(i) For facilities in Region I (as defined in section 635-4.1 of this Title) or for those facilities which are designated or have elected to report as Region I facilities, the price period is a 12 month period which begins on July 1st and ends on June 30th.

(ii) For facilities in Regions II and III (as defined in section 635-4.1 of this Title) or for those facilities which are designated or have elected to report as either Region II or Region III facilities, the price period is a 12 month period which begins on January 1st and ends on December 31st.

(i) Effective January 1, 2010 the calculation of reimbursement for supervised community residences shall be consolidated with the calculation of reimbursement for supervised IRAs, if any, as follows:

(ii) Countable service days.

(i) Effective January 1, 2010 the calculation of reimbursement for supportive community residences shall be consolidated with the calculation of reimbursement for supportive IRAs, if any, as follows:

(ii) Countable service days.

(i) For the provider to be paid a full month supervised IRA price, the individual must be enrolled in the provider's supervised community residence program for a minimum of 22 days in the calendar month; to be paid a full month supportive IRA price, the individual must be enrolled in the provider's supportive community residence program for a minimum of 22 days in the calendar month.

(ii) For the provider to be paid a one-half month supervised IRA price, the individual must be enrolled in the provider's supervised community residence program for a minimum of 11 days in the calendar month; to be paid a one-half month supportive price, the individual must be enrolled in the provider's supportive community residence program for a minimum of 11 days in the calendar month.

(i) In computing the countable service days, the provider cannot include days that the individual is in a hospital, nursing home, ICF/DD or other certified, licensed or government funded residential setting.

(ii) The day the individual is admitted or discharged from one of the other residential settings listed in subparagraph (i) of this paragraph may be a countable service day if, on that day, community residence staff deliver residential habilitation services to the individual at the community residence.

(iii) For supervised community residences only: in determining countable service days the provider may include days when an individual is away from the community residence, for purposes such as vacations and visits with family or friends, only when staff from the individual's community residence deliver and document services to that individual that are similar in scope, frequency and duration to the residential habilitation services typically delivered to the individual at the community residence.

(iv) The provisions of this paragraph notwithstanding, days when all individuals of the community residence are relocated due to an emergency or other conditions which necessitate relocation for the health and safety of those individuals may be considered as countable if:

(v) Services provided on countable service days must be documented. On any countable service day there must be documentation of at least one residential habilitation service delivered to the person by community residence staff on that day.

(i) For providers reporting as Region I providers in operation on June 30th, the appropriate trend factor shall be applied to the allowable operating costs, exclusive of property, used to establish the price in effect on June 30th. That trend factor is 2.08 percent to trend June 30, 2010 costs to 2010-2011. Retention of the proceeds attributable to the application of the trend factor increase shall be contingent upon the provider reporting the use of the funds in the form and format specified by the commissioner.

(ii) For providers reporting as Region II or Region III providers in operation on December 31st, the appropriate trend factor shall be applied to the allowable operating costs, exclusive of property, used to establish the price in effect on December 31st except that for calendar year 2010, the initial price exclusive of property in effect on January 1, 2010 shall be trended. From February 1, 2010 to December 31, 2010, facilities shall be reimbursed operating costs that result in a full annual trend factor of 2.08 percent for the calendar year price period. The trend factor in effect for the price period ending December 31, 2010 shall be deemed to be the 2.08 percent full annual trend. Retention of the proceeds attributable to the application of the trend factor increase shall be contingent upon the provider reporting the use of the funds in the form and format specified by the commissioner.

(i) Supervised community residences:

(ii) For supportive community residences the offset shall be $1,134 (or a prorated portion thereof for facilities which opened after April, 2009) and beginning January 1, 2010, $126 per month. Beginning January 1, 2018 through December 31, 2018 the offset shall be $161 per month. Effective January 1, 2019, the offset shall be $154 per month.

(i) There shall be three components of the efficiency adjustment as follows:

(ii) New sites. To the extent that a provider is subject to this efficiency adjustment, a corresponding correction to approved budgeted costs for new sites shall be made so that the percentage offsets in effect before inclusion of the new site—18 percent NPS, 5 percent administration and any residual adjustment thereto—shall be preserved when the new site’s budgeted costs are included in the calculation of the supervised IRA price.

(iii) For purposes of requesting a price adjustment, the effects of this efficiency adjustment resulting from the NPS and administrative reductions as described in clauses (i)(a) and (b) of this paragraph as well as any subsequent residual adjustment thereto per clause (i)(c) of this paragraph shall not be construed as a basis for loss. In processing a price adjustment, any revised price will be offset by the monetary effects of the NPS and administrative reductions including the residual adjustment thereto, if any.

(iv) The commissioner at his or her discretion may waive all or a portion of the NPS reduction as described in clause (i)(a) of this paragraph and/or the administrative reduction as described in clause (i)(b) of this paragraph for a provider upon the provider demonstrating that the imposition the reduction(s) would jeopardize the continued operation of the IRA(s) and/or community residence(s).

(i) For providers which reported on the survey that no health care benefits are offered, OPWDD determined an allocation 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 this funding, the allocation based on the total number of employees reported will be reduced by the number of excluded employees reported multiplied by $2,500. These funds 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 an allocation 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 this funding, the allocation based on the total number of employees reported will be reduced by the number of excluded employees reported multiplied by $325. These funds must be used to enhance employee health care benefits or to reduce employee out-of-pocket health- related expenses.

(i) For providers which reported on the survey that no employee health care benefits are offered, no additional funding 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 an allocation 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 this funding, the allocation 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. These funds must be used to reimburse health care expenses paid by employees.

(i) The annual allocation 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:

(ii) The annual allocation 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:

(i) Providers deemed eligible for HCE III funding 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 subparagraph (iii) of this paragraph. 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 funding level increase unless they have declined the 3.0 percent funding level increase in the eligible programs and services. Providers which receive this 1.0 percent funding level increase may not apply for employee health care funding described in subparagraph (ii) of this paragraph.

(ii) Providers deemed eligible for HCE III funding 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 subparagraph (iii) of this paragraph.

(iii) A provider approved to receive HCE III funding pursuant to subparagraph (i) or (ii) of this paragraph shall receive an amount that would have been paid if the HCE III initiative had been implemented April 1, 2007.

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

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

(i) Effective January 1, 2010, the health care adjustments (HCE I through III and HCA IV and HCA V) included in the price 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 components contained in the initial fee in effect on January 1, 2010. OPWDD shall use this fixed amount as the HCA payment 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 prices for services delivered on or after July 6, 2011 shall be used by non-benchmark providers for the purposes described in this subparagraph 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 price.

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

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

(i) ensure that all the requirements of section 671.6 of this Part are satisfied; and

(ii) ensure that persons for whom medical assistance reimbursement is requested, are eligible for participation in the medical assistance program.