Current through Register Vol. 46, No. 39, September 25, 2024
(a) In order
to receive reimbursement for the provision of community rehabilitation
services, each individual must have a service plan which documents the delivery
of appropriate community rehabilitation services which have been authorized by
a physician, or reauthorized pursuant to section
593.6(b)
of this Part.
(b) Reimbursement
will be based upon monthly and half-monthly rates. Such rates shall be paid
based upon a minimum number of face-to-face contacts between an eligible
resident of a program and a staff person of an approved provider of community
rehabilitation services, subject to the following provisions:
(1) A full monthly rate will be paid for
services provided to an eligible resident in residence for at least 21 days in
a calendar month, who has received at least four contacts with a staff person
of the program. For a teaching family home program, a youth shall have received
at least 11 contacts, at least three of which must be provided by authorized
program staff other than the teaching parents. At least four different
community rehabilitative services must have been provided.
(2) A half monthly rate will be paid for
services provided to an eligible resident in residence for at least 11 days in
a calendar month, who has received at least two contacts with a staff person of
the program. For a teaching family home program, a youth shall have received at
least six contacts, at least two of which must be provided by authorized
program staff other than the teaching parents. At least two different community
rehabilitation services must have been provided.
(3) Only one contact can be counted each day
and such contact shall be at least 15 minutes in duration.
(4) For reimbursement purposes, a contact
shall involve the performance of at least one of the services indicated in the
resident's current service plan.
(5) A reimbursable contact may occur at or
away from the program, except that a reimbursable contact may not occur at the
site of a licensed mental health outpatient program as such programs are
described in Part 587 of this Title, nor when the otherwise eligible resident
is an inpatient of any hospital for any reason or temporarily residing in any
other licensed residential facility.
(6) Reimbursement for contacts provided under
this program shall not be limited in any way by reimbursement for visits under
any outpatient program licensed by the Office of Mental Health on the same day
or reimbursement for visits provided by any comprehensive Medicaid case
management program approved by the Office of Mental Health.
(c) The rates for each approved
residential program for adults and community residence programs for children
shall be established by the Office of Mental Health, subject to the approval of
the Director of the Budget, pursuant to the following criteria:
(1) Providers of rehabilitation services
shall be assigned an individual provider monthly rate based upon their
cumulative approved costs for all sites divided by the maximum capacity for
their sites divided by 12 months, divided by the specific utilization factor
established by the Office of Mental Health for beds in adult congregate
programs, adult apartment programs or for children's residential services
programs. Rates for a half month service shall be 50 percent of the monthly
rate. The rate calculated under this methodology will be reduced by $4 for a
full month and $2 for a half month rate to account for payment pursuant to
subdivision (d) of this section. All rates subject to the approval of the
Division of Budget.
(2) All rates
for providers in New York City calculated pursuant to paragraph (1) of this
subdivision will be effective through May 31st of each year. All rates for
providers in the rest of the State shall be effective through November 30th.
The commissioner may authorize changes to rates to correct errors in the
original calculation of the rate or to reflect changes in approved
costs.
(3) The rate methodology for
rehabilitation services provided in residential programs operated by the Office
of Mental Health shall be the same as for other licensed providers except that
there shall be one statewide rate which shall be the lower of the calculated
rate or the highest rate approved for other providers. The rate shall be
promulgated on the same schedule as for providers outside New York
City.
(d) In addition to
the rates allowed in paragraph (c)(1) of this section, a provider may receive
an additional rate of $1 for each allowable service which is provided, as
delineated in section
593.4(b) or
(c) of this Part. No one service however may
be reimbursed more than once each month and no more than four may be reimbursed
accompanying a full month reimbursement nor more than two accompanying a half
month's reimbursement.
(e) In
addition to the rates allowed in paragraph (1) of subdivision (c) of this
section, for services provided on or after April 1, 2014, a provider shall
receive the equivalent of an additional 30 percent rate add-on for up to two
years for community rehabilitation services provided to adults who were
discharged directly from a State psychiatric center or nursing home to a
congregate residence. A provider shall receive the equivalent of an additional
15 percent rate add-on for up to three years for community rehabilitation
services provided to adults who were discharged directly from a State
psychiatric center or nursing home to an apartment residence.
