(i) Personal service costs include costs such as salaries, fringe benefits and accrued vacation costs for employees of the specialty hospital; and costs of persons performing services under contract to the specialty hospital. Services refers to the provisions of routine and ancillary care of individuals admitted to the specialty hospital in accordance with the provisions of this Part.

(ii) Administrative and general service costs refer to departments, divisions or other units which are operated for the benefit of the specialty hospital as a whole, and includes activities such as management, housekeeping, laundry, dietary services and operation and maintenance of grounds and physical plant.

(iii) OTPS costs include, but are not limited to, the costs of items such as food, minor equipment, supplies and materials, travel, medications and utilities.

(i) Budget reports.

(ii) Financial and statistical reports.

(i) Each provider shall submit with its annual financial report, statistical data relevant to program utilization and in the form and format supplied by OPWDD or its agent, Blue Cross/Blue Shield of Greater New York. Such data shall include a roster of individuals and their utilization review status for the financial reporting period in question, a listing of the actual number of service days for the specialty hospital and a listing by individual of the total number of days any individual was on alternate care determination status as defined in section 680.12(a)(3) of this Part. This data will correspond to the identical time period of the financial report.

(ii) Each provider shall, upon the request of OPWDD, submit statistical data relevant to the administration and operation of the program as determined by the commissioner. Such data shall be submitted within the time frames specified in the request.

(i) Each provider shall complete the required financial reports in accordance with generally accepted accounting principles, unless other principles are specified by this Part or the Medicare Provider Reimbursement Manual, commonly referred to as HIM-15, published by the U.S. Department of Health and Human Services Health Care Financing Administration (HCFA). The HIM-15 document is available from:

(ii) The Medicare Provider Reimbursement Manual may be reviewed in person during regular business hours at the:

(iii) Financial reports information shall be certified for their compliance with section 680.12(b)(3)(i) of this Part the provider's executive director or officer and by an independent licensed public accountant or certified public accountant who is not on the staff of the provider, on the staff of a program operated by the provider, and who has no financial interest in the provider nor is a related party as defined in Subpart 635-99 of this Title; and include a statement of the findings and opinion of the certified public accountant or licensed public accountant.

(iv) Budget reports shall be certified for their fair representation of anticipated expenditures by the provider's executive director or officer.

(i) The commissioner may grant an extension of time of up to 30 days for filing the required reports if OPWDD receives a written request for an extension from a provider, at least 15 days prior to the initial due date. Such request for extension shall document, in writing, that the provider cannot file the report by the due date for reasons beyond its control, and shall include an explanation of such reasons.

(ii) The commissioner may grant an additional extension of 30 days if the provider applies for an extension in accordance with the procedure stated in section 680.12(b)(4)(i) of this Part. The maximum allowable extension that may be granted will not exceed 60 days in total unless the commissioner, upon investigation, finds that failure to report is beyond the control of the provider and/or enforcement of the reporting time frame requirements would jeopardize the program's operation.

(iii) If a provider fails to file the required reports, on or before the due dates, taking into account any granted extensions, the commissioner may, at his or her discretion, reduce the specialty hospital's existing rate, exclusive of State-paid items, by five percent for a period beginning on the first day of the month following the due date of the required reports and continuing until the last day of the calendar month in which the required information is received.

(iv) In the event that the rate for a specific rate period cannot be developed so that it will be effective on the first day of the rate period, due to the facility's not submitting the required reports by the due date, the rate in existence on the last day of the rate period (i.e., the length of time as determined by the commissioner that an approved rate is valid) prior to the subject rate period, will be in effect until such time as OPWDD can develop a new rate. The rate in existence on the last day of the rate period may be reduced by five percent according to the provisions of section 680.12(b)(4)(iii) of this Part.

(v) When OPWDD develops a new rate for a specialty hospital for which a rate was paid in accordance with section 680.12(b)(4)(iv) of this Part, the rate developed will be effective on the first day of the first month following receipt of the required reports. The commissioner may, at his discretion and based on his finding that the factor(s) causing the delay has/have been corrected, make the rate retroactive to the beginning of the rate period in question if the provider makes such a request within 60 days subsequent to submission of the delinquent report.

(i) In the event that OPWDD determines that the required financial report is incomplete, inaccurate, incorrect or otherwise unacceptable, the provider shall have 30 days from the date of its receipt of notification to submit revised financial reports or additional data. Such data or reports shall be certified by the provider's executive director or officer and an independent licensed public accountant or certified public accountant pursuant to the requirements stipulated in section 680.12(b)(3) of this Part.

(ii) If the revised data referred to in section 680.12(b)(5)(i) of this Part are not received within 30 days of the provider's receipt of notification, the facility's existing rate may be reduced in accordance with section 680.12(b)(4)(iii) unless the commissioner has granted an extension pursuant to section 680.12(b)(4)(i) or (ii).

(iii) In the event the provider discovers that the financial reports it has submitted are incomplete, inaccurate or incorrect prior to receiving its new rate, the provider must notify OPWDD that such error exists. The provider will have 30 days from the date such notification is received by OPWDD to submit revised reports or additional data. Such data or report shall meet the certification requirements of the report being corrected. If the corrected data or report are received within a reasonable time before the issuance of the rate, OPWDD shall incorporate the corrected data or report into its computation of the rate without the provider having to file an appeal application. However, OPWDD will not accept the resubmission of a January 1-December 31, 2008 cost report subsequent to January 1, 2011 for the purposes of the calculation of the rate effective July 1, 2011 as described in clause (d)(5)(ii)(f) of this section.

(iv) If the revised data or report referred to in section 680.12(b)(5)(iii) of this Part are not received within the time periods set forth in section 680.12(b)(5)(iii), the facility's existing rate may be reduced in accordance with section 680.12(b)(4)(iii).

(i) Field audits or desk audits shall be conducted by the commissioner or his agent or the Department of Social Services at a time and place and in a manner to be determined by the commissioner or the DSS.

(ii) The audits may be performed on any financial or statistical records required to be maintained.

(iii) Any finding of an above-described audit shall constitute grounds for recoupment at the discretion of the commissioner, provided that such audit finding relates to the allowable costs, and to the extent that, except as authorized in 18 NYCRR 517.16, the audit finding has been upheld in a decision after a hearing or a hearing has not been requested on such finding.

(iv) The six-year limitation shall not apply in situations in which fraud may be involved or where the provider or an agent thereof prevents or obstructs the commissioner from performing an audit pursuant to this section.

(i) At the conclusion of the audit, the provider shall be afforded an opportunity to submit additional documentation to the commissioner. After the receipt and review of such additional documentation, a copy of the audit findings shall, within 120 days, be sent to the provider by certified mail, return receipt requested. In order to have the additional documentation considered, the provider must submit the documentation within the time specified.

(ii) The audit findings shall become final unless, within 30 days of receipt thereof, the provider requests an administrative review of the audit findings.

(iii) Request for administrative review of audit findings shall be sent to the commissioner by registered or certified mail.

(iv) Such requests shall contain a detailed statement of the provider's objections to the findings, along with copies of any documentation the facility wishes to submit.

(v) The provider shall be notified in writing of the determination of those items to which the provider objected, including a statement of the reasons therefor. The audit findings, as adjusted in accordance with the determination after administrative review, shall be final.