Current through Register Vol. 46, No. 39, September 25, 2024
(a) In addition to
the medical assistance reimbursement rates available pursuant to Part 579 of
this Title and section
588.13
of this Part, providers operating one or more outpatient programs licensed
pursuant to Part 585 or 587 of this Title may be eligible to receive
supplemental medical assistance reimbursement for community support program
services in accordance with this section. For purposes of this section:
(1) community support program services means
community-based services supported by State and local aid for local or unified
services pursuant to article 41 of the Mental Hygiene Law, or community-based
services supported by 100 percent State aid;
(2) local aid means local share of funds
which support services for persons with mental illness, comprised of local tax
levy funds or contributions from voluntary agencies; and
(3) State aid means State funds which support
local or unified services for persons with mental illness, with or without
matching local aid.
(b)
A provider shall be eligible for supplemental reimbursement pursuant to this
section if the provider:
(1) operates a
clinic treatment program, continuing day treatment program or day treatment
program licensed pursuant to Part 585 or 587 of this Title;
(2) directly provides community support
program services pursuant to a contract with the local governmental unit or the
Office of Mental Health;
(3) is not
operated by the Office of Mental Health; and
(4) is not operated by a general hospital as
defined in article 28 of the Public Health Law, that is also considered to be a
voluntary agency as defined in article 41 of the Mental Hygiene Law.
(c) For purposes of this section,
all providers operated by the New York City Health and Hospitals Corporation
which are eligible for supplemental reimbursement pursuant to subdivision (b)
of this section shall be considered, in combination, a single eligible
provider.
(d) Supplemental
reimbursement rates shall be calculated by the Office of Mental Health for each
eligible provider. The supplemental reimbursement rate, effective November 1,
1997, shall be calculated as follows:
(1)
Grants from State aid or local aid for community support program services for
the local fiscal year ended in 1997 for upstate and Long Island-based
providers, and for the local fiscal year ended in 1998 for New York City-based
providers, will be estimated for each eligible provider. For purposes of this
section, unless otherwise specified, such period shall be considered the base
year. Such estimates shall not include:
(i)
grants received pursuant to section 41.55 of the Mental Hygiene Law;
(ii) grants to housing programs;
(iii) any portion of grants to community
support programs for services which are reimbursed by medical assistance during
the base year;
(iv) any portion of
grants to an eligible provider for community support program services which are
delivered by another provider of service through a contract with the eligible
provider;
(v) grants received from
the Federal government;
(vi) any
portion of grants to community support programs for services which are
supported by contributions from voluntary agencies; or
(vii) any portion of grants determined by the
Office of Mental Health to be eligible for continued State aid.
(2) Grants estimated pursuant to
paragraph (1) of this subdivision shall be adjusted to reflect:
(i) the percentage of community support
program services which are determined by the Office of Mental Health to be
eligible for medical assistance reimbursement, consistent with Federal
standards; and
(ii) the percentage
of community support program services provided to recipients who are eligible
for medical assistance.
(3) The combined total of clinic treatment,
continuing day treatment, and day treatment units of service reimbursed by
medical assistance shall be calculated for each provider for each of the three
local fiscal years immediately prior to the base year. Such units of service
shall exclude collateral, group collateral, and home visits provided by an
outpatient program operated by a general hospital as defined in article 28 of
the Public Health Law. The average of the three annual totals shall be
calculated.
(4) Grants, as
recalculated pursuant to paragraph (2) of this subdivision, shall be divided by
the average annual units of service calculated pursuant to paragraph (3) of
this subdivision. The community support program rate cap will be established by
the Commissioner of Mental Health and approved by the Director of the Division
of the Budget.
(5) The calculation
pursuant to paragraph (4) of this subdivision shall be divided by 89 percent.
Such calculation shall be the provider's supplemental reimbursement
rate.
(6) On an annual basis, the
Office of Mental Health shall re-evaluate the percentage used in the
calculation pursuant to paragraph (5) of this subdivision. Upon modification of
such percentage, all providers' supplemental rates shall be
recalculated.
(7) On an annual
basis, the Office of Mental Health shall conduct a review of the number of
units of service calculated pursuant to paragraph (3) of this subdivision for
each provider. For purposes of such analyses, the most recently completed local
fiscal year shall be used as the base year. As appropriate, supplemental
reimbursement rates shall be recalculated, including any recalculations
pursuant to paragraph (6) of this subdivision.
(8) Rates calculated or recalculated pursuant
to this section are subject to appeal by the local governmental unit, or by the
provider with the approval of the local governmental unit. If a provider offers
community support program services solely pursuant to a contract with the
Office of Mental Health, such provider may request an appeal without the
approval of the local governmental unit. Appeals pursuant to this paragraph
shall be made within one year after receipt of initial notification of the most
recent supplemental reimbursement rate calculation or recalculation.
(e) The supplemental reimbursement
rate calculated pursuant to subdivision (d) of this section shall be added to
the reimbursement rates for each clinic treatment, continuing day treatment,
and day treatment program operated by the provider and licensed pursuant to
Part 585 or 587 of this Title. In outpatient programs operated by a general
hospital as defined in article 28 of the Public Health Law, the following visit
categories shall not be eligible for the supplemental reimbursement rate:
(1) collateral and group collateral visits in
clinic treatment and continuing day treatment programs; and
(2) collateral and home visits in day
treatment programs.
(f)
Supplemental payments which are in excess of 100 percent of the grants
calculated pursuant to paragraph (d)(2) of this section will be subject to
recovery by the Office of Mental Health through adjustment of future payments.
In cases where recoveries are necessary, the Office of Mental Health may adjust
the supplemental rate prospectively.
(g) If supplemental payments are less than
the grants calculated pursuant to paragraph (d)(2) of this section, the Office
of Mental Health shall, upon the request of the local governmental unit, amend
the supplemental reimbursement rate to ensure maintenance of historical levels
of funding for community support program services. If a provider offers
community support program services solely pursuant to a contract with the
Office of Mental Health, such provider may request a rate amendment without the
approval of the local governmental unit. In the event that amendment of the
supplemental reimbursement rate, consistent with the provisions of paragraph
(d)(4) of this section, will not ensure the maintenance of historical levels of
funding for community support program services, the State aid portion of the
grants pursuant to paragraph (d)(2) of this section, commensurate with the
shortfall, shall be allocated to the local governmental unit as State aid. If a
provider offers community support program services solely pursuant to a
contract with the Office of Mental Health, such State aid shall be allocated to
the provider. State aid allocated pursuant to this subdivision shall be subject
to the availability of appropriations in the Office of Mental Health's budget
and the approval of the director of the State Division of the Budget.
(h) Providers in receipt of supplemental
reimbursement pursuant to this section shall, at a minimum, maintain the level
of provision of community support program services or the expenditures for such
services, consistent with the level of such services provided in the most
recent local fiscal year in which such services were supported by State or
local aid, including any portion of grants which were supported by
contributions from voluntary agencies. If a provider reduces the provision of
community support program services or the expenditures for such services
subsequent to the calculation of the supplemental reimbursement rate pursuant
to subdivision (d) of this section, and such reduced services are not
transferred to another provider, the supplemental reimbursement rate, upon the
recommendation of the local governmental unit, shall be adjusted in proportion
to the reduction in community support program services. If a provider offers
community support program services solely pursuant to a contract with the
Office of Mental Health, the recommendation of the local governmental unit is
not required. Commensurate with the service reduction, the State aid portion of
grants pursuant to paragraph (d)(2) of this section shall be allocated to the
local governmental unit as State aid, upon the request of the local
governmental unit. If a provider offers community support program services
solely pursuant to a contract with the Office of Mental Health, such State aid
shall be allocated to the provider. State aid allocated pursuant to this
paragraph shall be subject to the availability of appropriations in the Office
of Mental Health's budget and the approval of the director of the State
Division of the Budget.
(i) If a
provider in receipt of supplemental reimbursement pursuant to this section
transfers or closes one or more community support programs, or portions
thereof, which were supported by grants included in the calculation of the
supplemental reimbursement rate pursuant to paragraph (d)(4) of this section,
such provider's supplemental reimbursement rate or grants shall be adjusted as
follows:
(1) If a community support program,
or a portion thereof, is transferred to another eligible provider within the
same local governmental unit, the supplemental rate will be eliminated or
recalculated for each eligible provider, upon the approval of the local
governmental unit, commensurate with the new level of community support program
services provided. If a provider offers community support program services
solely pursuant to a contract with the Office of Mental Health, the
recommendation of the local governmental unit is not required. In the event
that amendment of the supplemental reimbursement rate, consistent with the
provisions of paragraph (d)(4) of this section, will not ensure the maintenance
of historical levels of funding for community support program services, the
State aid portion of the grants pursuant to paragraph (d)(2) of this section,
commensurate with the shortfall, shall be allocated to the local governmental
unit as State aid. If a provider offers community support program services
solely pursuant to a contract with the Office of Mental Health, such State aid
shall be allocated to the provider. State aid allocated pursuant to this
paragraph shall be subject to the availability of appropriations in the Office
of Mental Health's budget and the approval of the director of the State
Division of the Budget.
(2) If a
community support program, or a portion thereof, is transferred to another
provider which is not eligible for supplemental reimbursement pursuant to
subdivision (b) of this section, or is closed without transfer to another
provider, the State aid portion of grants pursuant to paragraph (d)(2) of this
section commensurate with the program transfer or closure shall be allocated,
upon request by the local governmental unit, to the local governmental unit as
State aid. If a provider offers community support program services solely
pursuant to a contract with the Office of Mental Health, such State aid shall
be allocated to the provider. State aid allocated pursuant to this paragraph
shall be subject to the availability of appropriations in the Office of Mental
Health's budget and the approval of the director of the State Division of the
Budget.
(j) If a
provider operating a clinic treatment program, continuing day treatment program
or a day treatment program licensed pursuant to Part 585 or 587 of this Title
subsequently closes all such programs, the State aid portion of grants pursuant
to paragraph (d)(2) of this section shall be allocated, upon request by the
local governmental unit, to the local governmental unit as State aid. If a
provider offers community support program services solely pursuant to a
contract with the Office of Mental Health, such State aid shall be allocated to
the provider. State aid allocated pursuant to this subdivision shall be subject
to the availability of appropriations in the Office of Mental Health's budget
and the approval of the director of the State Division of the Budget.
(k) Providers in receipt of supplemental
reimbursement pursuant to this section shall:
(1) assure that community support program
services for recipients who are eligible for medical assistance are provided
pursuant to the recommendation of a licensed practitioner, as defined in Part
587 of this Title, and that there is a process for maintaining any records of
such recommendations; and
(2)
submit to the Office of Mental Health or the local governmental unit, upon
request, all cost, utilization, programmatic or clinical reports or
documentation required.
(l) In the event that the local share of the
supplemental medical assistance reimbursement commensurate with the grants
described in paragraph (d)(4) of this section exceeds the estimated local tax
levy portion of local aid, as described in paragraph (d)(2) of this section,
for all eligible providers within the local governmental unit's jurisdiction,
the State shall reimburse the local government for such excess, subject to the
availability of appropriations in the Office of Mental Health's budget and the
approval of the director of the State Division of the Budget.
(m) Receipt of supplemental reimbursement
pursuant to this section shall not affect receipt of supplemental reimbursement
available to a provider pursuant to Part 592 of this Title.
(n) Nothing in this section is intended to
alter the existing role, responsibility or authority of local governmental
units pursuant to article 41 of the Mental Hygiene Law.
