Current through Register Vol. 46, No. 39, September 25, 2024
(a)
The commissioner shall consider only those requests for revisions of certified
rates which result in a fiscal impact of over one percent of the certified
rate, and a minimum of $20,000; and which are based on:
(1) errors made by the Office of Mental
Health in the calculation of the rate of payment;
(2) errors in the financial or statistical
data submitted to the commissioner by a residential treatment
facility;
(3) a substantially
changed residential treatment facility determined to have a 20-percent change
in certified capacity, or a major change in resident population or resident
services, when such changes have been approved by the commissioner. Revisions
to the rate may also be initiated by the commissioner pursuant to this
subdivision;
(4) additional
staffing required to meet accreditation standards of the Joint Commission on
Accreditation of Hospitals, up to the full-time equivalent staffing standards
approved by the commissioner;
(5)
Federal- or State-mandated requirements resulting in increased costs;
(6) capital costs approved through the
applicable provisions of the Mental Hygiene Law and Part 551 of this
Title;
(7) family therapy expenses,
as determined by the commissioner;
(8) nursing services for changes in nursing
staff requirements, as determined by the commissioner;
(9) additional staffing and other than
personal service expenses, subject to prior written approval from the
appropriate regional office and the commissioner's designate, resulting from
patients who have been diagnosed with Acquired Immune Deficiency Syndrome
(AIDS). Approval for additional staffing and other personal service expenses
shall be based on the necessity of such services for the safety and well being
of patients and a determination that such expenses are within the appropriate
budgetary guidelines.
(b) Request for revision of a certified rate
of payment shall be sent to the commissioner by registered or certified mail
and shall contain a detailed statement of the basis for the requested revision
together with copies of any documentation a residential treatment facility
wishes to submit.
(1) A request based upon
the grounds set forth pursuant to paragraph (a)(1) or (2) of this section must
be accompanied by a detailed statement of the corrected financial or
statistical data certified pursuant to section
578.5(c)(2)
of this Part.
(2) A request based
upon the grounds set forth pursuant to paragraph (a)(1) or (2) of this section
shall be submitted within 120 days of receipt by a residential treatment
facility of the rate of payment computation sheet.
(3) A request for a revision pursuant to
paragraph (a)(3), (4), (5), (6), (7), (8) or (9) of this section must be
submitted within 60 days of the close of the rate of payment period in
question.
(4) A request for a
revision pursuant to paragraph (a)(6) of this section and consistent with this
section shall be processed on a semi-annual basis, beginning July 1,
1990.
(c) The
residential treatment facility shall be notified in writing of the
determination of the request for revision of a certified rate of payment,
including a statement of the reasons therefor.
(d) The affirmation or revision of a
certified rate of payment resulting from a request for revision of a certified
rate of payment shall be final unless within 30 days of receipt of such written
determination a residential treatment facility requests a hearing on factual
issues determined adversely to the residential treatment facility. Requests for
a hearing, and the conduct thereof, shall be in accordance with the provisions
of Part 503 of this Title.
(e) A
revision to the rate of payment determined pursuant to paragraph (a)(1) or (2)
of this section shall be effective on the first day for which the originally
certified rate of payment was effective.
