N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 636-2.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 636-2.3 - Definitions

(a) Broader community. Community settings that are used by the general public, where individuals have opportunities to interact with people who do not have disabilities, do not receive Medicaid HCBS, and are not paid to provide services to individuals.

(b) Heightened scrutiny. Review of a setting presumed to be isolating and/or having institutional qualities because it is:

(1) located in a building that is also a publicly or privately-operated facility that provides inpatient institutional treatment;

(2) in a building on the grounds of, or immediately adjacent to, a public institution; or

(3) any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community.

(c) Institutional. Operation of a setting and/or delivery of supports and services in a manner that is regimented and/or isolates individuals receiving Medicaid HCBS from the broader community.

(d) Institution, public. An institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. Medical institutions, intermediate care facilities, child care institutions, and publicly operated community residences are not included in this definition, nor does the term apply to universities, public libraries, or other similar settings.

(e) Physically accessible. Characteristic of a setting, including, but not limited to:

1) the setting provides an individual's full/unrestricted access to typical spaces in the home or day setting and supports their use;

2) the setting reflects an individual's needs and/or preferences including the presence of any necessary physical modifications; or

3) the setting supports the independence, comfort, preferences, and needs of the individuals who live in the residence or attend the day setting.

(f) Provider, OPWDD authorized. An organization that is authorized by OPWDD and/or the Department of Health (DOH) to deliver one or more Medicaid HCBS services operated, certified, funded, authorized, or approved by OPWDD, including:

(1) a care coordination organization authorized by DOH in collaboration with OPWDD pursuant to section 365-l of the Social Services Law;

(2) a managed care organization that is issued a certificate of authority to include OPWDD HCBS in its benefit package pursuant to Article 44 of the Public Health Law; or

(3) another organizational entity certified, contracted, or authorized by OPWDD to be responsible for operating, funding, authorizing, overseeing, or monitoring OPWDD HCBS.

(g) Setting. Any location where Medicaid HCBS are delivered including, but not limited to: OPWDD certified facilities (such as Individualized Residential Alternatives (IRAs), Community Residences (CRs), Family Care Homes (FCHs), Site-based Prevocational Services sites and Day Habilitation sites); non-certified settings in the broader community; and private homes.

(h) Setting, integrated. A setting where individuals receiving Medicaid HCBS have regular interactions with the broader community. Such settings afford individuals receiving HCBS opportunities to fully engage in community life and choose activities that optimize access to the broader community.

(i) Setting, isolated or isolating. A setting that is not integrated, where individuals receiving Medicaid HCBS typically only interact with other individuals receiving Medicaid HCBS or paid staff, and have limited/no access to, or interaction with, the broader community.

(j) Setting, provider owned or controlled residential. A residential setting that is co-owned, rented, or occupied by the individual receiving Medicaid HCBS, where a provider agency owns, co-owns, leases, co-leases, or has a direct or indirect financial relationship with the property owner or operates/manages the residential setting. A setting is not provider owned or controlled if the individual owns his/her residential setting or leases directly from a third party that has no direct or indirect financial relationship with a provider, and where an OPWDD HCBS authorized provider has no role in operating or managing the residential setting. All OPWDD certified settings, including Family Care homes, are considered provider owned or controlled for the purposes of this Part.

(k) Setting, provider owned or controlled non-residential. A non-residential setting where Medicaid HCBS are delivered, and a provider agency owns, co-owns, leases, co-leases, or has a direct or indirect financial relationship with the property owner or operates/manages the non-residential setting.

(l) Setting, private home. A residential setting in which an individual lives independently or with others and the setting is not owned or controlled by a provider agency.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 636-2.3

Adopted New York State Register May 29, 2019/Volume XLI, Issue 22, eff. 5/29/2019