§ 41.36 Community residential facilities. (a) As used in this section: 1. "Community residential facility" means any facility subject to licensure by the office for people with developmental disabilities which provides a supervised residence or residential respite services for individuals with mental disabilities. Such term does not include family care homes. 2. "Reimbursable services" means services, other than intermediate care services, comprehensive medicaid case management and personal care services for which funding is available under Title XIX of the federal social security act, provided at a community residential facility described by regulations of the commissioner of developmental disabilities for which fees or rates may be paid to a provider of services pursuant to this section. 3. "Income" means revenues received by a provider of services incidental to the operation of a community residential facility and includes: (i) revenues received from other units of state, local or federal government in consideration for the provision of care to a mentally disabled person, excluding that portion of such revenue specifically intended to offset capital costs and that portion of such revenue received pursuant to Title XIX of the federal social security act as payment for personal care services or comprehensive medicaid case management services; (ii) charges received from residents or on their behalf from third party insurers or medical assistance programs; and (iii) other funds received in the operation of the community residential facility. 4. "Provider of services" means a local government, voluntary agency or other entity or person that provides reimbursable services at a community residential facility. 5. "Commissioner" means the commissioner of developmental disabilities. (b) The commissioner shall establish, by rules or regulations, descriptive listings of reimbursable services at community residential facilities for which payments may be made pursuant to this section. Such services shall include direct care and support staff services, housing, administrative services and other than personal services. (c) The commissioner shall establish standards for programs funded under this section and shall by rule or regulation, subject to the approval of the director of the budget, establish fees or rates at least annually for each reimbursable service to be paid to providers of services. Fees or rates may be varied for geographic or other reasons. (d) Each local governmental unit shall include in its annual local plan a review of existing community residential facilities providing reimbursable services and a recommendation of anticipated needs for the development of such facilities, consistent with the needs of the mentally retarded and developmentally disabled within the jurisdiction of the local governmental unit. (e) Notwithstanding any inconsistent provision of this chapter, the commissioner may, from monies appropriated by the legislature for state aid for services provided pursuant to this article, grant state aid for the operation of a community residential facility through the payment of fees or rates for reimbursable services provided at such facility. (f) Providers of services may apply to the commissioner pursuant to this section to receive payment of fees or rates for the provision of reimbursable services at community residential facilities.(g) The commissioner may, after consideration of the service needs of the area in which a community residential facility is to operate, the capacity of the facility to meet those needs, the availability of services in the area, the annual comprehensive plan of the local governmental unit, the recommendations of the local governmental unit and the availability or resources therefor, grant state aid to a provider of services for the payment of fees or rates for reimbursable services, subject to the provisions of subdivision (h) of this section. (h) Payments for reimbursable services shall be made monthly. The commissioner shall each month advance to providers of services an equal monthly proration of fees or rates which may be paid for reimbursable services estimated to be provided during the fee or rate period, from which shall be deducted income received during the preceding months and rent charged clients. At the end of each fee or rate period, an adjustment shall be made so that payments of fees or rates for reimbursable services provided during the fee or rate period shall equal fees or rates for reimbursable services provided during the fee or rate period less income received and the rent charged clients as required in this subdivision. (i) No client shall be denied services because of inability to pay. Voluntary agencies and local governments may charge clients for the provision of reimbursable services and shall charge rent in accordance with the client's ability to pay and the availability to the client of health insurance or other third party reimbursement for the provision of such services. Charge and rental schedules shall be developed by the commissioner and approved by the director of the budget. Providers shall bill third party insurers and other state or local agencies directly if payments are available from such parties and report to the commissioner claims made against them and any billings of clients for whom such reimbursement is not available. Providers shall make reasonable efforts to collect such billings. In the event payment of charges is not received after such efforts, the provider shall assign the commissioner the right to enforce the claim and receive payment. Every effort shall be made to assure that the process of collection of charges from clients does not interfere with the therapeutic program. (j) Providers of service shall be reimbursed for capital costs in accordance with the provisions of this section. (k) Payments pursuant to this section shall be made in lieu of state aid for operating costs payable pursuant to any other provision of this article. (l) The operator of a community residential facility may appeal to the commissioner or his designee for reconsideration of his decision regarding authorization of payments to the facility and establishment of fees or rates for reimbursable services provided at the facility. The commissioner, after hearing such appeal or consideration of the recommendations of his designee, may amend such decision, subject to the approval of the director of the budget. (m) The commissioner shall issue regulations as necessary to implement the provisions of this section. Public hearings shall be held prior to final issuance of such regulations. (n) The commissioner shall establish a procedure, subject to the approval of the state comptroller, whereby payments in addition to the client's personal allowance may be made to providers of services for one or more of the following needs of clients residing in such facilities, limited to two hundred fifty dollars per client per year and paid semi-annually in the manner specified by such procedures: 1. Replacement of necessary clothing; 2. Personal requirements and incidental needs of clients;3. Recreational and cultural activities of clients. Such payments may be made from monies appropriated to the office for this purpose. Such payments shall be audited by the office pursuant to an audit plan approved by the comptroller. (o) Notwithstanding any inconsistent provision of this article, the commissioner may reimburse voluntary agencies for the reasonable cost of rental of a community residential facility less any income received from a state or federal agency or third party insurer which is specifically intended to offset the cost of rental of the facility or housing a client at the facility, subject to the availability of appropriations therefor and the commissioner's certification of the reasonableness of the rental cost, with the approval of the director of the budget.
§ 41.36 Community residential facilities. (a) As used in this section: 1. "Community residential facility" means any facility subject to licensure by the office for people with developmental disabilities which provides a supervised residence or residential respite services for individuals with mental disabilities. Such term does not include family care homes. 2. "Reimbursable services" means services, other than intermediate care services, comprehensive medicaid case management and personal care services for which funding is available under Title XIX of the federal social security act, provided at a community residential facility described by regulations of the commissioner of developmental disabilities for which fees or rates may be paid to a provider of services pursuant to this section. 3. "Income" means revenues received by a provider of services incidental to the operation of a community residential facility and includes: (i) revenues received from other units of state, local or federal government in consideration for the provision of care to a mentally disabled person, excluding that portion of such revenue specifically intended to offset capital costs and that portion of such revenue received pursuant to Title XIX of the federal social security act as payment for personal care services or comprehensive medicaid case management services; (ii) charges received from residents or on their behalf from third party insurers or medical assistance programs; and (iii) other funds received in the operation of the community residential facility. 4. "Provider of services" means a local government, voluntary agency or other entity or person that provides reimbursable services at a community residential facility. 5. "Commissioner" means the commissioner of developmental disabilities. (b) The commissioner shall establish, by rules or regulations, descriptive listings of reimbursable services at community residential facilities for which payments may be made pursuant to this section. Such services shall include direct care and support staff services, housing, administrative services and other than personal services. (c) The commissioner shall establish standards for programs funded under this section and shall by rule or regulation, subject to the approval of the director of the budget, establish fees or rates at least annually for each reimbursable service to be paid to providers of services. Fees or rates may be varied for geographic or other reasons. (d) Each local governmental unit shall include in its annual local plan a review of existing community residential facilities providing reimbursable services and a recommendation of anticipated needs for the development of such facilities, consistent with the needs of the mentally retarded and developmentally disabled within the jurisdiction of the local governmental unit. (e) Notwithstanding any inconsistent provision of this chapter, the commissioner may, from monies appropriated by the legislature for state aid for services provided pursuant to this article, grant state aid for the operation of a community residential facility through the payment of fees or rates for reimbursable services provided at such facility. (f) Providers of services may apply to the commissioner pursuant to this section to receive payment of fees or rates for the provision of reimbursable services at community residential facilities.(g) The commissioner may, after consideration of the service needs of the area in which a community residential facility is to operate, the capacity of the facility to meet those needs, the availability of services in the area, the annual comprehensive plan of the local governmental unit, the recommendations of the local governmental unit and the availability or resources therefor, grant state aid to a provider of services for the payment of fees or rates for reimbursable services, subject to the provisions of subdivision (h) of this section. (h) Payments for reimbursable services shall be made monthly. The commissioner shall each month advance to providers of services an equal monthly proration of fees or rates which may be paid for reimbursable services estimated to be provided during the fee or rate period, from which shall be deducted income received during the preceding months and rent charged clients. At the end of each fee or rate period, an adjustment shall be made so that payments of fees or rates for reimbursable services provided during the fee or rate period shall equal fees or rates for reimbursable services provided during the fee or rate period less income received and the rent charged clients as required in this subdivision. (i) No client shall be denied services because of inability to pay. Voluntary agencies and local governments may charge clients for the provision of reimbursable services and shall charge rent in accordance with the client's ability to pay and the availability to the client of health insurance or other third party reimbursement for the provision of such services. Charge and rental schedules shall be developed by the commissioner and approved by the director of the budget. Providers shall bill third party insurers and other state or local agencies directly if payments are available from such parties and report to the commissioner claims made against them and any billings of clients for whom such reimbursement is not available. Providers shall make reasonable efforts to collect such billings. In the event payment of charges is not received after such efforts, the provider shall assign the commissioner the right to enforce the claim and receive payment. Every effort shall be made to assure that the process of collection of charges from clients does not interfere with the therapeutic program. (j) Providers of service shall be reimbursed for capital costs in accordance with the provisions of this section. (k) Payments pursuant to this section shall be made in lieu of state aid for operating costs payable pursuant to any other provision of this article. (l) The operator of a community residential facility may appeal to the commissioner or his designee for reconsideration of his decision regarding authorization of payments to the facility and establishment of fees or rates for reimbursable services provided at the facility. The commissioner, after hearing such appeal or consideration of the recommendations of his designee, may amend such decision, subject to the approval of the director of the budget. (m) The commissioner shall issue regulations as necessary to implement the provisions of this section. Public hearings shall be held prior to final issuance of such regulations. (n) The commissioner shall establish a procedure, subject to the approval of the state comptroller, whereby payments in addition to the client's personal allowance may be made to providers of services for one or more of the following needs of clients residing in such facilities, limited to two hundred fifty dollars per client per year and paid semi-annually in the manner specified by such procedures: 1. Replacement of necessary clothing; 2. Personal requirements and incidental needs of clients;3. Recreational and cultural activities of clients. Such payments may be made from monies appropriated to the office for this purpose. Such payments shall be audited by the office pursuant to an audit plan approved by the comptroller. (o) Notwithstanding any inconsistent provision of this article, the commissioner may reimburse voluntary agencies for the reasonable cost of rental of a community residential facility less any income received from a state or federal agency or third party insurer which is specifically intended to offset the cost of rental of the facility or housing a client at the facility, subject to the availability of appropriations therefor and the commissioner's certification of the reasonableness of the rental cost, with the approval of the director of the budget.
§ 41.36 Community residential facilities. (a) As used in this section: 1. "Community residential facility" means any facility subject to licensure by the office for people with developmental disabilities which provides a supervised residence or residential respite services for individuals with mental disabilities. Such term does not include family care homes. 2. "Reimbursable services" means services, other than intermediate care services, comprehensive medicaid case management and personal care services for which funding is available under Title XIX of the federal social security act, provided at a community residential facility described by regulations of the commissioner of developmental disabilities for which fees or rates may be paid to a provider of services pursuant to this section. 3. "Income" means revenues received by a provider of services incidental to the operation of a community residential facility and includes: (i) revenues received from other units of state, local or federal government in consideration for the provision of care to a mentally disabled person, excluding that portion of such revenue specifically intended to offset capital costs and that portion of such revenue received pursuant to Title XIX of the federal social security act as payment for personal care services or comprehensive medicaid case management services; (ii) charges received from residents or on their behalf from third party insurers or medical assistance programs; and (iii) other funds received in the operation of the community residential facility. 4. "Provider of services" means a local government, voluntary agency or other entity or person that provides reimbursable services at a community residential facility. 5. "Commissioner" means the commissioner of developmental disabilities. (b) The commissioner shall establish, by rules or regulations, descriptive listings of reimbursable services at community residential facilities for which payments may be made pursuant to this section. Such services shall include direct care and support staff services, housing, administrative services and other than personal services. (c) The commissioner shall establish standards for programs funded under this section and shall by rule or regulation, subject to the approval of the director of the budget, establish fees or rates at least annually for each reimbursable service to be paid to providers of services. Fees or rates may be varied for geographic or other reasons. (d) Each local governmental unit shall include in its annual local plan a review of existing community residential facilities providing reimbursable services and a recommendation of anticipated needs for the development of such facilities, consistent with the needs of the mentally retarded and developmentally disabled within the jurisdiction of the local governmental unit. (e) Notwithstanding any inconsistent provision of this chapter, the commissioner may, from monies appropriated by the legislature for state aid for services provided pursuant to this article, grant state aid for the operation of a community residential facility through the payment of fees or rates for reimbursable services provided at such facility. (f) Providers of services may apply to the commissioner pursuant to this section to receive payment of fees or rates for the provision of reimbursable services at community residential facilities.(g) The commissioner may, after consideration of the service needs of the area in which a community residential facility is to operate, the capacity of the facility to meet those needs, the availability of services in the area, the annual comprehensive plan of the local governmental unit, the recommendations of the local governmental unit and the availability or resources therefor, grant state aid to a provider of services for the payment of fees or rates for reimbursable services, subject to the provisions of subdivision (h) of this section. (h) Payments for reimbursable services shall be made monthly. The commissioner shall each month advance to providers of services an equal monthly proration of fees or rates which may be paid for reimbursable services estimated to be provided during the fee or rate period, from which shall be deducted income received during the preceding months and rent charged clients. At the end of each fee or rate period, an adjustment shall be made so that payments of fees or rates for reimbursable services provided during the fee or rate period shall equal fees or rates for reimbursable services provided during the fee or rate period less income received and the rent charged clients as required in this subdivision. (i) No client shall be denied services because of inability to pay. Voluntary agencies and local governments may charge clients for the provision of reimbursable services and shall charge rent in accordance with the client's ability to pay and the availability to the client of health insurance or other third party reimbursement for the provision of such services. Charge and rental schedules shall be developed by the commissioner and approved by the director of the budget. Providers shall bill third party insurers and other state or local agencies directly if payments are available from such parties and report to the commissioner claims made against them and any billings of clients for whom such reimbursement is not available. Providers shall make reasonable efforts to collect such billings. In the event payment of charges is not received after such efforts, the provider shall assign the commissioner the right to enforce the claim and receive payment. Every effort shall be made to assure that the process of collection of charges from clients does not interfere with the therapeutic program. (j) Providers of service shall be reimbursed for capital costs in accordance with the provisions of this section. (k) Payments pursuant to this section shall be made in lieu of state aid for operating costs payable pursuant to any other provision of this article. (l) The operator of a community residential facility may appeal to the commissioner or his designee for reconsideration of his decision regarding authorization of payments to the facility and establishment of fees or rates for reimbursable services provided at the facility. The commissioner, after hearing such appeal or consideration of the recommendations of his designee, may amend such decision, subject to the approval of the director of the budget. (m) The commissioner shall issue regulations as necessary to implement the provisions of this section. Public hearings shall be held prior to final issuance of such regulations. (n) The commissioner shall establish a procedure, subject to the approval of the state comptroller, whereby payments in addition to the client's personal allowance may be made to providers of services for one or more of the following needs of clients residing in such facilities, limited to two hundred fifty dollars per client per year and paid semi-annually in the manner specified by such procedures: 1. Replacement of necessary clothing; 2. Personal requirements and incidental needs of clients;3. Recreational and cultural activities of clients. Such payments may be made from monies appropriated to the office for this purpose. Such payments shall be audited by the office pursuant to an audit plan approved by the comptroller. (o) Notwithstanding any inconsistent provision of this article, the commissioner may reimburse voluntary agencies for the reasonable cost of rental of a community residential facility less any income received from a state or federal agency or third party insurer which is specifically intended to offset the cost of rental of the facility or housing a client at the facility, subject to the availability of appropriations therefor and the commissioner's certification of the reasonableness of the rental cost, with the approval of the director of the budget.
