For “Other” lines 25 and 37:

Service Type

4. For “Other” lines 25 and 37:

The line detail must be entered into the worksheet if Column 1 is selected for lines 25 and/or 37.

The line detail and the detail value must be entered into the worksheet if Column 2 is checked for line 25. To activate the detail worksheet for either of these two lines, click on the corresponding line of Column 4 to display the line detail box. Open the worksheet by selecting that box or by double clicking the line field itself.

This schedule is used to report medical supplies that are included on the CFR. Complete this schedule only if Column 2 or 3 was selected on line 6 (Other Medical Supplies) of Schedule OPWDD-1. A separate schedule must be completed for each certified site.

NYS CFRS Software Note

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No data can be entered into this schedule prior to defining your agency and your agency’s program/sites in the software.

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In the Submission Definition screen, specify all of the agencies that fund/certify your programs.

Failure to do so will prohibit the completion of some schedules.

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Data in grayed-out fields has previously been entered into other CFR schedules and has been carried forward. If any of the carry-forward information is incorrect, it will need to be changed in the source schedule.

•

Please refer to Getting Started with NYS CFRS Software in Section 9 for more details.

Header Section

Agency Name: The name of the organization (service provider).

Agency Code: The five-digit code assigned to the organization (service provider).

Operating Certificate Number: The operating certificate number.

Medicaid Provider Agreement Number: The Medicaid provider agreement number issued by the New York State Department of Health.

Program Type and Code: The type of program and the corresponding code as listed in Appendix G.

County Code: The county code where the program/site is located using the applicable code listed in Appendix C.

Medical Supplies Included: Indicate which medical supplies were included in the amount reported on Column 4, line 6 (Other Medical Supplies) of schedule OPWDD-1.

Medical Supplies Not Included: Indicate which medical supplies were not included in the amount reported on Column 4, line 6 (Other Medical Supplies) of schedule OPWDD-1.

Note: This column is only on the OPWDD-2 form. It is not included in the CFRS software.

This schedule is used to detail property reimbursement and the relating expenses that have been reported on Schedule CFR-1 for the following programs:

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Day Treatment (Program Codes 0200 and 0202)

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HCBS Group Day Habilitation Service (Program Code 0223)

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HCBS Prevocational Service (Program Code 0227)

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ICF/IID (Program Codes 0090 and 1090)

NYS CFRS Software Note

•

No data can be entered into this schedule prior to defining your agency and your agency’s program/sites in the software.

•

In the Submission Definition screen, specify all of the agencies that fund/certify your programs.

Failure to do so will prohibit the completion of some schedules.

•

Data in grayed-out fields is a calculation or has previously been entered elsewhere in the CFR and has been carried forward. If any of the carry-forward information is incorrect, it will need to be changed in the source schedule.

•

Please refer to Getting Started with NYS CFRS Software in Section 9 for more details.

Header Section

Agency Name: The name of the organization (service provider).

Agency Code: The five-digit code assigned to the organization (service provider).

Detail Section

Program Code: The type of program and the corresponding code as listed in Appendix G.

Operating Certificate Number: The operating certificate number of the program/site. For Prevocational Services, use the identifying number from the DOH provided schedule.

Program/Site Address: The number, street, city, and zip code of the program/site.

NOTE: Column 3 indicates the CFR-1 line number on which the expense related to the revenue item from Column 1 is expected to be reported. Please note that the CFR-1 line may include expenses for items that are not related to the revenue item in Column 1. (For instance, CFR-1 Line 49 may include the lease expense for program administrative space. The portion of CFR-1 Line 49 related to this program administrative expense should not be included in Column 2 on OPWDD-5). Only include in Column 2 the expense from CFR-1 that directly relates to the revenue reported in Column 1.

Lease/Rental-Real Property: