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New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENEChapter XIV - Office for People With Developmental DisabilitiesPart 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities
Subpart 635-12 - Liability for Services
Section 635-12.9 - Fee schedules

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-12.9

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Current through Register Vol. 46, No. 51, December 18, 2024
Section 635-12.9 - Fee schedules
(a) This section applies to all services, whether or not they are preexisting services.
(b) For community residential habilitation services (delivered in a community residence which is not an individualized residential alternative [IRA]), the fee shall equal the Medicaid fee OPWDD established for the community residential habilitation services for the dates the services were provided.
(c) For residential habilitation services provided in an IRA, the fee shall equal the Medicaid price OPWDD established for the IRA residential habilitation services for the dates the services were provided.
(d) For residential habilitation services provided in a family care home, the fee shall equal the Medicaid price OPWDD established for the family care residential habilitation services for the dates the services were provided.
(e) For at home residential habilitation services, the fee shall equal the Medicaid fee OPWDD established for the at home residential habilitation services for the dates the services were provided.
(f) For day treatment services, the fee shall equal the Medicaid fee OPWDD established for the day treatment facility for the dates the services were provided.
(g) For an ICF/DD, the fee shall equal the Medicaid rate OPWDD established for the ICF/DD for the dates the services were provided, excluding any day program services add-on for education and related services in accordance with Title 8 NYCRR.
(h) For day habilitation services, the fee shall equal the Medicaid price OPWDD established for the day habilitation services for the dates the services were provided.
(i) For Medicaid service coordination, the fee shall equal the payment level applicable to the individual's situation as stated in the Medicaid service coordination vendor contract between the provider and OPWDD in effect on the dates the services were provided.
(j) For prevocational services, the fee shall equal the Medicaid price OPWDD established for the prevocational services on the dates the services were provided.
(k) For supported employment services, the fee shall equal the Medicaid fee OPWDD established for the supported employment services for the dates the services were provided.
(l) For respite services, the fee shall equal the Medicaid price OPWDD established for the respite services for the dates the services were provided.
(m) For blended or comprehensive services, the fee shall equal the price OPWDD established for the blended or comprehensive services for the dates the services were provided.
(n) For hourly community habilitation services, the fee shall equal the Medicaid fee OPWDD established for the hourly community habilitation services for the dates the services were provided.
(o) For community habilitation phase II services, the price shall equal the Medicaid fee OPWDD established for community habilitation phase II services for the dates the services were provided.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-12.9

Amended New York State Register July 1, 2015/Volume XXXVII, Issue 26, eff. 7/1/2015
Amended New York State Register October 28, 2015/Volume XXXVII, Issue 43, eff. 11/1/2015
Amended New York State Register April 20, 2016/Volume XXXVIII, Issue 16, eff. 4/20/2016
Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016