New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIII - Office of Mental Health
Part 512 - Personalized Recovery Oriented Services
Section 512.12 - Rates of payment

Universal Citation: 14 NY Comp Codes Rules and Regs ยง 512.12

Current through Register Vol. 46, No. 39, September 25, 2024

(a) Rates of payment shall be established on a prospective basis.

(b) Each rate of payment established pursuant to this section shall be a monthly rate determined by the commissioner and approved by the Division of the Budget.

(c) For purposes of this section, the Downstate Region shall mean the following counties: Bronx, Kings, New York, Queens, Richmond, Nassau, Putnam, Rockland, Suffolk and Westchester.

(d) For purposes of this section, the Upstate Region shall mean those counties of New York State that are not listed in subdivision (c) of this section.

(e) Effective April 1, 2015, the monthly base rate and component add-on schedules for PROS programs are as follows:

(1) Comprehensive PROS programs:
(i) for programs operated in the Downstate Region:

Monthly Base Rate*

Component Add-On

Pre-Adm

Level 1

Level 2

Level 3

Level 4

Level 5

IR

ORS

CT

2-12 Units

13-27 Units

28-43 Units

44-60 Units

61+ Units

$153.37

$235.57

$554.35

$790.93

$868.11

$1,000.44

$415.39

$355.88

$279.68

(ii) for programs operated in the Upstate Region:

Monthly Base Rate*

Component Add-On

Pre-Adm

Level 1

Level 2

Level 3

Level 4

Level 5

IR

ORS

CT

2-12 Units

13-27 Units

28-43 Units

44-60 Units

61+ Units

$140.35

$214.53

$504.24

$719.77

$787.94

$910.24

$377.55

$324.80

$254.63

* The Monthly Base Rate is determined by the total PROS units associated with a single PROS participant and his or her collateral(s) in a given month.

(2) Limited license PROS programs:
(i) for programs operated in the Downstate Region:

Reimbursement Category

Monthly Fee

Intensive Rehabilitation

$475.16

Ongoing Rehabilitation and Support

$391.95

(ii) for programs operated in the Upstate Region:

Reimbursement Category

Monthly Fee

Intensive Rehabilitation

$432.06

Ongoing Rehabilitation and Support

$355.88

(f) Hospital-based providers may receive an add-on to their monthly case payment that reflects their capital costs. The commissioner may impose a cap on the revenues generated from this rate add-on.

(1) For PROS programs operated by providers licensed pursuant to article 28 of the Public Health Law, there shall be added an allowance for the cost of capital, which shall be determined by the application of the principles of cost-finding for the Medicare program. No capital expenditure for which approval by the office is required under the applicable provisions of the Mental Hygiene Law or Part 551 of this Title shall be included in allowable capital costs for purposes of rate computation unless such approval has been secured.

(2) Allowable capital expenditures shall not include costs specifically excluded pursuant to section 2807-c of the Public Health Law.

(3) The capital payment per service month for a provider's PROS licensed outpatient mental health programs shall be determined by dividing all allowable capital costs of the provider's PROS programs, after deducting any exclusions, by the annual number of service months for all enrollees of the PROS program.

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