Current through Register Vol. 46, No. 39, September 25, 2024
(a) The
provider of service shall establish a process to collect and analyze data on
program and individual outcomes. A process shall be established for the routine
use of such data for decision-making purposes. In association with the
achievement of individual outcomes and reviews of related processes, providers
of service are encouraged to use evidence-based practices.
(b) The office, in conjunction with local
governmental units, will develop a plan regarding oversight and evaluation
criteria for PROS programs, including the development of performance
indicators.
(1) Each local governmental unit
shall decide the level of its participation in the oversight and evaluation of
PROS programs. Such participation shall include the execution of signed
agreements between the local governmental unit and each PROS program in the
geographic area served by the local governmental unit. Such provider agreements
may include performance indicators specified by the local governmental unit and
approved by the office.
(2) If the
local governmental unit and the PROS provider are unable to execute an
agreement in accordance with paragraph (1) of this subdivision, the office
shall review the situation and, if warranted, may execute an agreement directly
with the PROS provider. If the office determines that such an agreement will be
executed, it will so notify the local governmental unit.
(3) In the event that the PROS program is
operated by the local governmental unit, the PROS program shall execute a
provider agreement with the office.
(c) Provider agreements executed pursuant to
subdivision (b) of this section may include provisions authorizing a
withholding of up to 20 percent of the provider's monthly Medicaid payment if
the provider fails to comply with applicable data and reporting requirements,
operational requirements, or performance indicators. Such withholding of
Medicaid payments may be continued until the provider attains compliance, at
which time previously withheld funds shall be released to the provider.
(1) In regard to performance indicators which
are related to the outcome of individual usage of PROS services, no withholding
of Medicaid revenue for an individual PROS provider pursuant to this
subdivision shall occur earlier than the 12th month following the month in
which the operating certificate issued for that provider becomes effective, or
the 12th month following the effective date of the initial agreement developed
pursuant to subdivision (b) of this section, whichever is later.
(2) Any withholding of Medicaid payments
pursuant to this subdivision does not obviate the authority of the office to
initiate other administrative sanctions authorized pursuant to this Title or
applicable provisions of the Mental Hygiene Law.
