation services in accordance with the individual's individualized service plan (ISP) and residential habilitation plan on each of the 22 days of the enrollment requirement. These are known as countable service days.
(b) One-half of the full month supervised IRA price shall be paid for services provided to an individual who meets the enrollment requirement in subparagraph (11)[(ii)](iii) of this subdivision and who receives face-to-face residential habilitation services in accordance with the individual's ISP and residential habilitation plan on each of the 11 days of the enrollment requirement. These are known as countable service days.
• Renumbered subparagraph 635-10.5(b)(9)(vi) is amended as follows:
[(iv)](vi) Newly certified sites. A newly certified site is an IRA whose reimbursable costs are not already included in the monthly price and at which a provider is initially approved to deliver services pursuant to an operating certificate issued by OPWDD. A newly certified site's annual total reimbursable residential habilitation costs and certified capacity shall be included in the monthly price as calculated in accordance with subparagraph [(ii)]iv of this paragraph except for capital moveable equipment and property insurance components after December 31, 2010. If two countable service days are possible in the month of certification, the new site shall be included in the monthly price in the month of certification. If two countable service days are not possible in the month of certification, the new site shall be included in the monthly price effective the month after the month of certification.
• Renumbered clause 635-10.5(b)(9)(vii)(e) is deleted as follows:
[(e) OPWDD may opt to re-examine the capital moveable equipment and property insurance components of the supervised IRA price for purposes of recalculation after December 31, 2015, for Region II and Region III reporting providers, or after June 30, 2016, for Region I reporting providers.]
• Note: Existing paragraph 635-10.5(b)(10) was previously "reserved"
• Renumbered paragraph 635-10.5(b)(10) is amended by the addition of a new subparagraph (i) as follows and existing subparagraphs (i)-(v) are renumbered to be (ii)-(vi):
(i) Reimbursement for residential habilitation services provided in non-state operated IRAs and CRs on or after July 1, 2014 shall be in accordance with the provisions of Subpart 641-1 of this Title. Subpart 641-1 supersedes the provisions of subparagraphs (ii) - (v) of this paragraph for reimbursement of residential habilitation services provided in non-state operated supportive IRAs and CRs on and after July 1, 2014.
• Renumbered subparagraph 635-10.5(b)(10)(iv) is amended as follows:
[(iii)](iv) Countable service days.
(a) The full month [supported] supportive IRA price shall be paid for services provided to an individual who meets the enrollment requirement in subparagraph (11)[(i)](ii) of this subdivision and who receives face-to-face residential habilitation services in accordance with the individual's ISP and residential habilitation plan on four of the 22 days of the enrollment requirement. Services provided on these four days must be delivered, initiated or concluded at the site. No more than two days of service within a week may be counted toward the four-day requirement. These four days are countable service days.
(b) One-half of the full month [supported] supportive IRA price shall be paid for services provided to an individual who meets the enrollment requirement in subparagraph (11)[(ii)](iii) of this subdivision and who receives face-to-face residential habilitation services in accordance with the individual's ISP and residential habilitation plan on two of the 11 days of the enrollment requirement. Services provided on these two days must be delivered, initiated or concluded at the site. No more than one day of service within a week may be counted toward the two-day requirement. These two days are countable service days.
• Renumbered subparagraph 635-10.5(b)(10)(v) is amended as follows:
[(iv)](v) Newly certified sites. A newly certified site is an IRA whose reimbursable costs are not already included in the monthly price and at which a provider is initially approved to deliver services pursuant to an operating certificate issued by OPWDD. The approved total annual budgeted costs established for newly certified supportive IRA sites after June 30, 2011 shall reflect a two percent reduction in operating costs as was implemented for providers on July 1, 2011 pursuant to subparagraph (18)(iii) of this subdivision. A newly certified site's annual total reimbursable residential habilitation costs and certified capacity shall be included in the monthly price as calculated in accordance with subparagraph [(ii)](iii) of this paragraph except for capital moveable equipment and property insurance components after December 31, 2010. If two countable service days are possible in the month of certification, the new site shall be included in the monthly price in the month of certification. If two countable service days are not possible in the month of certification, the new site shall be included in the monthly price effective the month after the month of certification.
• Renumbered clause 635-10.5(b)(10)(vi)(e) is deleted as follows:
[(e) OPWDD may opt to re-examine the capital moveable equipment and property insurance components of the supportive IRA price for purposes of recalculation after December 31, 2015, for Region II and Region III reporting providers, and after June 30, 2016, for Region I reporting providers.]
• Paragraph 635.10.5(b)(11) is amended as follows:
(11) Enrollment requirements for [consumers] individuals enrolled in a supervised or supportive IRA.
(i) Effective July 1, 2014, for the provider to be paid for a daily unit of Supervised IRA RH the individual must be enrolled at the supervised IRA and either services are provided or the person is eligible for a therapeutic leave or retainer day in accordance with the provisions of paragraph (12) of this subdivision.
[(i)](ii)Prior to July 1, 2014, [F]for the provider to be paid a full month supervised IRA price, the [consumer] individual must be enrolled in the provider's supervised IRA program for a minimum of 22 days in the calendar month.[; to be paid a full month supportive price, the consumer must be enrolled in the provider's supportive IRA program for a minimum of 22 days in the calendar month.]
[(ii)](iii)Prior to July 1, 2014, [F]for the provider to be paid a one-half month supervised IRA price, the [consumer] individual must be enrolled in the provider's supervised IRA program for a minimum of 11 days in the calendar month. [; to be paid a one-half month supportive price, the consumer must be enrolled in the provider's supportive IRA program for a minimum of 11 days in the calendar month.]
(iv) For the provider to be paid a full month supportive price or rate, the individual must be enrolled in the provider's supportive IRA program for a minimum of 22 days in the calendar month.
(v) For the provider to be paid a one-half month supportive price or rate, the individual must be enrolled in the provider's supportive IRA program for a minimum of 11 days in the calendar month.
• Paragraph 635-10.5(b)(12) is amended as follows:
(12) Standards for [countable] service days.
(i) Supervised IRA RH service days, effective July 1, 2014, require:
(a) the individual's presence at the supervised IRA, or one of the following allowable exceptions:
(1) the day is a day of discharge from a hospital, nursing home, intermediate care facility (ICF), or other certified, licensed, or government funded residential facility when the individual returns to the supervised IRA;
(2) the day is a day when the individual's residence is converted from an ICF to a supervised IRA, or when the designation of an IRA is changed (supportive to supervised or supervised to supportive) and the individual is present at the facility;
(3) days when IRA staff deliver and document residential habilitation services to an individual who is away from the residence for the purpose of a vacation or a visit with family or friends, and the location of service delivery is documented; or
(4) days when residents of the IRA are relocated due to emergency conditions or other circumstances reported to and approved by the OPWDD regional office for the region where the IRA is located and the entity within OPWDD that is responsible for survey and certification activity. (Individuals must be present at the approved site and the location of the site documented); and
(b) provision and documentation of at least one face to face service in accordance with the individual's residential habilitation plan on each service day.
(ii) Theraputic leave and retainer days. Effective July 1, 2014, a supervised IRA provider will be paid for therapeutic leave days and retainer days in accordance with 14 NYCRR Subpart 641-1.
(iii) Countable service days prior to July 1, 2014:
[(i)](a) In computing the countable service days, the provider cannot include days [that] when the [consumer] individual is in a hospital, nursing home. ICF/DD or other certified, licensed or government funded residential setting.
[(ii)](b) The day the [consumer] individual is admitted or discharged from one of the other residential settings listed in [subparagraph (i)] clause (a) of this subparagraph may be a countable service day if, on that day, IRA staff deliver residential habilitation services to the [consumer] individual at the IRA.
[(iii)](c) For supervised IRAs only: in determining countable service days the provider may include days when an individual [consumer] is away from the IRA, for purposes such as vacations and visits with family or friends, only when staff from the [consumer's] individual's IRA deliver and document services to that [consumer] individual that are similar in scope, frequency and duration to the residential habilitation services typically delivered to the [consumer] individual at the IRA.
[(a)](1) No more than 14 days in a calendar month that meet the conditions of this subparagraph may be countable service days for a full month supervised IRA price.
[(b)](2) No more than seven days in a calendar month that meet the conditions of this subparagraph may be countable service days for one-half of a full month supervised IRA price.
[(iv)](d) The provisions of this paragraph notwithstanding, days when all [consumers] residents of the IRA are relocated due to an emergency or other conditions [which] that necessitate relocation for the health and safety of the [consumers] residents may be considered as countable if:
[(a)](1) the relocation is reported to and approved by OPWDD; and
[(b)](2) staff regularly assigned to the IRA continue to deliver and document residential habilitation services that are similar in scope, frequency and duration to those typically delivered to the [consumers] residents at the certified site.
[(v)](e) [s]Services provided on countable service days must be documented. On any countable service day there must be documentation of at least one residential habilitation service delivered to the [person] individual by IRA staff on that day.
• Section 671.7 is amended by the addition of a new subdivision (a) as follows and existing subdivision (a) is re-lettered to be (b) which was previously reserved:
(a) Effective July 1, 2014:
(1) reimbursement for residential habilitation services provided in non-state operated IRAs and CRs shall be in accordance with the provisions of Subpart 641-1 of this Title. Subpart 641-1 supersedes the provisions of subdivision (b) of this section for reimbursement of residential habilitation services provided in non-state operated supervised and supportive IRAs and CRs on or after July 1, 2014;
(2) the unit of service for residential habilitation services provided in non-state operated supervised IRAs and CRs shall be a daily unit of service. The requirements of this paragraph supersede the provisions of paragraph (b)(3)(ii) of this section for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014;
(3) residential habilitation services in non-state operated supervised CRs shall be provided and documented in accordance with subparagraphs 635-10.5(b)(11)(i) and (12)(i)-(ii) of this Title; and
(4) residential habilitation services in non-state operated supportive CRs shall be provided and documented in accordance with paragraph 635-10.5(b)(10) and subparagraphs (11)(iv)-(v) of this Title.
This notice is intended:
to serve as both a notice of emergency adoption and a notice of proposed rule making. The emergency rule will expire September 28, 2014.
Text of rule and any required statements and analyses may be obtained from:
Janet Felker, Regulatory Affairs Unit, Office for People With Developmental Disabilities (OPWDD), 44 Holland Avenue, 3rd floor, Albany, NY 12229, (518) 474-1830, email: RAU.Unit@opwdd.ny.gov
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
Five days after the last scheduled public hearing.
Additional matter required by statute:
Pursuant to the requirements of the State Environmental Quality Review Act, OPWDD, as lead agency, has determined that the action described herein will have no effect on the environment, and an E.I.S. is not needed.
Regulatory Impact Statement
1. Statutory authority:
a. OPWDD has the statutory authority to adopt rules and regulations necessary and proper to implement any matter under its jurisdiction as stated in the New York State Mental Hygiene Law Section 13.09(b).
b. OPWDD has the statutory responsibility for setting Medicaid rates and fees for other services in facilities licensed or operated by OPWDD as stated in section 43.02 of the Mental Hygiene Law.
2. Legislative objective: These proposed regulations further the legislative objectives embodied in sections 13.09(b) and 43.02 of the Mental Hygiene Law. The proposed emergency/proposed regulations concern a change in the unit of service for residential habilitation services delivered in supervised IRAs and CRs.
3. Needs and benefits: OPWDD is implementing emergency/proposed regulations that change unit of service requirements for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014. The emergency/proposed regulations change the unit of service from a monthly to a daily unit of service and change the service documentation requirements. These regulations conform OPWDD regulations to Department of Health (DOH) and other OPWDD regulations, both effective July 1, 2014 and satisfy commitments included in OPWDD's transformation agreement with the federal Centers for Medicare and Medicaid Services (CMS).
4. Costs:
a. Costs to the Agency and to the State and its local governments: The emergency/proposed regulations will be cost neutral to the State as the monies expended overall for residential habilitation provided in supervised CRs and IRAs will remain constant.
The emergency/proposed regulations do not apply to the State as a provider of services.
There will be no savings or costs to local governments as a result of these regulations because pursuant to Social Services Law sections 365 and 368-a, either local governments incur no costs for these services or the State reimburses local governments for their share of the cost of Medicaid funded programs and services. In addition, even if the amendments lead to an increase in Medicaid expenditures in a particular county, these amendments will not have any fiscal impact on local governments, as the contribution of local governments to Medicaid has been capped. Chapter 58 of the Laws of 2005 places a cap on the local share of Medicaid costs and local governments are already paying for Medicaid at the capped level.
b. Costs to private regulated parties: The emergency/proposed regulations will implement new unit of service requirements for residential habilitation delivered in supervised IRAs and CRs. These regulations require changes in billing and service documentation. OPWDD expects that changes will be addressed with existing staff and technology.
5. Local government mandates: There are no new requirements imposed by the rule on any county, city, town, village, or school, fire, or other special district.
6. Paperwork: The emergency/proposed amendments will require additional paperwork to be completed by providers. The emergency/proposed regulations change the unit of service for residential habilitation in supervised IRAs and CRs from a monthly to a daily unit of service. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new methodology will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days.
7. Duplication: The emergency/proposed regulations do not duplicate any existing State or federal requirements that are applicable to services for persons with developmental disabilities.
8. Alternatives: The change in the supervised IRA and CR residential habilitation unit of service is part of OPWDD's transformation agreement with CMS. An hourly unit of service was considered, but it was determined that a daily unit is more appropriate in a residential setting.
9. Federal standards: The proposed amendments do not exceed any minimum standards of the federal government for the same or similar subject areas.
10. Compliance schedule: The emergency/proposed regulations are effective on July 1, 2014.
OPWDD provided statewide provider training during April and May of 2014 and posted guidance on the new service documentation requirements and billing procedures in June 2014.
OPWDD expects to finalize the amendments as soon as possible within the timeframes established by the State Administrative Procedure Act.
Regulatory Flexibility Analysis
1. Effect on small business: OPWDD has determined, through a review of the certified cost reports, that most residential habilitation services delivered in Individualized Residential Alternatives (IRAs) and Community Residences (CRs) are provided by agencies that employ more than 100 people overall. However, some smaller agencies that employ fewer than 100 employees overall would be classified as small businesses. Currently, there are approximately 250 providers of residential habilitation services delivered in IRAs and CRs. OPWDD is unable to estimate the portion of these providers that may be considered to be small businesses.
OPWDD is implementing emergency/proposed regulations that change unit of service requirements for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014. The emergency/proposed regulations change the unit of service from a monthly to a daily unit of service and change the service documentation requirements.
The emergency/proposed amendments will require some additional paperwork to be completed by providers. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new unit of service will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days.
Although these regulations require changes in billing and service documentation, OPWDD expects that changes will be addressed with existing staff and technology.
2. Compliance requirements: The emergency/proposed regulations change the unit of service for residential habilitation in supervised IRAs and CRs from a monthly to a daily unit of service. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new methodology will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days.
3. Professional services: No additional professional services will be required as a result of these regulations and the regulations will not add to the professional service needs of local governments.
4. Compliance costs: The emergency/proposed amendments will require additional paperwork to be completed by providers. The emergency/proposed regulations change the unit of service for residential habilitation in supervised IRAs and CRs from a monthly to a daily unit of service. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new methodology will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days. OPWDD expects that the changes will be addressed with existing staff and technology and therefore compliance costs incurred by providers will be minimal.
5. Economic and technological feasibility: The proposed amendments do not impose on regulated parties the use of any new technological processes.
6. Minimizing adverse economic impact: OPWDD has also reviewed and considered the approaches for minimizing adverse economic impact as suggested in section 202-b(1) of the State Administrative Procedure Act. OPWDD determined that the requirements in the emergency/proposed regulations represent the most optimal approach to instituting the necessary change associated with OPWDD's and DOH's recently adopted rate setting regulations, and satisfying commitments included in OPWDD's transformation agreement with the federal Centers for Medicare and Medicaid Services (CMS), while minimizing any adverse impact on providers.
These amendments impose modest compliance response on regulated parties. Since the monthly unit of service required documentation of service delivery on at least twenty-two days each month; the emergency/proposed amendments will require additional documentation for at most nine days per month. OPWDD considers that these compliance activities are needed to implement the change in the unit of service and cannot be further minimized.
7. Small business participation: The change in the unit of service associated with OPWDD's and DOH's July 1, 2014 rate setting methodology was discussed with representatives of providers at meetings held between August 2013 and January 2014, including the New York State Association of Community and Residential Agencies (NYSACRA) (which represents some providers who have fewer than 100 employees).
OPWDD also provided statewide provider training during April and May of 2014 and posted guidance on the new service documentation requirements and billing procedures in June 2014.
Finally, these amendments do not impose any requirements on local governments, and (as noted in the Regulatory Impact Statement) have no fiscal impact on local governments.
Rural Area Flexibility Analysis
1. Description of the types and estimation of the number of rural areas in which the rule will apply: OPWDD services are provided in every county in New York State. 43 counties have a population of less than 200,000: Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Montgomery, Ontario, Orleans, Oswego, Otsego, Putnam, Rensselaer, St. Lawrence, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Wyoming and Yates. Additionally, certain townships in 10 other counties have a population density of 150 persons or less per square mile: Albany, Broome, Dutchess, Erie, Monroe, Niagara, Oneida, Onondaga, Orange, and Saratoga.
OPWDD is implementing emergency/proposed regulations that change unit of service requirements for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014. The emergency/proposed regulations change the unit of service from a monthly to a daily unit of service and change the service documentation requirements.
The emergency/proposed amendments will require some additional paperwork to be completed by providers, including providers in rural areas. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new unit of service will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days.
Although these regulations require changes in billing and service documentation, OPWDD expects that changes will be addressed with existing staff and technology.
These amendments do not impose any requirements on local governments, and (as noted in the Regulatory Impact Statement) have no fiscal impact on local governments, including local governments in rural areas.
2. Compliance requirements: The emergency/proposed regulations change the unit of service for residential habilitation in supervised IRAs and CRs from a monthly to a daily unit of service. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new methodology will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days.
3. Professional services: No additional professional services will be required as a result of these regulations and the regulations will not add to the professional service needs of local governments.
4. Compliance costs: The emergency/proposed amendments will require additional paperwork to be completed by providers. The emergency/proposed regulations change the unit of service for residential habilitation in supervised IRAs and CRs from a monthly to a daily unit of service. The monthly unit of service required documentation of service delivery on at least twenty-two days each month; the new methodology will require daily documentation. In addition, providers will need to bill for each day that services are delivered, rather than billing on a monthly basis. The regulations also require providers to report retainer days, therapeutic leave days, and vacant bed days. OPWDD expects that the changes will be addressed with existing staff and technology and therefore compliance costs incurred by providers will be minimal.
5. Minimizing adverse economic impact: OPWDD has also reviewed and considered the approaches for minimizing adverse economic impact as suggested in section 202-bb(2)(b) of the State Administrative Procedure Act. OPWDD determined that the requirements in the emergency/proposed regulations represent the most optimal approach to instituting the necessary change associated with OPWDD's DOH's recently adopted rate setting regulations, and satisfying commitments included in OPWDD's transformation agreement with the federal Centers for Medicare and Medicaid Services (CMS), while minimizing any adverse impact on providers.
These amendments impose modest compliance response on regulated parties. Since the monthly unit of service required documentation of service delivery on at least twenty-two days each month; the emergency/proposed amendments will require additional documentation for at most nine days per month. OPWDD considers that these compliance activities are needed to implement the change in the unit of service and cannot be further minimized.
6. Participation of public and private interests in rural areas: The change in the unit of service associated with OPWDD's and DOH's July 1, 2014 rate setting methodology was discussed with representatives of providers at meetings held between August 2013 and January 2014, including the New York State Association of Community and Residential Agencies (NYSACRA), NYSARC, and CP of NYS (which represent some providers from rural areas of the state).
OPWDD also provided statewide provider training during April and May of 2014 and posted guidance on the new service documentation requirements and billing procedures in June 2014.
Job Impact Statement
OPWDD is not submitting a Job Impact Statement for this emergency/proposed rulemaking because this rulemaking will not have a substantial adverse impact on jobs or employment opportunities.
OPWDD is implementing emergency/proposed regulations that change unit of service requirements for residential habilitation services provided in non-state operated supervised IRAs and CRs on or after July 1, 2014. The emergency/proposed regulations change the unit of service from a monthly to a daily unit of service and change the service documentation requirements.
Although these regulations require changes in billing and service documentation, OPWDD expects that changes will be addressed with existing staff and technology.
The amendments are therefore expected to have no impact on jobs and employment opportunities with providers.
