Limited Home Care Services Agencies

Section [86-8.1] 86-9.1 Services.

(a) Reimbursement is available under this Subpart only for the following services provided directly by limited home care services agencies, licensed by the department pursuant to section thirty-six hundred five of the Public Health Law, to eligible individuals who are residents of adult homes or enriched housing programs certified in accordance with article seven of the Social Services Law: (1) Level II personal care services, as defined in 18 NYCRR section 505.14(a)(6)(ii), including related nursing supervision, authorized and provided in accordance with rules and regulations of the department, but not including Level I personal care services as defined in 18 NYCRR section 505.14(a)(6)(i); and (2) the administration of subcutaneous and/or intramuscular injections and application of sterile dressings by a registered professional nurse, including associated nursing tasks. Reimbursement is available under this Subpart only for services provided by limited home care services agencies which are not services that must be provided to residents of adult homes or enriched housing programs pursuant to article seven of the Social Services Law and rules and regulations of the department.

Section [86-8.2] 86-9.2 Computation of the Rates of Payment

(a) For purposes of this Subpart, rates of payment for Level II personal care services shall be calculated for two regions: a downstate region to consist of Bronx, Kings, New York, Queens and Richmond counties and an upstate region to consist of all other counties in New York State. For purposes of this Subpart, rates of payment for registered professional nurse services shall be calculated for two regions: a downstate region to consist of Rockland, Westchester, Nassau, Suffolk, Bronx, Kings, New York, Queens and Richmond counties and an upstate region to consist of all other counties in New York State.

(b) For each region, the unit of measure for which a limited home care services agency may bill for services rendered is a quarter hour.

(c) For purposes of this Subpart, the rate of payment for Level II personal care services for the downstate region shall be the weighted average January 1, 1997 Level II personal care rate for the downstate region. For purposes of this Subpart, the rate of payment for Level II personal care services for the upstate region shall be the weighted average January 1, 1997 Level II personal care rate for the upstate region for direct care and training, capital, and criminal checks, plus no more than fifteen percent of such rate for administrative expenses.

(d) For purposes of this Subpart, the rate of payment for registered professional nurse services for the downstate region for the administration of subcutaneous and/or intramuscular injections and application of sterile dressings shall be the average January 1, 1997 fee established for nursing services rendered by a registered professional nurse on a private practitioner basis for the downstate region. For purposes of this Subpart, the rate of payment for registered professional nurse services for the upstate region for the administration of subcutaneous and/or intramuscular injections and application of sterile dressings shall be the average January 1, 1997 fee established for nursing services rendered by a registered professional nurse on a private practitioner basis for the upstate region.

Statutory Authority:

The statutory authority for these regulations is contained in sections 2803, 2807 and 2808 of the Public Health Law, which authorize the State Hospital Review and Planning Council to adopt and amend rules and regulations, subject to the approval of the commissioner. The proposed regulations make a technical change to re-designate the current Subpart 86-8 of NYCRR Title 10, as Subpart 86-9 of NYCRR Title 10.

Basis:

Subpart 86-8 has been designated for use for regulations relating to outpatient reimbursement utilizing Ambulatory Patient Groups, as authorized by Public Health Law § 2807(2-a)(e). Accordingly it is proposed that the current Subpart 86-8, pertaining to reimbursement for limited home care services agencies, be re-designated as Subpart 86-9. No other amendments to such regulations are being proposed.

A Job Impact Statement is not required pursuant to Section 201-a(2)(a) of the State Administrative Procedures Act since it is apparent, from the nature and purpose of the proposed rule, that it will not have a substantial adverse impact on jobs or employment opportunities. The proposed regulation only serves to re-designate the current Subpart 86-8 of 10 NYCRR as Subpart 86-9.