Current through Register Vol. 46, No. 39, September 25, 2024
(a) Clinic treatment facilities will
transition to full payment under the APG reimbursement methodology over a
multi-year period beginning on July 1, 2011. Reimbursement during this
transition period shall consist of a blended payment comprised of:
(1) a partial operating payment determined by
the clinic's average operating payment under the pre-existing reimbursement
methodology (average legacy fee); plus
(2) a complementary partial operating payment
calculated under the APG reimbursement methodology; plus
(3) a capital cost component, if
any.
(b) The average
legacy fee shall be established for each clinic treatment facility as follows:
(1) Counts of paid visits for each clinic and
visit type under the pre-existing reimbursement methodology
(i.e., "full," "brief," "group," "collateral," "intake," and
"diagnostic/evaluation" visit types) shall be determined for service dates
between April 1, 2009 and March 31, 2010. OPWDD reserves the right to adjust
this look-back period to accommodate instances wherein a clinic was not
certified by OPWDD for the entire year.
(2) Each clinic's total operating payment by
visit type shall be determined by multiplying the count of paid visits for the
visit type determined in paragraph (1) of this subdivision by the operating
component of its fee (i.e., full fee minus its capital cost
component) in effect on June 30, 2011 for the same visit type. OPWDD may adjust
these results to prevent a clinic from incurring a decrease or increase in
Medicaid reimbursement disproportionate to that of the clinics within its peer
group.
(3) The total operating
payments by visit type determined in paragraph (2) of this subdivision shall be
summed and then divided by the clinic's total paid visits across all visit
types.
(c) Payment will
be made pursuant to the transition phase-in schedule outlined in this
subdivision.
(1) The first phase shall begin
on July 1, 2011 and end on June 30, 2012. Payment for services provided during
the first phase shall reflect a blend of 75 percent clinic average legacy fee,
25 percent operating payment calculated under APG reimbursement methodology,
plus capital add-on, if any.
(2)
The second phase shall be a twelve month period beginning July 1, 2012. Payment
for services provided during this phase shall reflect a blend of 50 percent
clinic average legacy fee, 50 percent operating payment calculated under APG
reimbursement methodology, plus capital add-on, if any.
(3) The third phase shall be a six month
period beginning July 1, 2013. Payment for services provided during this phase
shall reflect a blend of 25 percent clinic average legacy fee, 75 percent
operating payment calculated under APG reimbursement methodology, plus capital
add-on, if any.
(d)
Payment for all services provided on or after January 1, 2014 shall be based in
total on the APG reimbursement methodology.
(e) Clinic treatment facilities that begin
operation on or after July 1, 2011 shall be reimbursed in accordance with the
transition phase-in schedule identified in subdivision (c) of this section
except that the average of the legacy fees for all clinic treatment facilities
shall be used in the payment calculation, instead of the clinic-specific
average legacy fee.
