Dear Administrator: 2004 Personal Care Software

June 01, 2005

RE: 2004 Personal Care Software

Dear Administrator:

In accordance with Section 505.14 of Title 18 NYCRR, all personal care services agencies that have contracts with a local social services department for the provision of personal care services to Medicaid recipients shall complete and file annual financial and statistical reports as the Department of Health may require on forms supplied by the Department. It is anticipated that the 2004 Personal Care Software will be available on the Internet no later than June 1, 2004.

This report will be used to report your actual 2004 costs and statistics and may be used for the promulgation of Personal Care Services Medicaid Rates for the year 2006. If you are a new provider who opened during 2004 and therefore do not have actual costs and statistics for the full year 2004, you will need to report your budgeted costs and estimated statistics for 2006. All other agencies who were in operation prior to January 1, 2004 must submit a properly certified report with actual costs and statistics for 2004.

The 2004 Personal Care Provider Cost Report (PCPCR01) must be filed with the Department no later than August 31, 2005. The reports will be filed electronically using the Health Provider Network (HPN).

Health Provider Network (HPN) Address

You may download the software from the department's Internet-Based Health Provider Network. This may be accessed at https://commerce.health.state.ny.us/hpn . Once you have reached this page, you will need to access the section entitled "Programs" and then click on the Program Area for the Division of Health Care Financing. Once you have reached our division's Home Page, you may access the Personal Care Agencies Cost Report 2004 (PCPCR04) for download.

Enclosed with this letter are instructions on using the HPN and on installing the software onto your computer.

Regulatory Amendments

Effective February 23, 2004, the regulations governing the submission of personal care cost reports were amended to institute a penalty for agencies who fail to comply with the annual cost report requirements in Title 18 NYCRR Section 505.14(h)(7). Specifically, Section 505.14(h)(7)(i)(a)(6) has been added to require that a 2% penalty be applied to the current rate if an agency fails to file the required cost report on or before the due date (as noted above, the 2004 report due date is August 31, 2005 ). The regulations require such penalty to be applied effective the first of the month following the due date and continuing until the end of the month of cost report submission. The regulations also state that failure to timely file the required certifications ( within two weeks of report submission) shall render a cost report incomplete and invoke the 2% penalty for failure to file.

These regulatory amendments also require the Department, in Section 505.14(h)(7)(iii)(a), to notify agencies of their initial calendar year rates of payment at least 30 days prior to the effective date. Therefore, agencies must be notified of their calendar year 2006 rates by December 2, 2005.

Extensions to the Due Date

Section 505.14(h)(7)(i)(a)(3) allows the Department to grant a provider an additional 30 calendar days to submit the report. Prior to the due date, the provider must establish, to the Department's satisfaction, that it cannot submit the cost report on time due to reasons beyond the provider's control. No extensions will be granted to provider's who have failed to enroll in the Health Provider Network (HPN).

If you cannot submit your cost report by the due date, you must send a letter to the Department prior to that date, which states the reason the report cannot be submitted on time and the local social services district for which you are requesting the extension. No telephone requests for extensions will be accepted. You will be notified in writing of the Department's decision on your extension request.

The letter should be addressed to:

Mr. Timothy E. Casey
New York State Department of Health
Bureau of Long Term Care Reimbursement
943 Corning Tower Building
Empire State Plaza
Albany, NY 12237-0709.

NOTE: As noted above, recent regulatory amendments require the Department to notify personal care agencies of their 2006 calendar year rates by December 2, 2005. Given the limited timeframe to review cost reports and develop rates for approximately 400 provider contracts, an agency whose cost report is not filed by the original due date of August 31, 2005, may experience a delay in the determination of their initial 2006 calendar year rate.

Current Agency Charge Information

Provider's must report their agency's current charges on "Part 1- General Information, Public Fee Schedule" as part of the electronically filed cost report. This should reflect the most currently available public-fee information applicable to the 2006 rate year. Subsequent changes in agency charges do not have to be made electronically. You should use the paper form "Personal Care Services Report of Current Charges," transmitted to you with your 2005 Medicaid rate notification, to report agency charge changes which occur after you file your 2004 report.

Changes for the 2004 Cost Report

No significant changes have been made to the Cost Report software utilized for 2003 reports. However, you should refer to the Dear Administrator letter dated June 1, 2004 to be reminded of the changes which were made to the 2003 report that will continue for 2004 reporting.

Personal Care Provider Cost Report Data Security

The Department has developed a data security system. Once your cost report passes all edits and is finalized, a Declaration Control Number (DCN) will appear on the computer screen and each page of report printouts. Any change in the cost report will cause the DCN to be erased and another DCN will not be generated until the report is finalized again. Please refer to the HELP section of the PCPCR software for information on creating the Final Cost Report and the DCN Number.

Filing the Report

The Department will be accepting reports when you receive this letter. When the report has been successfully uploaded and filed with the Department, the agency will receive an electronic acknowledgment indicating the report is accepted and echoing back the DCN for the agency's report. This will happen each time that the agency files a report with a different DCN. Reports with the same DCN will be rejected after the first report is accepted.

Operator and Independent Accountant Certifications

The Bureau must receive the originally executed copies of both the operator's certification (Schedule E) and the accountant's opinion (Schedule F) no later than September 14, 2005. These statements can be printed from the software and the original hard copy must be mailed to the address listed above. If a facility files multiple reports, certifications are required only for the "final" report. The DCN of the "final" report must appear on both Schedule E (Operator's Certification) and Schedule F (Accountant's Opinion). Please refer to the HELP section of the PCPCR software for information on creating the Final Cost Report and the DCN.

If multiple reports are filed, the Department will deem the last report filed for a district contract as the facility's "final" report, unless the agency notifies the Bureau, in writing, that an earlier submission should be recognized as the "final" report. The agency must clearly identify such earlier submission by DCN as the "final" report and insure that the certifications are appropriately completed for the "final" report.

Should your Personal Care Agency have any problems or have questions regarding the completion of the electronic cost report please call the Personal Care Rate Unit at (518) 473-8910.

Should you have any problems or questions regarding the electronic mail network please contact the HELP line at 1-800-638-3808.

Sincerely,

Kathleen E. Gill
Chief Health Care Fiscal Analyst
Bureau of Long Term Care Reimbursement

Enclosures