N.Y. Comp. Codes R. & Regs. tit. 14 § 690.7

Current through Register Vol. 46, No. 50, December 11, 2024

Section 690.7 - Fee-setting and financial reporting for day treatment facilities

(a) Rates of payment made for day treatment services rendered to title XIX recipients shall be at the levels set forth in the approved New York Medicaid State Plan. The rates shall be contingent upon Federal financial participation (FPP) and approval.

(b)Reporting requirements.

(1) Each provider shall submit reports in accordance with the requirements of Subpart 635-4 of this Title.

(2) Each provider shall report on its cost report the amount of funded depreciation for each of its day treatment programs and expenditures from funded depreciation for each of its day treatment programs. See clauses (d)(2)(ii)(d)-(e) and paragraph (e)(6) of this section.

(3) For purposes of this section a day treatment program shall be defined as budget-based if such program did not submit a 12-month cost report for either the January 1, 1988 through December 31, 1988, or July 1, 1988 through June 30, 1989 cost-reporting period. Budget information shall include 12 months of projected units of service in accordance with clause (e)(1)(i)(c) of this section, a participant roster and a completed Developmental Disabilities Profile (DDP) for each participant.

(4) Each agency operating a day treatment program shall submit, with its cost report, a listing of the persons who were enrolled in the program during the period covered by the cost report.

(c)Allowable capital and utility costs.

(1) General conditions.

(i) To be considered allowable, costs must be properly chargeable to necessary care rendered in accordance with the requirements of this Part and any applicable codes, rules, regulations and laws.

(a) Except where specific rules concerning allowability of costs are stated herein or in Subpart 635-6 of this Title, the Medicare Provider Reimbursement Manual, commonly referred to as HIM-15 shall be used to determine the allowability of costs. Said guidelines are published by the U.S. Department of Health and Human Services' Health Care Financing Administration (HCFA). The HIM-15 document is available from:

The HIM-15 document is available from:

Health Care Financing Administration

Division of Communication Services

Production and Distribution Branch

Room 577, East High Rise Building

6325 Security Boulevard

Baltimore, MD 21207

It may be reviewed in person during regular business hours at the:

(1) NYS Department of State, 41 State Street, Albany, NY 12207; or

(2) by appointment at the NYS Office for People With Developmental Disabilities, Division of Revenue Management, 30 Russell Road, Albany, NY 12206.

(b) Where specific rules stated herein or HIM-15 are silent concerning the allowability of costs, the commissioner shall determine allowability of costs based on reasonableness and relationship to the provision of care and generally accepted accounting principles.

(c) As determined by the commissioner, expenses or portions of expenses reported by an individual day treatment program that are not reasonably related to the efficient and economical provision of care in accordance with any applicable certification standards because of either the nature or amount of the item, shall not be allowed.

(2) Capital costs.

(i) Notwithstanding subparagraph (iv) of this paragraph, in the case of any provider which has been notified by OPWDD on or after July 1, 1986 that there is a preliminary reservation of State aid funds for a capital grant pursuant to Mental Hygiene Law, section 41.18(c) or 41.23, the basis for computing depreciation on the day treatment program which is the subject of the capital grant shall include the day treatment program's depreciable project costs which were funded with such capital grant, provided that the provider has not repaid the entire principal owed on the real property of the day treatment program. If the depreciable project costs are adjusted after audit, the basis for computing depreciation on the day treatment program will be changed to such adjusted depreciable project costs. Upon full repayment of principal, the basis for depreciation for the day treatment program will cease to include the amount of the capital grant. Any provider which receives such a capital grant shall enter into certain assurances with the OPWDD whereby the provider agrees that:

(a) the difference between depreciation in the fee attributable to the day treatment program's depreciable project costs (other than depreciation attributable to the provider's equity in the day treatment program's real property at the time such property is put into use as a day treatment program) and the principal which is repaid shall be deposited in an investment approved by the commissioner. The commissioner's approval shall be based on whether the investment is secure, bears interest, is liquid, and is appropriate to the purpose for which it is being made;

(b) except as provided in clause (e) of this subparagraph, withdrawals from such investment shall be made only for the purpose of repayment of indebtedness owed on the real property of the facility;

(c) each withdrawal must be signed by the commissioner; and

(d) if the provider ceases to operate the facility as a day treatment program for persons with developmental disabilities, or as any facility certified by OPWDD, it will repay to the OPWDD the balance on deposit in the secure investment at the time of such cessation, including interest earned on the investment;

(e) with the commissioner's approval based on cost savings, a provider may use withdrawals from the investment cited in clause (b) of this subparagraph for repayment of indebtedness owed on the real property of another facility which received a capital grant under this subparagraph or under subparagraph (ii) of this paragraph, or if there is no such other facility which is mortgaged, for the repayment of indebtedness owed on the real property of another facility which is mortgaged under the same mortgage as the facility;

(f)depreciable project costs shall mean those acquisition and construction costs of a day treatment program which have been approved, either before or after audit, by the New York State Office of the State Comptroller or by OPWDD's designee. Such costs shall not include the cost of the land.

(ii) Notwithstanding subparagraph (iv) of this paragraph, any provider which has been notified by OPWDD before July 1, 1986 that there is a preliminary reservation of State aid funds for a capital grant pursuant to Mental Hygiene Law, section 41.18(c) or 41.23, may apply to the commissioner to have the basis for computing depreciation on the facility include the day treatment program's depreciable project costs which were funded with the capital grant. Such application must be submitted to the commissioner on or before December 31, 1986 on the forms prescribed by the commissioner. Such application shall be granted at the discretion of the commissioner upon a showing that inclusion in the depreciation basis of the day treatment program's depreciable project costs which were funded with the capital grant is necessary to the financial viability of the facility and will not impede the day treatment program's efficient and economical operation. If the commissioner approved such application, the day treatment program's fee shall be revised retroactive to July 1, 1986 to include in the depreciation basis the day treatment program's depreciable project costs which were funded with the capital grant, and the provider shall enter into certain assurances described in subparagraph (i) of this paragraph. Upon full repayment of principal, the basis for depreciation for the day treatment program will cease to include the amount of the capital grant. If the depreciable project costs are adjusted after audit, the basis for computing depreciation on the day treatment program will be changed to such adjusted depreciation project costs.

(iii) For any real property transaction on or before December 31, 1985 resulting in a change of ownership, and resulting in a transaction that is not an at-arm's-length transaction, as defined in clause (i)(b) of this paragraph, the historical cost of the asset shall be limited to the seller's net book value.

(iv) Restricted funds are funds expended by the day treatment program, which include grants, gifts, and income from endowments, whether cash or otherwise, which must be used only for a specific purpose as designated by the donor or grant instrument. Except as provided for in subparagraphs (i) and (ii) of this paragraph, restricted funds are to be deducted from the designated costs when determining allowable capital costs. The commissioner may waive the provisions of this section at his discretion only in those instances where the provider makes a reasonable demonstration that the imposition of the requirements of this section would cause undue financial harm to the ongoing operation of the day treatment program.

(v)Start-up costs are those costs which are incurred from the period the provider receives approval pursuant to the certification of need process for a facility to become a day treatment program to the date the first individual is admitted. However, costs incurred during the period from the first admission to the effective date of the initial Medicaid certification shall not be considered as start-up costs.

(a) OPWDD will reimburse a facility for all allowable start-up costs incurred in the preparation of the facility during that six-month period prior to the date of the first admission. The commissioner may grant an extension of the six-month limit for good cause shown. However, under no circumstances shall a facility be allowed reimbursement of start-up costs for any period of time exceeding 18 months prior to the date of the first admission.

(b) Allowable start-up costs may include, but are not limited to:

(1) personal service expenses;

(2) utility expenses;

(3) taxes;

(4) insurance expenses;

(5) employee training expenses;

(6) housekeeping expenses;

(7) repair and maintenance expenses; and

(8) administrative expenses.

(c) Any costs that are properly identifiable as organization costs or capitalizable as construction costs shall be classified as such and excluded from start-up costs.

(d) If all portions of the day treatment program's facility are prepared at the same time, start-up costs shall be accumulated in a single deferred account and shall be amortized from the date of the first admission. However, if only portions of the day treatment program's facility are prepared (i.e., preparation of a floor or wing), start-up costs shall be capitalized and amortized separately. In either case, start-up costs shall be amortized over a period not to exceed 60 months from the date of the first admission.

(d)Fee-setting.

(1) For the purpose of setting the day treatment fee, units of service shall include the total number of half-day units of service (more than three hours but less than five hours), the number of full-day units of service (five hours or more) and partial day units of service (such as in the amount of at least 11/2 hours but less than three hours). Units of service are billable in the above amounts based on a unit of service per person per day. Billable services include the initial contact visit, enrollment for completing a preliminary screening, and services for individuals formally admitted to the day treatment program in accordance with section 690.5 of this Part.

(i) Units of service for the fee-setting calculation shall utilize projected or actual units of service as follows:

(a) For the April 1, 1991 through December 31, 1991 fee-setting calculation, actual units of service shall be from the January 1, 1988 through December 31, 1988 cost report, for facilities in Region II or III, including those programs in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section and excluding those programs in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section. For the July 1, 1991 to June 30, 1992 fee-setting calculation, actual units of service shall be from the July 1, 1988 through June 30, 1989 cost report, for programs in Region I, including those programs in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section and excluding those programs in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section.

(b) For the January 1, 1992 through December 31, 1992, April 1, 1992 through March 31, 1993, and July 1, 1992 through June 30, 1993 fee-setting calculations, and thereafter, actual units of service shall be from the cost report, submitted in accordance with paragraph (b)(1) of this section, two years prior to the period for which the fee is being set. For example, for the fee period of January 1, 1997 through December 31, 1997, the units of service shall be those reported on the cost report for the period of January 1, 1995 through December 31,1995. For programs for which OPWDD has not received such cost report at the time of the fee-setting calculation, OPWDD shall utilize the units of service paid for through the Medicaid Management Information System (MMIS), during the required cost report period.

(c)Projected units of service shall mean the estimated monthly attendance multiplied by the expected number of days the program will be open for each month. This computation shall be made for each month and summed and annualized for the number of months in the fee period. Projected units of service will be used in the absence of actual units of service from the cost reports required pursuant to clause (a) or (b) of this subparagraph. Projected units of service will be required upon issuance of an operating certificate for a new site or an amended operating certificate reflecting a change in capacity. Projected units of service shall be utilized for fee-setting purposes until a full-year cost report, subsequent to the cost report period in which the issuance of an operating certificate for a new site occurred, is used for fee-setting purposes. Projected units of service shall also be utilized for fee-setting purposes until a full-year cost report, subsequent to the cost report period in which the change in capacity occurred, is utilized for fee-setting purposes. If the estimated units of service have not been received by OPWDD by the date required, OPWDD shall utilize the units of service paid for through the MMIS, beginning with the program's initial certification or the first full month since the change in certified capacity occurred. If the available MMIS units of service are for less than a 12-month period, they shall be annualized for fee-setting purposes.

(2) Fee base period.

(i) For facilities in Regions II and III, excluding those facilities in Regions II and III designated or elected to a Region I reporting year end and fiscal cycle in accordance with Subpart 635-4 of this Title, the base period shall be from January 1st to December 31, 1988.

(ii) For facilities in Region I, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title the base period shall be from July 1, 1988 to June 30, 1989.

(iii) For facilities in Region I designated or elected to a Region II or III reporting year- end and fiscal cycle in accordance Subpart 635-4 of this Title, the base period shall be January 1st to December 31, 1988.

(iv) All dollar amounts cited in this section shall reflect base period costs for the period of January 1, 1988 through December 31, 1988.

(3) The fee for day treatment facilities shall be a fixed amount plus operating, capital, and transportation component add-ons. The fixed amount and operating component add-ons shall reflect base period costs and shall be subject to trend factors pursuant to paragraph (6) of this subdivision. As appropriate, OPWDD shall apply trend factors to the fixed amount and each facility's total reimbursable operating components as determined by this section. Such trend factors shall be applied only to the fixed amount and the operating components with the capital and transportation components added to this result to utilize in calculating the final fee.

(i) The operating component add-ons shall be case mix, case mix intensity, salary, staff training and utilities. Day treatment programs that have submitted cost reports that contain full year costs for the periods January 1, 1988 through December 31, 1988 and July 1, 1988 through June 30, 1989 shall also be eligible to qualify for either cap adjustment component add-on or an allocation adjustment component add-on. In addition, day treatment programs in Region II and III that participated in the salary enhancement plan pursuant to chapter 54 of the Laws of 1988 shall also receive a salary enhancement cost adjustment component add- on. Operating component add-ons shall reflect base year costs and shall be subject to a trend factor pursuant to paragraph (6) of this subdivision.

(ii) The capital component shall include property, equipment, and start up costs pursuant to paragraph (c)(2) of this section. The capital component will not be subject to a trend factor.

(iii) For the April 1, 1991 through December 31, 1991 fee period, day treatment programs in Regions II and III including those programs in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title shall also receive an annualization cost component add-on.

(iv) Effective July 1, 1995, the fixed amount shall be $36.67.

(v) The operating component add-ons shall be computed as follows. Such component add-ons shall be added to the fixed amount.

(a) Case mix component. The developmental disabilities profile (DDP) shall be administered to each person attending the day treatment program. The DDP may be reviewed in person during regular business hours at the:

(1) NYS Department of State, 41 State Street, Albany, NY 12207; or by appointment at the:

(2) NYS Office for People With Developmental Disabilities, Division of Revenue Management, 30 Russell Road, Albany, NY 12206.

(a) Utilizing the individual's adaptive, maladaptive, and health/medical DDP scores, each person's scores shall be assigned as follows to its corresponding DDP percentile level. For facilities whose fee period is July 1st through June 30th, this provision applies to the fee periods July 1, 1994 through June 30, 1996, and thereafter. For facilities whose fee period is January 1st through December 31st, this provision applies to the fee periods January 1, 1994 through December 31, 1995 and thereafter. Corrected or updated DDP scores shall be implemented in accordance with paragraph (7) of this subdivision. The total number of persons assigned to each percentile level shall be multiplied by the dollar amount associated with that percentile level. Total dollars for each percentile level shall be summed together and divided by the number of persons for whom there are DDP scores.

REGION I

For the period July 1, 1994 through June 30, 1995:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
(I) 0 - 39.99	<239	<34	<3	0
(II) 40 - 69.99	>or=239	>or=34	>or=3	2.11
<333	<92	<7
(III) 70 - 89.99	>or=333	>or=92	>or=7	4.22
<410	<132	<11
(IV) >or=90	>or=410	>or=132	>or=11	8.72

For the period(s) beginning July 1, 1995:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
(I) 0 - 39.99	<242	<39	<4	0
(II) 40 - 69.99	>or=242	>or=39	>or=4	2.11
<338	<97	<8
(III) 70 - 89.99	>or=338	>or=97	>or=8	4.22
<420	<133	<12
(IV) >or=90	>or=420	>or=136	>or=12	8.72

REGIONS II AND III

For the period January 1, 1994 through December 31, 1994:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
(I) 0 - 39.99	<239	<34	<3	0
(II) 40 - 69.99	>or=239	>or=34	>or=3	2.11
<333	<92	<7
(III) 70 - 89.99	>or=333	>or=92	>or=7	4.22
<410	<132	<11
(IV) >or=90	>or=410	>or=132	>or=11	8.72

For the period(s) beginning January 1, 1995:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
(I) 0 - 39.99	<242	<39	<4	0
(II) 40 - 69.99	>or=242	>or=39	>or=4	2.11
<338	<97	<8
(III) 70 - 89.99	>or=338	>or=97	>or=8	4.22
<420	<133	<12
(IV) >or=90	>or=420	>or=136	>or=12	8.72

(1) Individual scores shall be assigned to percentile level I if all three of the individuals' DDP scores are less than the 40th percentile of all DDP scores.

(2) Individual scores shall be assigned to percentile level II if the individual has one DDP score on any one dimension is equivalent to or that is greater than the 40th percentile and less than the 70th percentile.

(3) Individual scores shall be assigned to percentile level III, if the individual has one DDP score on any one dimension that is equal to or greater than the 70th percentile and less than the 90th percentile.

(4) Individual scores shall be assigned to percentile level IV if the individual has one DDP score on any one dimension that is greater than or equal to the 90th percentile.

(b) Case mix intensity component add-on. The highest single DDP percentile ranking for each individual program participant in any one of the three DDP scoring dimensions, adaptive, maladaptive and health/medical, shall be summed and divided by the total number of program participants with DDP scores, yielding an average percentile level for each program. For facilities whose fee period is July 1st through June 30th, this provision applies to the fee periods July 1, 1994 through June 30, 1996 and thereafter. For facilities whose fee period is January 1st through December 31st, this provision applies to the fee periods January 1, 1994 through December 31, 1995 and thereafter. Corrected or updated DDP scores shall be implemented in accordance with paragraph (7) of this subdivision. The add-on shall be allowed as follows:

REGION I

For the period July 1, 1994 through June 30, 1995:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
<75th	<350	<100	<8	0
75 - 79.99	>or=350	>or=100	NA	.88
<366	<110
80 - 84.99	>or=366	>or=110	>8	3.52
<385	<121	<10
85 - 89.99	>or=385	>or=121	=10	13.20
<410	<132
90 - 92.99	>or=410	>or=132	>or=11	30.80
<431	<140	<13
>92.99	>or=431	>or=140	>or=13	39.60

For the period(s) beginning July 1, 1995:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
75th	<354	<105	<8	0
75 - 79.99	>or=354	>or=105	=8	0.88
<371	<117
80 - 84.99	>or=371	>or=117	=9	3.52
<392	<125
85 - 89.99	>or=392	>or=125	>or=10	13.20
<420	<136	<12
90 - 92.99	>or=420	>or=136	>=12	30.80
<441	<144
>92.99	>or=441	>or-144	>12	39.60

REGIONS II AND III

For the period January 1, 1994 through December 31, 1994:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
<75th	<350	<100	<8	0
75 - 79.99	>or=350	>or=100	NA	0.88
<366	<110
80 - 84.99	>or=366	>or=110	>8<10	3.52
<385	<121
85 - 89.99	>or=385	>or=121	=10	13.20
<410	<132
90 - 92.99	>or=410	>or=132	>=11	30.80
<431	<140	<13
>92.99	>or=431	>or=140	>or=13	39.60

For the period(s) beginning January 1, 1995:

Percentile	Adaptive	Maladaptive	Health/Medical	$ Add-On
75th	<354	<105	<8	0
75 - 79.99	>or=354	>or=105	=8	0.88
<371	<117
80 - 84.99	>or=371	>or=117	=9	3.52
<392	<125
85 - 89.99	>or=392	>or=125	>or=10	13.20
<420	<136	<12
90 - 92.99	>or=420	>or=136	=12	30.80
<441	<144
>92.99	>or=441	>or=144	>12	39.60

(c) Staff training component. The add-on shall be $.32.

(d) For day treatment programs required to independently pay utilities, the utilities component shall be the amount of utilities as reported in the most recent cost report divided by the units of service pursuant to paragraph (1) of this subdivision.

(1) The utilities amount shall reflect the costs on an annual basis trended by an amount to be determined by the commissioner.

(2) A day treatment program shall receive the statewide median for utilities if the most recent cost report is not available, or does not cover the full period of the cost report.

(3) Utilities may be updated to reflect documented actual costs and/or cost increases due to expansion of the physical plant approved pursuant to paragraph (c)(2) of this section.

(e) Salary component. The salary component of the fee shall be computed as follows:

(1) An agency salary per FTE shall be computed for each agency. The agency salary per FTE shall be equal to the total agency day treatment noncontracted personal service costs reported on the appropriate January 1, 1988 through December 31 1988 or July 1, 1988 through June 30, 1989 cost reports divided by total reported agency day treatment FTE's and the result is multiplied by. 9533 in order to reflect a median day treatment salary for each agency. The noncontracted personal service costs reported on the January 1, 1988 through December 31, 1988 cost report shall be inclusive of nine months of salary enhancement for programs that participated in the salary enhancement program of chapter 54 of the Laws of 1988. The agency salary for programs defined as budget based will be adjusted to reflect the agency salary of other existing day treatment programs operated by the provider. If the provider does not operate other day treatment programs, the day treatment agency salary shall be equal to the agency salary of ICF/DDs and/or community residences operated by the providers. Day treatment agency salaries derived from other day treatment programs or ICF/DD and/or community residence programs operated by the provider shall be adjusted by. 9533 to reflect median day treatment agency salary. Budget based programs will be considered to be in a deficit (I) in accordance with subclause (v)(e)(3) of this paragraph. If the provider does not operate other day treatment or ICF/DD programs, the agency salary per FTE shall be equal to the day treatment statewide salary of $16,799.

(2) The agency salary per FTE shall be compared to the day treatment statewide salary of $16,799.

(3) Surplus/deficit (I). A surplus/deficit analysis shall be computed for each day treatment program that filed a 12-month cost report for January 1, 1988 through December 31, 1988 or July 1, 1988 through June 30, 1989. The surplus/deficit analysis shall be computed using the actual units of service from the 1988 cost report and, as appropriate, either the January 1, 1990 or July 1, 1990 day treatment fixed amount and operating cost components in effect as of October 1, 1990, detrended to the base period. The trend factor used to detrend Region I fixed amount and operating cost components is 15.66 percent. The trend factor used to detrend Region II and III fixed amount and operating cost components is 13.65 percent. The detrended fixed amount and operating cost components shall be compared to the program specific operating costs from the appropriate cost report so as to determine the site specific surplus or deficit. The surplus or deficit derived from this analysis shall be titled surplus/deficit (I). The surplus/deficit (I) shall not be computed for sites defined as budget based except as assigned in subclause (1) of this clause.

(4) Salary component add-ons in accordance with the schedule identified below shall be added to fixed amount for each day treatment site.

(i) If the agency salary per FTE pursuant to subclause (1) of this clause is greater than the 50th percentile of the statewide day treatment industry and the day treatment program is experiencing a surplus (I) in accordance with subclause (3) of this clause, the salary component shall be $6.10.

(ii) If the agency salary per FTE pursuant to subclause (1) of this clause is greater than the 50th percentile of the day treatment industry and the day treatment program is experiencing a deficit (I) in accordance with subclause (3) of this clause, the salary component shall be $6.10 plus the amount of costs equal to the agency salary per FTE divided by the statewide salary of $16,799 multiplied by $29.09, minus $29.09. The 21.2 percent fringe factor is added to this amount.

(iii) If the agency salary per FTE pursuant to subclause (1) of this clause is greater than the 40th percentile or equal to the day treatment statewide salary of $16,799, the salary component add-on shall be $6.10.

(iv) If the agency salary per FTE pursuant to subclause (1) of this clause is equal to or greater than the 30th percentile or less than the 40th percentile of the day treatment industry, the salary component add-on shall be $3.89.

(v) If the agency salary per FTE pursuant to subclause (1) of this clause is equal to or greater than the 20th percentile or less than the 30th percentile of the day treatment industry, the salary component add-on shall be $2.37.

(vi) If the agency salary per FTE pursuant to subclause (1) of this clause is equal to or greater than the 10th percentile or less than the 20th percentile of the day treatment industry, the salary component add-on shall be $1.50.

(vii) If the agency salary per FTE pursuant to subclause (1) of this clause is less than the 10th percentile of the day treatment industry, the salary component add-on shall be $0.

(f) Salary enhancement cost adjustment component add-on. The fixed amount for day treatment programs that participated in the salary enhancement plan pursuant to chapter 54 of the Laws of 1988 during the period January 1, 1988 through December 31, 1988 and submitted a 12-month cost report for the same period, shall receive a salary enhancement cost adjustment component add-on. Budget based day treatment programs in Regions II and III whose agency salary per FTE pursuant to subclause (1) of this clause, is equal to the agency salary of other existing day treatment programs operated by the same provider shall also receive the salary enhancement cost adjustment component add-on. The salary enhancement cost adjustment component may be revised to reflect additional FTE's for programs that have experienced a capacity change resulting in the issuance of a new operating certificate.

(1) The salary enhancement cost adjustment component shall be calculated as follows:

(i) For day treatment programs in Region II, the total number of direct care and support FTE's shall be multiplied by 25 percent of $1,900 and increased by a fringe benefit factor of. 212 percent and divided by the units of service pursuant to paragraph (1) of this subdivision.

(ii) For day treatment programs in Region III, the total number of direct care and support FTE's shall be multiplied by 25 percent of $1,690 and increased by a fringe benefit factor of. 212 percent and divided by the units of service pursuant to paragraph (1) of this subdivision.

(g) Cap adjustment component add-on and allocation component add-on.

(1) In order to determine eligibility for either the cap adjustment component add-on or the allocation component add-on, a surplus/deficit analysis shall be computed for each day treatment program using operating fees determined in accordance with subparagraph (iv) and clauses (v)(a)-(f) of this paragraph and the actual units of service from the 1988 cost report. Such operating fee revenues shall be compared to program specific operating costs from either the January 1, 1988 through December 31, 1988 or July 1, 1988 through June 30, 1989 cost reports. The surplus or deficit derived from this analysis shall be titled surplus/deficit (II).

(2) Day treatment programs determined to be in a deficit (II) pursuant to subclause (1) of this clause that received salary components in accordance with subparagraph (4)(ii) of this subdivision shall receive a cap adjustment component equal to the deficit (II) divided by the units of service pursuant to paragraph (1) of this subdivision.

(3) Day treatment programs determined to be in a deficit (II) pursuant to subclause (1) of this clause, that received salary components in accordance with subparagraphs (4)(iii) through (vii) of this subdivision shall receive an allocation component equal to $3.07.

(vi) The property and capital equipment component add-on shall be equal to the amount of allowable capital costs as defined in paragraph (c)(2) of this section and Subpart 635-6 of this Title, divided by the units of service figure. At the onset of each fee period the OPWDD shall review the property and equipment component add-on for substantial material changes and if said changes conform to the requirements of paragraph (c)(2) of this section and Subpart 635-6 of this Title, the property and capital equipment shall be revised to reflect said changes.

(vii) Effective July 1, 1996, there shall be a separate transportation component add-on to the facility's fee. This component add-on for each day treatment facility shall be determined using the following methodology.

(a) Using a payment/rate data sample from calendar years 1995 and 1996, the weighted transportation average shall be calculated by dividing the aggregate transportation payments by the aggregate transportation units of service on a facility specific basis. One round trip shall equal one unit of service.

(1) The weighted transportation average for each day treatment facility shall be ranked among all day treatment facilities statewide.

(i) If a facility's weighted transportation average is $11.16 or less, the weighted transportation average shall be held 100 percent harmless.

(ii) If a facility's weighted transportation average exceeds $11.16, 40 percent of the weighted transportation average shall be held harmless.

(2) After deducting the 40 percent to be held harmless, the net weighted transportation average for each site (i.e., the remaining 60 percent of the weighted transportation average) shall be re-ranked. Based on the new percentile rankings, a percentage offset shall be deducted from the net weighted transportation average. A facility's percentage offset shall be determined by locating its net weighted transportation average (i.e., the remaining 60 percent of the weighted transportation average) in the following table.

Percentile Rank	Net Weighted Transportation Average	Percentage Offset
5 or <	$0 - $7.25	5
6 to 9	$7.26 - $8.12	7.5
10 to 29	$8.13 - $10.19	10
30 to 49	$10.20 - $13.31	12.5
50 to 59	$13.32 -$13.79	15
60 to 69	$13.80 - $14.00	16.5
70 to 79	$14.01 - $14.96	20
80 to 84	$14.97 - $15.76	22.5
85 or >	Over 15.76	25

(3) The amount remaining after the application of the percentage offset (the 60 percent of the weighted transportation average reduced by the offset percentage in the table above) shall be added to the hold harmless amount to determine a facility's modified weighted transportation average.

(i) If the modified weighted transportation average falls below $11.16, the modified weighted transportation average shall be adjusted to $11.16.

(ii) If the modified weighted transportation average exceeds $30, the modified weighted transportation average shall be adjusted to $30.

(4) The modified weighted transportation average shall be multiplied by the total to and from day treatment transportation units and divided by the total day treatment units of service to create a day treatment transportation component add-on. This shall be a separate component added to the day treatment fee.

(b) If an agency currently providing day treatment does not have to and from transportation payment/rate data available for a particular facility for the period used to calculate the modified weighted transportation averages, or if an agency opens a new day treatment facility, the modified weighted transportation average shall be equal to the lesser of the facility's budgeted amount for transportation based on the transportation requirements of the person(s) to be transported to and from the day treatment facility or the average of the modified weighted transportation averages for all other day treatment facilities operated by the agency.

(c) If an agency does not currently operate a day treatment facility, and opens a day treatment facility or if an agency does not have to and from transportation payment/rate data for any of its day treatment facilities for the period used to calculate the modified weighted transportation averages, the modified weighted transportation average shall be equal to the lesser of the facility's budgeted amount for transportation based on the transportation requirements of the person(s) to be transported to and from the day treatment facility or the average of the modified weighted transportation averages for all day habilitation programs operated by the agency as described in section 635-10.5(c)(2) of this Title.

(d) If the agency does not currently operate a day treatment facility or day habilitation program, the modified weighted transportation average shall be equal to the lesser of the new day treatment facility's budgeted amount for transportation based on the transportation requirements of the person(s) to be transported to and from the day treatment facility or 75 percent of the regional modified weighted transportation average associated with transporting individuals to and from day treatment facilities. The table below shows the regional modified weighted transportation averages:

Region	Average	75 Percent of Average
1	$21.37	$16.03
2	$21.17	$15.88
3	$15.97	$11.98

(e) Agencies that operated only day habilitation programs prior to July 1, 1996, and opened a day treatment facility for the first time between July 1, 1996 and September 3, 1996 shall receive a one time fee adjustment if the agency received 75 percent of the regional modified weighted transportation average for day treatment transportation and is now receiving either the day treatment facility's budgeted transportation amount or the average of the agency's day habilitation modified weighted transportation averages. The one time fee adjustment shall be either:

(1) a one time fee increase if the lesser of the need-based budgeted transportation amount or the average of the agency's day habilitation modified weighted transportation averages is greater than 75 percent of the regional modified weighted average for transportation to and from day treatment facilities; or

(2) a one time fee decrease if the lesser of the need-based budgeted transportation amount or the average of the agency's day habilitation modified weighted transportation average is less than 75 percent of the regional modified weighted average for transportation to and from day treatment facilities.

(4) For the January 1, 1991 to December 31, 1991 and the July 1, 1991 to June 30, 1992 fee periods, and thereafter, the final fee shall be equal to the property and equipment component calculated in accordance with clause (3)(v)(h) of this subdivision plus the greater of subparagraph (i) or (ii) of this paragraph. For January 1, 1992 to December 31, 1992 and the July 1, 1992 to June 30, 1993 fee periods, the final fee shall be equal to the property and equipment component calculated in accordance with clause (3)(v)(h) of this subdivision plus subparagraph (ii) of this paragraph:

(i) for Region I facilities and those facilities designated or elected to a Region I year- end and fiscal reporting cycle, 99.5 percent of the fixed fee and operating components contained in the June 30, 1991 fee trended to the July 1, 1991 to June 30, 1992 fee period. For Region II and III facilities and those facilities designated or elected to a Region II or III year-end reporting and fiscal cycle, 99.5 percent of the fixed amount and operating components contained in the December 31, 1990 fee trended to January 1, 1991 to December 31, 1991 fee period. Trend factors shall be applied in accordance with paragraph (6) of this subdivision; or

(ii) the fixed fee and operating components determined in accordance with paragraph (3) of this subdivision trended to the appropriate fee period. The final fee for day treatment programs that did not have a fee in effect on December 31, 1990 or June 30, 1991, shall be equal to this fee.

(iii) Effective July 1, 1996, there shall be an efficiency adjustment as described herein and applied as a reduction to the calculated operating component of the fee.

(a) The efficiency adjustment shall be a percentage reduction based on the $10.12 associated with total agency and program administration in the fixed component of the fee. Except as provided for in clause (b) of this subparagraph, all cost and revenue information, used to determine the efficiency adjustment percentages, shall be based on reported cost and revenue information for the calendar 1992 or 1992-93 cost reporting year. Each provider shall be assigned a percentage value from the table at subclause (3) of this clause, based on total program cost, a program surplus/deficit group designation and an administration percentage group designation.

(1) Determination of program surplus/deficit group. A determination shall be made as to whether each provider has a program surplus or deficit, for the combined total of all community residence and day treatment programs and all residential habilitation and day habilitation services. Surplus/deficit shall equal gross revenue (less any prior period adjustments) minus allowable costs.

(i) For those providers with a reported deficit, this deficit shall be considered the final deficit amount for the purpose of this calculation.

(ii) For those providers with a reported program surplus, a certain portion of that surplus shall be exempted to establish an adjusted surplus. The adjusted surplus shall be the reported surplus minus the exempt amount. Exempt amounts shall be determined as follows. For providers whose total program costs are:

(A) less than $1 million, the exempt amount shall be $10,000;

(B) between $1 million and less than $3 million, the exempt amount shall be $22,500;

(C) between $3 million and $7 million, the exempt amount shall be $35,000;

(D) over $7 million, the exempt amount shall be $40,000.

(iii) The reported deficit or the adjusted surplus shall be given one of the following designations used to determine the efficiency adjustment percentage in the table at the end of this section:

(A) S2 if the adjusted surplus is equal to or greater than $200,000;

(B) S1 if the adjusted surplus is from $20,000 to $199,999;

(C) BE if the reported deficit is not greater than ($19,999) or the adjusted surplus is not greater than $19,999 (BE - break even);

(D) D1 if the reported deficit is from ($20,000) to ($199,999);

(E) D2 if the reported deficit is equal to or greater than ($200,000).

(2) Determination of a calculated administration percentage group. A determination shall be made of a provider's calculated administration cost, where administration percentage shall equal the sum of agency administration plus the program administration divided by the result of total operating cost minus the sum of capital costs, agency administration and program administration. There shall be five group designations that express the calculated administration percentage as a departure from the average percentage for all provider agencies. Those percentages centered around the average are designated with the abbreviation AVG. There are also two group designations for percentages over the average, abbreviated OA2 and OA1 and two designations for under the average, abbreviated UA2 and UA1. These abbreviations appear in the table of percentages at the end of this section as well as in the following regional tables. Each provider's assignment to one of the five group designations shall be based on the provider's calculated administration percentage, total program cost and elected or assigned region (refer to subdivision [a] of this section). Each provider's administration percentage group designation shall be determined using the following tables.

REGION ONE

Program Cost in Millions of Dollars (< less than; > greater than)

< $1	$1 to < $3	$3 to $7	> $7
Administration Percentage				Group
.3100 PLUS	.4500 PLUS	.4500 PLUS	.4500 PLUS	OA2
.2600.3099	.3500.4499	.3500.4499	.3500.4499	OA1
.2300.2599	.3200.3499	.3200.3499	.2800.3499	AVG
.1900.2299	.2500.3199	.2400.3199	.2400.2799	UA1
.0000.1899	.0000.2499	.0000.2399	.0000.2399	UA2

REGION TWO

Program Cost in Millions of Dollars (< less than; > greater than)

< $1	$1 to < $3	$3 to $7	> $7
Administration Percentage				Group
.3100 PLUS	.4500 PLUS	.3500 PLUS	.3500 PLUS	OA2
.2900.3099	.3500.4499	.2800.3499	.2500.3499	OA1
.2150.2899	.3200.3499	.2500.2799	.1900.2499	AVG
.1900.2149	.2500.3199	.2000.2499	.1700.1899	UA1
.0000.1899	.0000.2499	.0000.1999	.0000.1699	UA2

REGION THREE

Program Cost in Millions of Dollars (< less than; > greater than)

< $1	$1 to < $3	$3 to $7	> $7
Administration Percentage				Group
.4200 PLUS	.3500 PLUS	.2800 PLUS	.4200 PLUS	OA2
.3300.4199	.2700.3499	.2550.2799	.3300.4199	OA1
.2400.3299	.2250.2699	.2300.2549	.2400.3299	AVG
.1851.2399	.1900.2249	.2100.2299	.1851.2399	UA1
.0000.1850	.0000.1899	.0000.2099	.0000.1850	UA2

(3) Determination of the efficiency adjustment percentage. Each provider shall be assigned an efficiency adjustment percentage value from the following table, based on the surplus/ deficit group designation and the administration percentage group designation. The amount associated with the administration component of the fixed fee shall be determined by multiplying the administration component of the fixed fee times the units of service. The resulting total amount shall then be reduced by an efficiency adjustment percentage.

S2	S1	BE	D1	D2
OA2	17.00%	16.00%	15.00%	14.00%	13.00%
OA1	16.25%	15.25%	14.25%	13.25%	12.25%
AVG	15.50%	14.50%	13.50%	12.50%	11.50%
UA1	14.75%	13.75%	12.75%	11.75%	10.75%
UA2	14.00%	13.00%	12.00%	11.00%	10.00%

(i) New day treatment program sites operating subsequent to the 1992 or 1992-93 cost reporting period shall be assigned the cell value designated for the rest of the day treatment programs operated by the provider agency.

(ii) New agencies operating day treatment programs subsequent to the 1992 or 1992-93 cost reporting period shall be assigned the center cell value, i.e., AVG-BE, in the table found in this subclause.

(b) Providers may request that OPWDD use a more recent cost reporting period, as an alternative to their 1992 or 1992-93 reporting period, to determine the efficiency adjustment percentage as described herein. Approval to use an alternative reporting period shall be granted if, upon a fiscal review by the commissioner, it is determined that the cost report for the alternative reporting period more accurately reflects the provider's current financial status. For the purpose of determining the efficiency adjustment percentage only, providers may submit corrections to their 1992 or 1992-93 cost report. Such corrections shall be certified by a certified public accountant. Providers may request the use of an alternative reporting period or may submit corrections to their 1992 or 1992-93 cost report only once. Such requests or corrections shall be made in writing and received by OPWDD by December 31, 1996. Providers shall also have until December 31, 1996 to notify OPWDD of errors made in calculating the efficiency adjustment.

(5) The final adjusted fee shall be equal to the final fee determined in paragraph (4) of this subdivision, except as provided below:

(i) Day treatment programs in Regions II and III including those programs in Region I designated or elected to a Region II and III year-end reporting and fiscal cycle shall receive the annualization component add-on for the period April 1, 1991 to December 31, 1991. The annualization component add-on shall be equal to the difference between the fee in effect on March 31, 1991 and the April 1, 1991 final fee calculated pursuant to paragraph (4) of this subdivision for the period January 1, 1991 to March 31, 1991 divided by the units of service pursuant to paragraph (1) of this subdivision. The annualization component add-on shall be added to the final fee determined in accordance with paragraph (4) of this subdivision, and the resulting fee shall be considered the final adjusted fee.

(ii) Effective January 1, 1999, a cost of living add-on may be included in the final adjusted fee. This add-on will be an increase to the fee due to a 2.5 percent increase in salaries and salary related fringe benefits. Inclusion of the add-on is subject to a resolution of the facility's governing body that funding received will be used solely to effect a 2.5 percent increase beginning with the lowest paid employees. To be deemed reimbursable, both the resolution and an implementation plan must be submitted by the facility and approved by the commissioner.

(iii) Facilities initially certified as day treatment facilities on or after April 30, 1999 shall be deemed to have met the requirements for an approved cost of living add-on described in subparagraph (ii) of this paragraph, and a corresponding factor shall be included in the final adjusted fee.

(iv) Effective July 1, 2000, day treatment facilities may be eligible for a salary enhancement add-on to be included in their final adjusted fee. 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 direct care and support workers. Inclusion of the add-on is subject to the provider agency submitting a resolution of its governing body that funding received will be used to effect this salary increase. To receive the add-on the agency must submit the resolution and implementation plan to OPWDD and the commissioner must approve them.

(v) Facilities initially certified as day treatment facilities on or after April 1, 2001 shall be deemed to have met the requirements for an approved salary enhancement add-on described in subparagraph (iv) of this paragraph, and a corresponding factor shall be included in the final adjusted fee.

(vi) Effective January 1, 2003, day treatment programs may be eligible for a cost of living adjustment (COLA) add-on to be included in their final adjusted fee. This add-on is a three percent increase to the personal service portion of allowed reimbursement, for expenditures related to recruitment and retention of staff for the period of April 1, 2002 through March 31, 2003. On or after January 1, 2003, eligible facilities will receive an amount that they would have received if the COLA add-on were added to the final adjusted fee on December 1, 2002. The provider is required to submit to OPWDD a letter of attestation, signed by the executive director and president or equivalent of the governing body, which details how the COLA is expended.

(vii) Facilities initially certified on or after April 1, 2003 shall be deemed to have met the requirements for an approved COLA add-on described in subparagraph (vi) of this paragraph, and a corresponding factor shall be included in the final adjusted fee.

(viii) Effective April 1, 2005, costs incurred as a result of requests for criminal history record checks under section 16.33 of the Mental Hygiene Law and section 845-b of the Executive Law shall be allowable costs and shall be considered part of the fee.

(ix) The day treatment facility shall be responsible for the cost of services which:

(a) are necessary to meet the needs while attending the program; and

(b) which prior to August 1, 2004 could have been met by home health aide or personal care services separately billed to Medicaid.

(6) OPWDD shall employ any or all of the following trend factor components:

(i) Region I. The following trend factor shall be applied to the fee in effect on June 30th of the prior year:

(a) 5.71 percent for 1988-89 to 1989-90 including those facilities in Regions II and III designated or elected to a Region reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Regions II and III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(b) 7.51 percent for 1989-90 to 1990-91 including those facilities in Region II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(c) 6.24 percent for 1990-91 to 1991-92 including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(d) 4.85 percent for 1991-92 to 1992-93 including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(e) 3.73 percent for 1992-93 to 1993-94, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(f) 3.79 percent for 1993-94 to 1994-95, including those facilities in Regions II or III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(g) 3.16 percent for 1994-95 to 1995-96, including those facilities in Regions II or III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(h) 0.00 percent for 1995-96 to 1996-97, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(i) 0.00 percent for 1996-97 to 1997-98, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(j) 0.00 percent for 1997-98 to 1998-99, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(k) 0.00 percent for 1998-99 to 1999-2000, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(l) 0.00 percent for 1999-2000 to 2000-2001, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title.

(m) 0.00 percent for 2000-2001 to 2001-2002, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section.

(n) 0.00 percent for 2001-2002 to 2002-2003, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section.

(o) 0.00 percent for 2002-2003 to 2003-2004, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section.

(p) 0.00 percent for 2003-2004 to 2004-2005, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section.

(q) 0.00 percent for 2004-2005 to 2005-2006, including those facilities in Regions II and III designated or elected to a Region I reporting year-end and fiscal cycle and excluding those facilities in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with subparagraph (b)(1)(iv) of this section.

(ii) Regions II and III. The following trend factor shall be applied to the fee in effect on December 31st of the prior year:

(a) 5.71 percent 1988 to 1989, including those facilities in Region I designated to Region II or III and excluding those facilities in Region II or III designated to Region I in accordance with Subpart 635-4 of this Title.

(b) 7.51 percent for 1989 to 1990, including those facilities in Region I designated or elected to Regions II or III and excluding those facilities in Region II and III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(c) 6.24 percent for 1990 to 1991, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(d) 4.85 percent for 1991 to 1992, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(e) 3.73 percent for 1992 to 1993, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(f) 3.79 percent for 1993 to 1994, including those facilities in Region I designated or elected to Regions II and III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(g) 3.16 percent for 1994 to 1995, including those facilities in Region I designated or elected to Region II and III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(h) 0.00 percent for 1995 to 1996, including those facilities in Region I designated or elected to a Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(i) 0.00 percent for 1996 to 1997, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(j) 0.00 percent for 1997 to 1998, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with Subpart 635-4 of this Title.

(k) 0.00 percent for 1998 to 1999, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(l) 0.00 percent for 1999 to 2000, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(m) 0.00 percent for 2000 to 2001, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(n) 0.00 percent for 2001 to 2002, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(o) 0.00 percent for 2002 to 2003, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(p) 0.00 percent for 2003 to 2004, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(q) 0.00 percent for 2004 to 2005, including those facilities in Region I designated or elected to Region II or III and excluding those facilities in Region II or III designated or elected to Region I in accordance with subparagraph (b)(1)(iv) of this section.

(iii) Regions I, II, and III.

(a) Effective January 1, 2006, facilities in all three regions may be eligible to receive a variable trend factor for employee health care enhancement (HCE).

(1) Providers are eligible to have a variable trend factor included in their fee if they submitted a completed 2005 OPWDD survey on health care benefits for all full- and part-time employees.

(2) Based on a survey of providers, OPWDD determined a benchmark of health care benefits offered to employees by providers. In September 2005, OPWDD notified those providers if their health care benefits were at, above, or below the benchmark.

(3) Providers whose employee health care benefits are below the benchmark may apply to OPWDD for a variable trend factor to be effective January 1, 2006 and to be calculated as follows:

(i) For providers which reported on the survey that no health care benefits are offered, OPWDD determined a variable trend factor for each provider based on the total number of employees reported multiplied by $2,500, except that if there are any employees who were reported on the survey and to whom the provider chooses not to offer funding from the variable trend factor, the variable trend factor based on the total number of employees reported will be reduced by the number of excluded employees reported multiplied by $2,500. The funding from this variable trend factor must be used to establish employee health care benefits or to reduce employee out- of-pocket health-related expenses.

(ii) For providers which reported on the survey that employee health care benefits are offered to some or all employees, OPWDD determined a variable trend factor for each provider based on the total number of employees reported multiplied by $325, except that if there are any employees who were reported on the survey and to whom the provider chooses not to offer funding from the variable trend factor, the variable trend factor based on the total number of employees reported will be reduced by the number of excluded employees reported multiplied by $325. The funding from this variable trend factor must be used to enhance employee health care benefits or to reduce employee out-of-pocket health-related expenses.

(4) Effective January 1, 2006, providers may receive a variable trend factor that would have been received during the period of April 1, 2004 through December 31, 2005 if the variable trend factor described in clause (c) of this subparagraph had been paid. Providers whose employee health care benefits are below the benchmark may apply to OPWDD for the variable trend factor as follows:

(i) For providers which reported on the survey that no employee health care benefits are offered, no variable trend factor for the period of April 1, 2004 through December 31, 2005 is available.

(ii) For providers which reported on the survey that employee health care benefits are offered to some or all employees, OPWDD determined a variable trend factor for each provider based on the total number of employees reported multiplied by $325, except that if there are any employees who were reported on the survey and to whom the provider chooses not to offer funding from this variable trend factor, the variable trend factor based on the total number of employees reported will be reduced by the number of excluded employees reported multiplied by $325. The annual allocation of $325 will be adjusted for the 21-month period of April 1, 2004 through December 31, 2005. Funding from this variable trend factor must be used to reimburse health care expenses paid by employees.

(5) In order to receive a variable trend factor described in clause (c) or (d) of this subparagraph, the provider must send to OPWDD a completed written application submitted in the form and format specified by the commissioner.

(6) Funding from the variable trend factor is contingent upon OPWDD's approval of the application. OPWDD will base its decision on whether the application is complete; whether it complies with the requirements of this subparagraph; and whether the application recognizes the provider's lowest paid employees. OPWDD may request additional information and/or documentation as needed before approving the application.

(7) Payment of the variable trend factor described in clause (c) or (d) of this subparagraph shall be subject to the provider submitting a resolution by its governing body that funds received will be used to implement the plans described in the provider's approved application. To receive the variable trend factor, the provider must submit the resolution and the commissioner must approve it.

(b) Effective October 1, 2006, facilities are eligible for a trend factor of 2.8 percent to the operating portion of the fee. This trend factor is for expenditures related to the promotion of recruitment and retention of staff or to respond to other critical non-personal service costs during the period of April 1, 2006 through March 31, 2007. In order to receive this trend factor, the provider is required to submit to OPWDD a letter of attestation, signed by the executive director and president or equivalent of the governing body, which details how the trend factor monies are expended. Facilities initially certified on or after April 1, 2007 shall be deemed to have met the requirements for the letter of attestation required by this clause.

(c)Employee health care enhancement II.

(1) Effective January 1, 2007 providers may be eligible to receive a variable trend factor for health care enhancement II (HCE II). Provides must use these funds to establish or enhance employee health care benefits or to reduce employee out of pocket health care expenses.

(2) In order to receive the variable trend factor described in this subdivision, the provider must have sent to OPWDD a completed written application by July 31, 2006, unless this deadline was extended by the commissioner.

(3) Receipt of the variable trend factor is contingent upon OPWDD's approval of the application. OPWDD shall decide whether to approve the application based on whether the application is complete; whether it complies with the requirements of this subdivision; and whether the application recognizes the provider's lowest paid employees. OPWDD may request additional information and/or documentation, or revisions to an application, before approving the application.

(4) The variable trend factor for HCE II is available at either $2,500 per employee or $425 per employee, as follows:

(i) The variable trend factor at the $2,500 level is determined by OPWDD based on the total number of employees included in the provider's approved HCE II application multiplied by $2,500. Funding at the $2,500 level is available to providers which:

(A) submitted an application for HCE II variable trend factor at the $2,500 level; and

(B) do not offer health care benefits; and

(C) were insufficiently funded for health care, as determined by OPWDD. Affected providers were notified by OPWDD of this determination.

(ii) The variable trend factor at the $425 level is determined by OPWDD based on the total number of employees included in the provider's approved HCE II application multiplied by $425. Funding at the $425 level is available to providers which:

(A) offer health care benefits to some or all employees and submitted an application for the HCE II variable trend factor at the $425 level; or

(B) applied for HCE II variable trend factor at the $2,500 level but received funding at the $2,500 per employee level pursuant to clause (c) of this subparagraph; or

(C) submitted an application at the $2,500 level but have sufficient funding for health care, as determined by OPWDD. Affected providers were notified by OPWDD of this determination.

(5) The application submitted to OPWDD shall include plans for the expenditure of the HCE II variable trend factor in conformance with this subdivision. Such HCE II plans shall assure that all employees included in the application are entitled to some benefit from HCE II, although the value per employee may be lesser or greater than $2,500 or $425 per employee. Higher paid employees whose earnings exceed a salary cap established by the provider may be excluded from receipt of any HCE II funds if these funds are reallocated to lower paid staff.

(6) A provider approved to receive HCE II variable trend factor pursuant to item (c)(4)(ii) of this subparagraph shall receive an amount that would have been paid if the HCE II initiative had been implemented April 1, 2006.

(7) Payment of the HCE II variable trend factor shall be subject to the provider submitting a resolution by its governing body that funds received shall be used to implement the plans described in the provider's approved application. To receive the variable trend factor the provider must submit the resolution and the commissioner must approve it.

(8) A fee revised by OPWDD pursuant to this subdivision shall not be considered final unless and until approved by the State Division of the Budget.

(d) Effective June 1, 2007, facilities are eligible for a trend factor of 2.3 percent to the operating portion of the fee. This trend factor is for expenditures related to the promotion of recruitment and retention of staff or to respond to other critical non-personal service costs during the period of April 1, 2007 through March 31, 2008. From June 1, 2007 to March 31, 2008, facilities will be reimbursed operating costs that result in a full annual trend factor of 2.3 percent as if the trend factor were reimbursed from April 1, 2007 through March 31, 2008. In order to receive this trend factor, the provider is required to submit to OPWDD a letter of attestation, signed by the executive director and president or equivalent of the governing body, which details how the trend factor monies are expended. Facilities initially certified on or after April 1, 2008 shall be deemed to have met the requirements for the letter of attestation required by this clause.

(e) Employee health care enhancement III.

(1) Effective January 1, 2008 providers may be eligible to receive a variable trend factor for the health care enhancement III (HCE III) included in their fee.

(2) Variable trend factor. Based on a survey of providers' historical data as of January 1, 2005, OPWDD determined a benchmark of health care benefits offered to employees by providers. Prior to September 30, 2007, OPWDD notified those providers which OPWDD deemed eligible for an HCE III variable trend at the benchmark level. Providers deemed eligible for an HCE III variable trend below the benchmark level were mailed applications with instructions.

(i) Providers deemed eligible for the HCE III variable trend factor at the benchmark level shall receive an amount equaling 1.0 percent of the operating costs exclusive of any HCE III component contained in the fee in effect on January 1, 2008 net of any funding provided pursuant to item (iii) of this subclause. Providers which also operate programs and services eligible for the 3.0 percent funding level increase under this Chapter may not receive this 1.0 percent variable trend factor unless they have declined the 3.0 percent funding level increase in the eligible programs and services. Providers which receive this 1.0 percent variable trend factor may not apply for the employee health care variable trend factor described in item (ii) of this subclause.

(ii) Providers deemed eligible for the HCE III variable trend factor below the benchmark level may apply to OPWDD to receive an amount equaling 1.0 percent of the operating costs exclusive of any HCE III component contained in the fee in effect on January 1, 2008 net of any funding provided pursuant to item (iii) of this subclause.

(A) Providers shall use these funds to establish or enhance employee health care benefits and/or to reduce employee out-of-pocket health care expenses and/or to offset the portion of premium increases paid by the provider which exceeds the portion of the trend factor or COLA applicable to those premium increases. Providers shall assure that benefits resulting from this additional funding recognize their lower paid employees.

(B) In order to receive the variable trend factor described in this item, the provider must have sent to OPWDD a completed application and attestation received or postmarked by October 1, 2007, unless the deadline was extended by the commissioner. In the application and attestation, the provider must have indicated its intended use of the funds; agreed to obtain a resolution by December 31, 2007 from its governing body authorizing such use; and agreed to maintain on file the resolution as well as records detailing the distribution of HCE III funds.

(C) Funding is contingent upon OPWDD's approval of the application and attestation. OPWDD shall decide whether to approve the application and attestation based on whether it is complete and conforms to the requirements of this subdivision. OPWDD may request additional information or documentation before approving the application and attestation.

(iii) A provider approved to receive an HCE III variable trend factor pursuant to item (i) or (ii) of this subclause shall receive an amount that would have been paid if the HCE III initiative has been implemented April 1, 2007.

(3) A fee revised by OPWDD pursuant to this clause shall not be considered final unless and until approved by the State Division of the Budget.

(f) Effective August 1, 2008, facilities are eligible for a trend factor of 3.2 percent to the operating portion of the fee. This trend factor is for expenditures related to the promotion of recruitment and retention of staff or to respond to other critical non-personal service costs during the period of April 1, 2008 through March 31, 2009. From August 1, 2008 to March 31, 2009, facilities will be reimbursed operating costs that result in a full annual trend factor of 3.2 percent as if the trend factor were reimbursed from April 1, 2008 through March 31, 2009. In order to receive this trend factor, a provider which did not submit a Letter of Attestation for 2007-2008 is required to submit to OPWDD a Letter of Attestation, signed by the Executive Director and President or equivalent of the governing body, which details how the trend factor monies are expended. Facilities initially certified on or after April 1, 2009 shall be deemed to have met the requirements for the Letter of Attestation required by this clause.

(g) From April 1, 2009 to March 31, 2010 the trend factor shall be 0.00 percent for all facilities.

(h) Health care adjustments (HCA) IV and V.

(1) Variable trend factor. Effective November 1, 2009, providers may be eligible to receive a variable trend factor for the health care adjustments IV and V included in their fees.

(2) Benchmark providers and non-benchmark providers. Based on a survey of providers' historical data as of January 1, 2005, OPWDD determined a benchmark of health care related benefits offered to employees by providers. Prior to October 31, 2007, OPWDD notified those providers which OPWDD deemed eligible for the HCE III variable trend factor at the benchmark level. Providers eligible for HCE III variable trend factor at the benchmark level are eligible for the HCA IV and HCA V variable trend factors at the benchmark level. All other providers are eligible for the HCA IV and HCA V variable trend factors below the benchmark level.

(3) Funding.

(i) Providers eligible for HCA IV and HCA V funding at the benchmark level.

(A) The variable trend factors for HCA IV and HCA V for benchmark providers shall be 1.0 percent of the allowable operating costs used in establishing the provider specific fees. Each adjustment shall be applied sequentially to effect compounding of the adjustments.

(B) Providers which also operate programs and services eligible for the 3.0 percent funding level increase under this Chapter may not receive these 1.0 percent variable trend factor increases unless they have declined the 3.0 percent funding level increase in the eligible programs and services. Providers which receive these 1.0 percent variable trend factor increases may not apply for employee health care funding described in item (ii) of this subclause.

(ii) Providers eligible for HCA IV and HCA V funding below the benchmark level may apply to OPWDD to receive the variable trend factors.

(A) The HCA IV and HCA V variable trend factors for providers eligible for funding below the benchmark shall be 1.0 percent of the allowable operating costs used in establishing the provider specific fees. Each adjustment shall be applied sequentially to effect compounding of the adjustments.

(B) Providers shall use these funds first to offset health care premium increases. Remaining funds shall be used to establish or enhance employee health care related benefits and/or to reduce employee out-of-pocket health care related expenses.

(C) In order to receive the HCA IV and HCA V variable trend factors, the provider must have sent to OPWDD a completed application and attestation received or postmarked no later than September 11, 2009 unless the deadline was extended by the commissioner. In the application and attestation, the provider must have indicated its intended use of the funds; agreed to obtain a resolution by October 31, 2009 from its governing body authorizing such use; and agreed to maintain on file the resolution as well as records detailing the distribution of HCA IV and HCA V funds.

(D) The variable trend factor is contingent upon OPWDD's approval of the application and attestation based on whether it is complete and conforms to the requirements of this subdivision. OPWDD may request additional information or documentation before approving the application and attestation.

(4) Catch-up provisions. Effective November 1, 2009, benchmark providers which do not receive any HCA funding at the 3.0 percent level and non-benchmark providers with approved applications shall be eligible to receive additional funding for HCA IV in an amount that would have been received for the period of April 1, 2008 through October 31, 2009 if the 1.0 percent variable trend factor had been implemented on April 1, 2008. Effective November 1, 2009 benchmark providers which do not receive any HCA funding at the 3.0 percent level and non-benchmark providers with approved applications shall be eligible to receive additional funding for HCA V in an amount that would have been received for the period of April 1, 2009 through October 31, 2009 if the 1.0 percent variable trend factor had been implemented on April 1, 2009. Nothing in this subclause shall entitle a provider to receive payment for services which have not been provided.

(5) Consolidation of HCE and HCA funds effective January 1, 2010.

(i) Effective January 1, 2010, the HCE I through III and HCA IV and HCA V variable trend factors included in the fee shall be consolidated into a single discrete amount. For purposes of determining this amount, OPWDD shall combine the HCE I through III and HCA IV and HCA V variable trend factors contained in the initial fee in effect on January 1, 2010. OPWDD shall use this fixed amount as the HCA variable trend factor for the fee periods beginning on or after January 1, 2010.

(ii) Effective January 1, 2010, with the consolidation of the health care adjustments, non-benchmark providers shall use HCE I, II and III funds first to either offset health care premium increases and/or to maintain benefits that were established and funded with previous HCE I, II and III receipts. Remaining funds shall be used to establish or enhance employee health care related benefits and/or to reduce employee out-of-pocket health care related expenses. Non-benchmark providers shall continue to use HCA IV and V funds first to offset health care premium increases. Remaining funds shall be used to establish or enhance employee health care related benefits and/or to reduce employee out-of-pocket health care related expenses. Health care enhancement/adjustment funds included in the fees for services delivered on or after July 6, 2011 shall be used by non-benchmark providers for the purposes described in this item and/or for any other options that continue and/or enhance existing health care benefits and/or improve the recruitment and/or retention of the provider's lower paid employees. However, in using these funds accordingly, non-benchmark providers may establish which priorities serve the needs of such employees. Additionally, on July 6, 2011, health care enhancement/adjustment funding shall be included in the reimbursable cost category of fringe benefits in the fee.

(6) Provider's distribution of HCA IV and HCA V funds is subject to audit to ensure conformity with the requirements of this paragraph and distribution of funds consistent with the provider's approved application.

(i) From April 1, 2010 to March 31, 2011 the trend factor shall be 0.00 percent for all facilities.

(j) Health care adjustments (HCA) VI.

(1) Variable trend factor. Effective October 1, 2010, providers may be eligible to receive a variable trend factor for the health care adjustment (HCA) VI included in their fees.

(2) Benchmark providers and non-benchmark providers. Based on a survey of providers' historical data as of January 1, 2005, OPWDD determined a benchmark of health care related benefits offered to employees by providers. Prior to October 31, 2007, OPWDD notified those providers which OPWDD deemed eligible for the health care enhancement (HCE) III variable trend factor at the benchmark level. These providers are "benchmark providers" and are eligible for HCA VI funding at the benchmark level. All other providers ("non-benchmark providers") are eligible for the HCA VI funding below the benchmark level.

(3) Funding.

(i) Providers eligible for HCA VI funding at the benchmark level.

(A) The variable trend factor for HCA VI for benchmark providers shall be 1.0 percent of the allowable operating costs used in establishing the provider specific fees in effect on April 1, 2010.

(B) Providers which also operate programs and services eligible for the 3.0 percent funding level increase under this Chapter may not receive the 1.0 percent variable trend factor increase unless they have declined the 3.0 percent funding level increase in the eligible programs and services.

(C) Providers eligible for funding at the benchmark level may not apply for HCA VI variable trend factor funding described in item (ii) of this subclause.

(ii) Providers eligible for HCA VI funding below the benchmark level may apply to OPWDD to receive the variable trend factor.

(A) The HCA VI variable trend factor for providers eligible for funding below the benchmark shall be 1.0 percent of the allowable operating costs used in establishing the provider specific fees in effect on April 1, 2010.

(B) Providers shall use these funds first to offset health care premium increases. Remaining funds shall be used to establish or enhance employee health care related benefits and/or to reduce employee out-of-pocket health care related expenses. Health care adjustment funds included in the fees for services delivered on or after July 6, 2011 shall be used by non-benchmark providers for the purposes described in this subitem and/or for any other options that continue and/or enhance existing health care benefits and/or improve the recruitment and/or retention of the provider's lower paid employees. However, in using these funds accordingly, non-benchmark providers may establish which priorities serve the needs of such employees. Additionally, on July 6, 2011, health care adjustment funding shall be included in the reimbursable cost category of fringe benefits in the fee.

(C) In order to receive the HCA VI variable trend factor, the provider must have sent to OPWDD a completed application and attestation received or postmarked no later than August 13, 2010 unless the deadline was extended by the commissioner. In the application and attestation, the provider must have indicated its intended use of the funds; agreed to obtain a resolution by September 30, 2010 from its governing body authorizing such use; and agreed to maintain on file the resolution as well as records detailing the distribution of HCA VI variable trend factor funds.

(D) The variable trend factor is contingent upon OPWDD's approval of the application and attestation based on whether it is complete and conforms to the requirements of this subdivision. OPWDD may request additional information or documentation before approving the application and attestation.

(iii) Effective October 1, 2010, benchmark providers which do not receive any HCA VI funding at the 3.0 percent level and non-benchmark providers with approved applications shall be eligible to receive additional funding for HCA VI variable trend factor in an amount that they would have received if the HCA VI variable trend factor had been in effect for the period from April 1, 2010 through September 30, 2010. Nothing in this item shall entitle a provider to receive payment for services which have not been provided.

(4) Provider's distribution of HCA VI variable trend factor funds is subject to audit to ensure conformity with the requirements of this paragraph and distribution of funds consistent with the provider's approved application.

(iv) Where appropriate, the commissioner may use some combinations in whole or in part of the yearly components to project cost data into the appropriate fee period.

(7) The commissioner may make corrections or adjustments to the fees based upon the following:

(i) Errors which occurred in the computation of the fee.

(ii) Final audit findings made in accordance with subdivision (f) of this section.

(iii) The day treatment provider may request corrections to the fee within 90 days of receipt of the fee. Such requests for corrections are limited to errors in a cost report pursuant to subparagraph (b)(4)(iii) of this section, corrections to the DDP, and corrections to the transportation component add-on pursuant to subparagraph (3)(vii) of this subdivision. If corrections to the DDP would result in an increase to the final adjusted fee, the commissioner may independently review the corrected DDPs. During the period when the commissioner is reviewing the provider-submitted revised DDP data, both the raw score and the percentile charts found in clauses (3)(v)(a) and (b) of this subdivision, in effect at that time, and that were used to calculate the fee for the prior fee period, shall be utilized for fee-setting purposes until the commissioner's review is completed. Should the commissioner's review verify the provider-submitted revisions to the DDP data, said revised DDP data shall be utilized for fee-setting purposes retroactive to the first day of the fee period. The case mix component add-on and the case mix intensity component add-on may be recalculated only if there is a 10-percent or greater change in participants resulting from either a change in certified capacity or a turnover in program participants, or a correction to the DDP score approved by the commissioner. Day treatment programs must report to the Bureau of Rate Setting all participant change greater than 10 percent.

(iv) Adjustment to actual units of service.

(a) OPWDD may, upon request from a day treatment facility, adjust the units of service used for the facility's calculation for the prior fee period to actual units of service delivered during such fee period. However, such adjustment will be limited to situations where the agency demonstrated it was in a deficit situation for the prior fee period and had, for reasons beyond its control, not been able to deliver the units of service used to calculate the fee for the prior fee period.

(b) The day treatment provider must request adjustments to the facility's actual units of service within 150 days of the fiscal reporting period for which said adjustment is sought.

(8) All fees, and any corrections to fees shall not be considered final, unless approved by the director of the Division of the Budget.

(9) Funded depreciation.

(i) Applicability. Paragraph (6) of this subdivision shall apply to all day treatment programs except those governed by subparagraphs (c)(2)(i) and (ii) of this section. Paragraph (6) of this subdivision shall apply to day treatment programs which were governed by clause (c)(2)(ii)(d) or (e) of this section but which are no longer governed by either such clause because the provider has repaid the entire principal owed on the real property of the day treatment programs.

(ii) Effective July 1, 1986, for any fee period during which the reimbursement attributable to depreciation on a day treatment program's real property, excluding equipment, exceeds the provider's principal repayment obligations on indebtedness attributable to such real property, such provider shall fund depreciation by depositing such difference in an interest bearing checking account or other secure investment. If the provider operates more than one day treatment program governed by paragraph (6) of this subdivision the provider may maintain one funded depreciation account for two or more day treatment programs. The provider shall not commingle such funded depreciation account(s) with other monies of the provider. The provider shall not be required to fund depreciation attributable to the provider's equity in such real property. The provider may expend the funds in such account, including accrued interest, to retire all or a portion of the indebtedness attributable to such real property, or for building improvements and/or fixed equipment necessary to the day treatment program.

(10) The day treatment fees in effect for the period March 29, 1991 through March 31, 1991 for Region II and III facilities and including those programs in Region I designated or elected to a Region II or III reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title, determined in accordance with the day treatment fee-setting methodology pursuant to this section in effect on March 28, 1991 shall remain in effect through March 31, 1991. The day treatment fees for the period March 29, 1991 through June 30, 1991 for Region I facilities including those Region II and III facilities designated or elected to a Region I reporting year-end and fiscal cycle in accordance with Subpart 635-4 of this Title, determined in accordance with the day treatment fee-setting methodology pursuant to this section in effect on March 28, 1991 shall remain in effect through June 30, 1991.

(e)Case mix methodology.

(1) DDP factor scores shall be determined in accordance with subparagraphs (i) through (iii) of this paragraph.

(i) The adaptive factor score shall be computed by subtracting from 500 the sum of the adaptive indexes. The adaptive indexes are self care, daily living, cognitive, communication and motor.

(a) SELF-CARE

TOTAL SUPPORT Completely dependent	ASSISTANCE Requires lots of hands-on help	SUPERVISION Requires mainly verbal prompts	INDEPENDENT Starts and finishes without prompts or help
Toileting/bowels	0	1	2	3
Toileting/bladder	0	1	2	3
Taking a shower/ bath	0	1	2	3
Brushing teeth/ cleaning dentures	0	1	2	3
Brushing/combing hair	0	1	2	3
Selecting clothes appropriate to weather	0	1	2	3
Putting on clothes	0	1	2	3
Undressing self	0	1	2	3
Drinking from a cup or glass	0	1	2	3
Chewing and swallowing food	0	1	2	3
Feeding self	0	1	2	3

The self care items shall be assigned points as follows: 0 = Total support, 1 = Assistance, 2 = Supervision, 3 = Independent. The self care index is obtained by dividing the total number of points by the total possible points (33) and multiplying by 100. The self care index is computed from all items for which information is provided. In the case of missing information, the total points possible is reduced accordingly.

(b) DAILY LIVING

TOTAL SUPPORT Completely Dependent	ASSISTANCE Requires lots of hands-on help	SUPERVISION Requires mainly verbal prompts	INDEPENDENT Starts and finishes without prompts or help
Making bed	0	1	2	3
Cleaning room	0	1	2	3
Doing laundry	0	1	2	3
Using telephone	0	1	2	3
Shopping for a simple meal	0	1	2	3
Preparing foods that do not require cooking	0	1	2	3
Using stove or microwave	0	1	2	3
Crossing street in residential neighborhood	0	1	2	3
Using public transportation for a simple direct trip	0	1	2	3
Managing own money	0	1	2	3

The daily living items shall be assigned points as follows: 0 = Total support, 1 = Assistance, 2 = Supervision, 3 = Independent. The daily living index is obtained by dividing the total number of points by the total possible points (33) and multiplying by 100. The daily living index is computed from all items for which information is provided. In the case of missing information, the total points possible is reduced accordingly.

(c) COGNITIVE

Sort objects by size

Correctly spell first and last name

Tell time to nearest five minutes (digital or analog)

Distinguish between right and left

Count ten or more objects

Understand simple functional signs

(e.g., EXIT, restrooms)

Do simple addition and subtraction of figures

Read and comprehend simple sentences

Read and comprehend newspaper or magazine articles

The cognitive index is equal to the total number of "yes" responses to the cognitive questions divided by 9 and multiplied by 100. Each "yes" response is equal to 1. In the case of missing information, the divisor (9) must be reduced accordingly.

(d) COMMUNICATION

Understands the meaning of "No"

Understands one-step directions (e.g., "Put on your coat.")

Understands two-step directions (e.g., "Put on your coat, then go outside.")

Understands a joke or story

Indicates a "Yes" or "No" response to a simple question

Asks simple questions

Relates experiences when asked

Tells a story, joke, or the plot of a television show

Describes realistic plans in detail

The communication index is equal to the total number of "yes" responses to the communication questions divided by 9 and multiplied by 100. Each "yes" response is equal to 1. In the case of missing information, the divisor (9) must be reduced accordingly.

(e) MOTOR

Walks independently or walks independently but with difficulty (no corrective device)

Can roll from back to stomach

Can pull self to standing

Can walk up and down stairs alternating feet from step to step

Can pick up a small object

Can transfer an object from hand to hand

Can mark with pencil, crayon or chalk

Can turn pages of a book one at a time

Can copy a circle from an example

Can cut with scissors along a straight line

The motor index is equal to the total number of "yes" responses to the mobility and motor questions divided by 10 and multiplied by 100. Each "yes" response is equal to 1. In the case of missing information, the divisor (10) must be reduced accordingly.

(ii) The maladaptive score shall be computed by subtracting from 200 the sum of the behavior frequency and behavior consequences indexes.

(a) BEHAVIOR FREQUENCY

NOT THIS YEAR	OCCASIONALLY Less than once a month	MONTHLY About once a month	WEEKLY About once a week	FREQUENTLY Several times a week	DAILY Once a day or more
Has tantrums or emotional outbursts	5	4	3	2	1	0
Damages own or other's property	5	4	3	2	1	0
Physically assaults others	5	4	3	2	1	0
Disrupts other's activities	5	4	3	2	1	0
Is verbally or gesturally abusive	5	4	3	2	1	0
Is self-injurious	5	4	3	2	1	0
Teases or harasses peers	5	4	3	2	1	0
Resists supervision	5	4	3	2	1	0
Run or wanders away	5	4	3	2	1	0
Steals	5	4	3	2	1	0

The behavior frequency Index assigned points as follows: 5 = not this year, 4 = occasionally, 3 = monthly, 2 = weekly, 1 =frequently, 0 = daily. The behavior frequency index shall be obtained by dividing the total number of points by the total number of possible points (50) and multiplying by 100. Behavior frequency index is computed for all items for which information is provided. The maximum points (50) is reduced by 5 for each missing answer.

(b) BEHAVIOR CONSEQUENCES INDEX

Behavior problems currently prevent this person from moving to a less restrictive setting

Specific behavioral programming or procedures are required

Individual's environment must be carefully structured to avoid behavior problems

Because of behavior problems, staff must sometimes intervene physically with individual, e.g., physically restrain or guide individual from room

Because of behavior problems, a supervised "time-out" period is needed at least once a week

Because of behavior problems, person requires one-on-one supervision for many program activities

The behavior consequences index shall be equal to the number of "no" responses divided by 6 and multiplied by 100. Each "no" response is equal to 1. The score is computed based on the questions answered. The maximum points possible (6) must be reduced by 1 for each missing answer.

(iii) The health medical factor score shall be computed by summing the points from the number of medical conditions, the seizure score, the number of medications, the medication support level, and the number of medical consequences to a maximum of 31.

(a) MEDICAL CONDITIONS

Respiratory

(e.g., asthma, emphysema, cystic fibrosis)

Cardiovascular

(e.g., heart disease, high blood pressure)

Gastro-intestinal

(e.g., ulcers, colitis, liver and bowel difficulties)

Genito-Urinary

(e.g., kidney problems)

Neoplastic Disease

(e.g., cancer, tumors)

Neurological Diseases (e.g., MS, Organic Brain Syndrome, ALS, Huntington's disease)

The number of medical conditions shall be equal to the number of "yes" responses. Each "yes" response, is equal to 1.

(b) SEIZURE

Seizure History

Yes - 1

No - 0

Types of seizures individual has experienced in the last twelve months?

No seizures this year

Simple partial (Simple motor movements affected; no loss of awareness)

Complex partial (Loss of awareness)

Generalized - Absence (Petit Mal)

Generalized - Tonic-Clonic (Grand Mal)

Had some type of seizure - not sure of type

Frequency of seizures that involve loss of awareness and/or loss of consciousness?

1 None during past year

2 Less than once a month

3 About once a month

4 About once a week

5 Several times a week

6 Once a day or more

Seizure score. The number of seizure types identified to a maximum of (5) shall be added to the seizure frequency score calculated as follows: 0 = no history of seizures, 1 =no seizures in the last year, 2 through 7 = points assigned are one more than the number circled under Frequency. The maximum seizure score possible is 5 + 7 = 12.

(c) PRESCRIPTIONS.

Indicate all types of prescription medications received on an ongoing basis.

No prescription medications

Antipsychotic or antidepressant for behavior management (e.g.,Thorazine, Mellaril, Prolixin, Lithium, Elavil)

Antianxiety agent for behavior management (e.g., Librium, Valium)

Anticonvulsant

Diabetes medication

Other maintenance medications prescribed to treat an existing medical condition.

Prescribed medications is equal to the total number of medications circled. The maximum possible score is 5.

(d) MEDICATION SUPPORT

The level of support individual receives when taking prescription medications?

0 No medications received at Day Treatment Program

1 Independent (Individual is totally responsible for medication)

2 Supervision (Individual keeps own medication but needs verbal prompts from staff)

3 Assistance (Staff keeps medication and gives to individual for self-administration)

4 Total Support (Staff assumes total responsibility for giving medication, e.g., injection, in food, drops)

The level of support necessary for medications is scored as follows: 0 = no medications are necessary or no medications are given at the program, 1 = individual is independent in taking medication, 2 = individual requires supervision in taking medication, 3 = person needs assistance from staff in taking medication, 4 = person is totally dependent on staff to take mediations

(e) MEDICAL CONSEQUENCES

Indicate whether or not individual:

Missed more than a total of two weeks of day programming due to medical conditions during the last year

Was hospitalized for medical problem in the last year

Presently requires direct care staff be trained in special health care procedures (e.g., ostomy care, positioning, adaptive devices)

Presently requires special diet planned by dietician, nutritionist, or nurse (e.g., high fiber, low calorie, low sodium, pureed)

Number of Medical Consequences shall be equal to the total number of "yes" responses. Each "yes" response is equal to 1. The maximum total is 4.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 690.7

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016

Amended New York State Register June 16, 2021/Volume XLIII, Issue 24, eff. 6/16/2021