N.Y. Comp. Codes R. & Regs. tit. 14 § 81.10

Current through Register Vol. 46, No. 45, November 2, 2024

Section 81.10 - Fees and reimbursement fees

(a) Fees in schools and integrated residential communities.

(1) Fees shall be subject to the approval of the commissioner, who shall act with the concurrence of the Director of the Budget.

(2) Fees shall be adjusted to reflect each client's ability to pay. Fees charged recipients of public assistance or Supplemental Security Income benefits shall not exceed amounts available to such persons under law less the personal allowance required to be reserved for the use of the recipient pursuant to State law and regulations.

(3) Subject to the availability of resources to clients, the commissioner, with the concurrence of the Director of the Budget, may approve temporary increases in fees to meet extraordinary expenses generally incurred by providers. Such increases in fees may be individually calculated to reflect extraordinary expenses actually incurred by each provider.

(4) Requests for approval of fees or temporary increases in fees shall be made in accordance with procedures prescribed by the Commissioner of Mental Retardation and Developmental Disabilities.

(5) Upon approval of a fee or a temporary increase in fees, the provider shall give the client 30 days' written notice of the implementation of the adjusted fee.

(b) Reimbursement fees for integrated residential communities, as described in section 27.2(g) of this Title, shall be subject to the approval of the commissioner, who shall act with concurrence of the Director of the Budget.

(1) Effective June 1, 2000, such reimbursement shall be based upon the average of the nonpersonal service percentage component for fee setting regions I, II, and III of the 1998 supervised community residence fees, as developed and calculated pursuant to sections 671.7 and 686.13 of this Title.

(2) An integrated residential community (IRC) may be eligible for a salary enhancement add-on to be included in the fee established by paragraph (1) of this subdivision. This add-on will be an increase to the fee to recognize the costs of a $750 annual salary increase per full time equivalent, plus salary related fringe benefits, for those direct care and support workers of the IRC who are salaried employees. Inclusion of the add-on is subject to IRC submitting a resolution of its governing body that the additional funding received will be used to effect this salary increase. To receive the add-on the IRC must submit this resolution and an implementation plan to OMRDD and the commissioner must approve them.

(3) This fee shall be claimed as follows:

(i) The full monthly fee shall be claimed for services to an individual admitted and in residence for at least 21 days of a calendar month.

(ii) One-half of the monthly fee shall be claimed for services to an individual admitted and in residence for at least 11 days of a calendar month.

(iii) No reimbursement fee may be claimed for services to an individual if the integrated residential community charges fees other than an individual's Supplemental Security Income benefits as provided for in paragraph (a)(2) of this section.

(4) Trend factors applicable to reimbursement fees for integrated residential communities. The following trend factors shall be applied to the IRC fee established pursuant to paragraphs (1)-(2) of this subdivision and approved by the commissioner acting with the concurrence of the Director of the Budget.

(i) Effective February 1, 2007, integrated residential communities shall receive an amount they would have received if there had been a trend factor of 5.33 percent applied to the fee in effect for calendar year 2005. The fee in effect for the fee period ending December 31, 2004 shall be deemed to be increased in the amount of 5.33 percent.

(ii) Effective February 1, 2007, integrated residential communities shall receive an amount they would have received if there had been a trend factor of 3.03 percent applied to the fee in effect for calendar year 2006. The fee in effect for the fee period ending December 31, 2005 shall be deemed to be increased in the amount of 3.03 percent.

(iii) From February 1, 2007 to December 31, 2007, integrated residential communities shall be reimbursed operating costs that result in a full annual trend factor of 2.97 percent for the fee period. On January 1, 2008, the trend factor for the previous fee period shall be deemed to be the 2.97 percent full annual trend.

(iv) Effective February 1, 2008, integrated residential communities shall be reimbursed operating costs that result in a full annual trend factor of 3.52 percent for the 2008 fee period. On January 1, 2009, the trend factor for the previous fee period shall be deemed to be the 3.52 percent full annual trend.

(v) 0.00 percent for the 2009 fee period.

(vi) Effective February 1, 2010, integrated residential communities shall receive an amount that they would have received if the trend factor in subparagraph (v) of this paragraph had been 3.06 percent. On January 1, 2010, the trend factor for the previous fee period shall be deemed to be the 3.06 percent full annual trend. Retention of the proceeds attributable to the application of the trend factor increase shall be contingent upon the provider reporting the use of the funds in the form and format specified by the commissioner.

(vii) From February 1, 2010 to December 31, 2010, integrated residential communities shall be reimbursed operating costs that result in a full annual trend factor of 2.08 percent for the annual fee period. On January 1, 2011, the trend factor for the previous fee period shall be deemed to be the 2.08 percent full annual trend. Retention of the proceeds attributable to the application of the trend factor increase shall be contingent upon the provider reporting the use of the funds in the form and format specified by the commissioner.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 81.10