N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-99.1
Home and community-based services waiver-authorization from the Secretary of the Federal Department of Health and Human services whereby pursuant to 42 USC section 1396n:
"The Secretary may by waiver provide that a State plan approved under this Title may include as "medical assistance" under such plan payment for part or all of the cost of a home or community-based services (other than room and board) approved by the Secretary which are provided pursuant to a written plan of care to individuals with respect to whom there has been a determination that but for the provision of such services the individuals would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded the cost of which could be reimbursed under the State plan. For purposes of this subdivision, the term "room and board" shall not include an amount established under a method determined by the State to reflect the portion of costs of rent and food attributable to an unrelated person caregiver who is residing in the same household with an individual who, but for the assistance of such caregiver, would require admission to a hospital, nursing facility, or intermediate care facility for the mentally retarded."
Anyone who is 18 years of age or older, or is the parent of a child, or has married.
For the purposes of the home and community-based services (HCBS) waiver, a party chosen by the participant in the waiver who assists the person with the application process and in the development, implementation, review, and revision of the services, supports, and activities that the person chooses in order to attain his or her personal life goals and individualized service environment. A capable adult, as defined in section 633.99 of this Title may choose not to have an advocate. The advocate must be 18 years or older and may include an involved parent or other member of the family, legal guardian, friend, or member of the community who is not providing direct services to the person pursuant to the individualized service plan or who is not employed by an entity providing direct services to the participant in the waiver. However, an ombudsperson at a development center, appointed pursuant to section 13.34 of the Mental Hygiene Law, may also be considered as a person's choice for his/her advocate. The fact that someone is functioning in the role of advocate for a person enrolled in the HCBS waiver does not endow that party with any legal authority over the person's affairs unless they also happen to be the adult person's guardian or the parent of a minor.
The "operator" of a facility, program or service operated, certified, authorized, or funded through contract by OPWDD. In the case of State-operated facilities, the DDSO is considered to be the "agency." Family care providers are not to be considered an agency (also see "agency, sponsoring").
As used in this Part, a term used to indicate that the stated requirement needs to be considered in relation to the administrative structure of both the agency and the site- specific facility and acted upon accordingly.
The administrator of one or more family care homes. In the case of family care homes operated under State auspice, the DDSO is considered to be the sponsoring agency.
The monthly personal allowance is that portion of income which is made available on a monthly basis to every person residing in a facility operated or certified by OPWDD which is intended for the personal expenditure by an individual.
Ancillary costs are those charges identified in a lease in additional to monthly rent. These include but are not limited to: special assessments, taxes, co-op or condominium maintenance fees, utility payments assessed to the lessee by the lessor pursuant to the terms of the lease, and lessor-financed renovations billed as additional rent.
A lease approved by OPWDD and the New York State Division of the Budget.
A proprietary lease approved by OPWDD and the New York State Division of the Budget.
Space between the top of the uppermost floor construction and underside of the roof.
That space of a building that is partly below grade which has more than half of its height, measured from floor to ceiling, above the average established curb level or finished grade of the ground adjoining the building.
For the purposes of this Part, an individual 18 years of age or older who is able to understand the nature and implications of an issue. The assessment of capacity in relation to each issue as it arises will be made by the individual's program planning team (see glossary). Capability, as stipulated by this definition, does not mean legal competency; nor does it necessarily relate to an individual's capability to independently handle his or her own financial affairs; nor does it relate to the individual's capacity to understand appropriate disclosures regarding proposed professional medical treatment. Whenever there is doubt on the part of any other party interested in the welfare of the individual as to that individual's ability to make decisions, as ascertained by the program planning team or others called upon by an agency, a determination of capability for a specific issue or issues may be made by a Capability Review Board (see glossary, section 624.20 of this Title) designated by the commissioner except that in an ICF/DD facility the requirements of section 681.13 of this Title may apply. A capable adult individual cannot override the authority granted a guardian pursuant to article 81 of the Mental Hygiene Law or of a conservator or a committee appointed pursuant to articles 77 and 78 of the Mental Hygiene Law (now repealed); or the authority granted a guardian in accordance with the Surrogate Court Procedure Act.
That space of a building that is partly or entirely below grade, which has more than half of its height, measured from floor to ceiling, below the average established curb level or finished grade of the ground adjoining the building.
A State-operated facility designated as a school for the care and treatment of people with developmental disabilities.
See "standards of certification."
At least annual dry cleaning of a person's clothing, such as a wool coat, which the manufacturer has specified, dry clean only, and which was purchased at the agency's/facility's, sponsoring agency's, or family care provider's discretion. Items which must be dry cleaned which are purchased at the sole discretion of a person, would be paid for by that person.
A clothing supply for a person which is in good repair and which ensures that he or she is outfitted daily in clean clothing, appropriate to the season, to the occasion, and to his or her age, sex, and size. Appropriate sleep wear is also required.
The New York State Uniform Fire Prevention and Building Code or the Building Code of the City of New York.
The commissioner of the New York State Office for People With Developmental Disabilities, or his or her designee.
An individual or individuals possessing significant ownership or equity in the provider and the organization serving the provider.
Competitive Integrated Employment. Employment integrated in the general workforce, for which an individual is compensated at or above the applicable County, State, or Federal minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.
See "principles of compliance."
The amount of rent stated in the lease or proprietary lease as rent, additional rent, maintenance, special assessments, or any other additional charges, costs, expenses, liabilities and obligations. Notwithstanding the foregoing, contract rent shall not include an amount greater than the amount approved by OPWDD and the Division of the Budget.
The power, directly or indirectly, to significantly influence or direct the actions or policies of someone or an organization.
An organization or someone who, by reason of a direct or indirect ownership interest (whether of record or beneficial), has the ability, acting either alone or in concert with others with ownership interest, to direct or exert a controlling influence on the management policies of the provider. Except as otherwise provided in this section, neither the commissioner, nor any employee of the OPWDD, nor any member of a local legislative body of a county or municipality, nor any county or municipal official except when acting as the administrator of a program, shall by reason of his or her official position be deemed a controlling party of the provider; nor shall anyone who serves as an administrator or other employee of a provider be deemed to be a controlling party of such provider solely as a result of such position or his or her official actions in such position.
A corporation or organization formed for the purpose of co-operative ownership of real estate.
A partner in a partnership of which the provider is also a partner.
A corporation formed pursuant to the Not-for-Profit Corporation Law for some benevolent or charitable purpose and not for the purposes of making financial return on investment.
The Developmental Disabilities services Office is the local administrative unit of OPWDD. The governing body of the DDSO is the central office administration of OPWDD. The DDSO director is its chief executive officer.
A developmental disability as defined in section 1.03 (22) of the Mental Hygiene Law.
The Dormitory Authority of the State of New York as successor to the Facilities Development Corporation, and the Dormitory Authority of the State of New York as the successor to the Medical Care Facilities Finance Agency.
Any building that contains one or two dwelling units used, intended, or designed to be built, used, rented, leased, let or hired out to be occupied, or that are occupied for living purposes.
A single unit providing complete independent living facilities for one or more parties, including permanent provisions for living, sleeping, eating, cooking and sanitation. A building containing three or more dwelling units is considered a multiple dwelling.
Within an approved home and community-based services waiver district, a service delivery system in which the person's living arrangement and service delivery reflect the person's personal goals, preferences and needs are not linked, with services considered discretely rather than in a package. That is, housing and services are mutually exclusive considerations, as is the selection of specific services from the list of available approved services. The individualized services environment is in distinct contrast to an overall or comprehensive residential services model, in which housing and some services are intrinsically linked (i.e., where a person lives largely determines the services received). In the individualized service environment, where a person lives has no necessary connection to the services received, even those which may be received at the housing site. The administrative separation of housing from service, and the separation of services from categorical groups, is the keystone of the individualized service environment structure. It is this feature which makes it possible to achieve the goal of designing completely individualized service plans.
The amount the provider paid, excluding the amount paid from borrowed funds, for the purchase, alteration, construction, rehabilitation and/or renovation of real property, for costs attributable to the negotiation or settlement of sale or purchase of such real property and for other reasonable and necessary costs related to such purchase, alteration, construction, rehabilitation and/or renovation, including, but not limited to, design fees and short term interest.
The first $65 of gross monthly wages plus half the balance. The purpose of the exemption is to provide a person who is working with funds to be used for work-related expenses, such as carfare to work.
Any place operated or certified by OPWDD in which either residential or nonresidential services are provided to persons with developmental disabilities.
A site certified for the delivery of services in accordance with Part 679 of this Title, Clinic Treatment Facilities.
A site certified for the delivery of services in accordance with Part 85 of this Title, Operation of Outpatient Facilities for the Mentally Disabled.
A site certified for the delivery of services in accordance with Part 690 of this Title, Day Treatment services.
A site certified for the delivery of services in accordance with Part 676 of this Title, Diagnostic and Research Clinics.
A site certified for the delivery of services in accordance with Part 681 of this Title, Intermediate Care Facilities for Persons With Intellectual and Developmental Disabilities and 42 CFR 483, Conditions of Participation for ICF/IIDs.
A site certified for the delivery of services in accordance with Part 85 of this Title, Operation of Outpatient Facilities for the Mentally Disabled.
The rent that the property would most probably command on the open market as indicated by rents being paid and asked for comparable properties in the same geographic area as of the date of the appraisal.
A payment (as of December 23, 1992) of up to $250 per year, per person residing in a voluntary-operated community residence which may be available to the operator of the facility for one or more of the following needs of the people residing there:
The funds are made available in accordance with section 41.36 (n) of the Mental Hygiene Law and payment is made on a semi-annual basis to the agency operating the community residence.
The policymaking authority of a facility responsible for the overall operation and management of one or more facilities operated by an agency.
The combination of a private residence and a party (or parties) who reside therein, certified by OPWDD, pursuant to and in accordance with the provisions of article 16 of the New York State Mental Hygiene Law and Part 687 of this Title to provide care for persons with developmental disabilities.
Brother, sister, grandparent, grandchild, first cousin, aunt, uncle, spouse, parent or child of an individual, whether such relationship arises by reason of birth, marriage or adoption.
The combined amount of earned and unearned income that remains (on a monthly basis) after the calculation of personal allowance.
For the purposes of this Part, a minor or adult with a diagnosis of developmental disability, who has been or is being served by a State, private or voluntary operated facility certified by OPWDD. This shall include minors or adults who have applied to or have been screened for services and for whom a clinical record is maintained or possessed by such a facility.
The amount equal to depreciation (subject to the limitations in section 635-6.4 of this Part), the associated interest expense on capital indebtedness, if any, and other expenses approved by OPWDD. OPWDD shall approve such other expenses if they are reasonable in an amount and directly related to owning and maintaining the property in question. The types of other expenses directly related to owning and maintaining the property in question include, but are not limited to, real estate taxes, water and sewer charges, heat and utilities, maintenance costs, legal and accounting fees, lawn care, snow removal, rubbish and insurance.
Anyone who is under the age of 18.
For persons residing in ICF/DDs and specialty hospitals, the combined amount of earned and unearned income, which remains on a monthly basis after the calculation of personal allowance. This is the amount to be paid to the provider for cost of care.
Someone designated by the governing body (defined in this section) with overall and ultimate responsibility for the operation of services certified, authorized or funded through contract by OPWDD, or his or her other designee for specific responsibilities and/or equipment as specified in written agency/facility policy. In a DDSO, this party is referred to as the director.
An option, stated in a lease, to renew the lease at a specific amount of rent and term of renewal, where such rent and term of renewal, were stated in the original lease at the time the parties entered into the original lease, and were not negotiated by the parties subsequent to the signing of the original lease.
A corporation, partnership or unincorporated association.
That portion of the current family care appropriation which is available on an annual basis to meet the needs of each eligible person residing in a family care home. The monies provided under section 16.23 (e) of the Mental Hygiene Law are included in the family care client payment. As of December 23, 1992, the family care client payment is a maximum of $600 per eligible person residing in the home and is paid to the provider on a semi-annual basis to meet the needs of those people. It is allocated as follows:
($500 maximum)
The maximum monthly amount a person is expected to pay for the cost of care.
For the purposes of this Part, a minor or adult with a diagnosis of developmental disability, who has been or is being served by a State, private or voluntary operated facility certified by OPWDD. This shall include minors or adults who have applied to or have been screened for services and for whom a clinical record is maintained or possessed by such a facility.
The written document that is developed by an individual's chosen service coordinator, the individual and/or the parties chosen by the individual, often known as the person's circle of support, that describes the services, activities and supports, regardless of the funding source, and that constitutes the person's individualized service environment. This document may be known by a different name but it must comprise the elements described in this definition. The goal of the ISP is to ensure the provision of those things necessary to sustain the person in his/her chosen environment and preclude movement to an ICF/DD. These services, activities and supports, identified in the ISP, are to reflect the preferences, capabilities, and capacities of the person and emphasize the development of self-determination (i.e., making personal choices), independence, productivity, and integration into the community. The ISP identified by personal descriptive and identification information, contains at a minimum:
It is the responsibility of the individual's chosen service coordinator to ensure that the ISP is reviewed at least semi-annually and includes consideration of the information obtained from other-than-OPWDD providers (if any), who are providing services (e.g., as appropriate, the individualized plan for employment [IPE] or the individualized education plan [IEP]). The service oordinator should also ensure that a review of the ISP occurs when the individual and/or parties chosen by the individual request it; or when the capabilities, capacities or preferences of the individual have changed and warrant a review; or when it is determined by the service coordinator that the prevailing plan (or portions of the plan) is/are ineffective. If habilitation services are provided (i.e., residential habilitation, day habilitation, community habilitation, supported employment, pre-vocational services, pathway to employment), the relevant habilitation plan(s) must be developed, and on a semiannual basis thereafter, reviewed and revised as necessary by the habilitation service provider. The ISP shall include or contain as attachments the following:
The ISP is equivalent to a clinical record for the purposes of confidentiality and access.
As used in this Part, the term indicating the need for appropriate written guidance for staff, whether such guidance is in the form of a policy statement with accompanying procedures, or procedures only. Determination of the nature of the material is that of the agency/facility.
Someone or an organization beneficially owning, holding or having the power to vote, 10 percent or more of any class of securities issued by a corporation.
Those requirements with which an agency must comply, but against which the facility will not be routinely surveyed for recertification purposes. However, evidence of failure to comply with the principles may be the basis for decertification in accordance with article 16 of the New York State Mental Hygiene Law. Where herein specified, principles of compliance shall also be applicable to programs or services funded by OPWDD. Evidence of failure to comply with designated principles, may be a basis for discontinuance of OPWDD funding.
A lease between a co-operative, as lessor, and a person or organization with membership or ownership interest in the co-operative, as lessee.
For the purpose of this Part:
Someone or an organization which to a significant extent is associated or affiliated with the individual or provider by common ownership or control, or which to a significant extent has control of, or is controlled by, the individual or provider, by common ownership or control.
A facility providing housing, supplies and services for persons with developmental disabilities and who, in addition to these basis requirements, need supportive interpersonal relationships, supervision, and training assistance in the activities of daily living. Community residences are designed to accomplish two major goals:
All real or personal property, other than current monthly income, which is owned by a person individually or jointly with others.
Resources accrued in the name of a person that exceed the maximum resource limit established by the Supplemental Security Income (SSI) program or Medicaid. For persons who are potentially SSI eligible, excess resources are resources above the resource limit applied by the Social Security Administration is establishing SSI eligibility. For persons who are not potentially SSI eligible (e.g., do not meet the SSI disability criteria), excess resources are those resources above the resource limit applied by the Department of Health in establishing Medicaid eligibility.
A review conducted to determine whether it is appropriate to use a person's excess resources for a particular medical/dental supply or service. The participants in this review are: the person whose excess resources are being considered for use; the payee of that person, if other than the chief executive officer or program administrator; the person's correspondent; any legal fiduciary; the party designated as having coordination responsibility for the person's plan of services; and, for State-operated programs, the resource and reimbursement agent.
A site certified for the delivery of services in accordance with Parts 27, Quality of Care and Treatment and 81 of this Title, Operation of Schools for the Mental Retarded.
The allowable acquisition cost of the asset(s) to the first owner of record who has received payment from the State of New York for the asset(s), minus any paid depreciation.
Supplies and services which are necessary to a person's medical well-being. Except in an emergency, a review and approval of the appropriateness of a medical or dental supply is always made by the agency/facility or sponsoring agency before the service or supply is obtained.
(by) Site, day habilitation.
Any building or space that is purchased or leased by an authorized provider for the purpose of the delivery of day habilitation services through the home and community-based services (HCBS) waiver.
For the purpose of this Part is:
Those criteria which specify the basis of documenting compliance for the purposes of issuing an operating certificate. The basis of documentation may include facility specific records; specified forms or reports; specified contents of records, reports or forms; and/or other means of assessing compliance such as interviews with individuals, employees or volunteers, and/or onsite observation of activities and the environment. Where herein specified, standards of certification shall also be applicable to programs or services funded by OPWDD. Evidence of failure to comply with designated standards, may be a basis for discontinuance of OPWDD funding.
Members of a group of persons, acting as a unit, responsible for identifying an individual's needs; for developing, implementing, evaluating the plan of services for that person; and ensuring that he or she is appropriate to remain in the current setting. Regulations for a specific class facility are to be referenced for specific details. For those persons enrolled in the home and community-based services waiver (HCVS), the program planning team is defined as the person and the waiver case manager, and the advocate (if appropriate) as well as any other party or parties considered, at any given time, as being appropriate for participation by the group.
At least a pillow, blanket(s), mattress pad(s), sheets, pillowcases, washcloths, and towels for each person. Quantities must be sufficient to allow availability of clean items for the person's use.
As used in section 635-10.4 of this Part, means travel of a waiver participant which is essential to the person's participation in the particular HCBS waiver service(s).
One or more rooms with provision for living, cooking, sanitary and sleeping facilities arranged for the use of a family.
Any means, including, but not limited to observation, interview and the written word, that provides a basis for being reasonably assured that a requirement has been met.
N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-99.1