N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-2.11

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

Section 86-2.11 - Adjustments to direct component of the rate

(a) Payments for 1986 and subsequent rate years for the direct component of the rate as defined in section 86-2.10(c) of this Subpart shall be adjusted periodically as described in this section to reflect changes in the case mix of facilities.

(b) Facilities shall report to the department changes in patient case mix as follows:

(1) Full reassessments. Facilities shall, on a schedule to be established by the department, assess all their patients semiannually and submit patient review instruments pursuant to section 86-2.30 of this Subpart. The department shall consider, in developing such schedule, that for each of the six months in a semiannual period, there would be submitted approximately 1/6 of the assessments for all patients in the State.

(2) Assessment of patients admitted since the last assessment period. Three months from the date facilities are scheduled to perform full reassessments, facilities shall assess patients admitted and still residing in the facility since the last full assessment period. Patient review instruments for such patients shall be submitted pursuant to section 86-2.30 of this Subpart on a schedule to be established by the department. The department shall consider, in developing such schedule that for each of the six months in a semiannual period, there would be submitted approximately 1/6 of the assessments of such new admissions.

(3) Notification to department of patients discharged since last assessment period. Facilities shall notify the department of any patients assessed during the previous full reassessment period as described in paragraph (1) of this subdivision and since discharged concurrent with the submission required by paragraph (2) of this subdivision for patients admitted since the last assessment period.

(c) Payment rates for the direct component of the rate as defined in section 86-2.10(c) of this Subpart shall be adjusted, on a facility specific basis for changes in patient case mix retroactive to the beginning date of the month in which the assessment of patients was scheduled by the department and performed by the facility.

(d) Adjusted payment rates shall be determined by recalculating a facility's number of patients in each patient classification group as a result of the submissions in accordance with this section and such results shall be used in the calculation of the facility specific direct adjusted payment price per day pursuant to section 86-2.10(c)(4) of this Subpart.

(e) Trending. Payment rates for the operating component of the rate as defined in section 86-2.10(b)(2) of this Subpart may be adjusted for changes in the trend factors originally promulgated by the department in accordance with section 86-2.12 of this Subpart.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-2.11