New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XXI - OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES
Part 841 - Medical Assistance for Chemical Dependence Services
Section 841.5 - Provisions applicable to all eligible providers

Universal Citation: 14 NY Comp Codes Rules and Regs ยง 841.5

Current through Register Vol. 46, No. 12, March 20, 2024

(a) Limits on Compensation. The maximum reimbursable costs for salaries for positions/titles shall be consistent with the requirements of the limits on executive compensation in this Title.

(b) Financial and Statistical Reporting:

(1) Each eligible provider shall maintain financial records and records relative to numbers and types of services provided and shall prepare and submit to the Office financial and statistical reports in accordance with the requirements of the Office.

(2) All financial reports to be prepared and submitted to the Office shall:
(i) be prepared in accordance with generally acceptable accounting principles;

(ii) be certified by an independent certified public accountant or an independent licensed accountant and shall include a statement of opinion on the data therein, unless this requirement is otherwise waived or modified by the Office; and

(iii) be accompanied by a complete copy of the eligible provider's certified financial statements.

(3) All reports to be prepared and submitted to the Office shall:
(i) be certified by the chief administrative officer or director of the eligible provider;

(ii) be on forms prescribed by the Office; and

(iii) include financial and statistical data for each service for which rates or fees are established.

(4) Reporting Requirements. Reports required to be submitted by this section shall be submitted within 120 days after the close of the eligible provider's fiscal year. Extensions of time for filing reports may be granted by the commissioner upon application received prior to the due date of the report and only in circumstances where the eligible provider establishes by documentary evidence that the reports cannot be filed by the due date for reasons beyond the control of the eligible provider.

(5) If the eligible provider determines that the information on reports filed is inaccurate, incomplete or incorrect, the eligible provider shall immediately file with the Office the corrected reports which comply with the requirements of this section.

(6) If the required financial and statistical reports are determined by the Office to be incomplete, inaccurate or incorrect, the eligible provider has 30 days from the date of receipt of notification from the office to provide the correct or additional data.

(7) Penalties for Non-compliance.
(i) If an eligible provider fails to file the required financial and statistical reports, in accordance with this Part, on or before the due date, or Office approved extended due date, the Office may, at its discretion, reduce said eligible provider's existing Medicaid payments by up to twenty (20) percent, beginning the first day of the month following the original due date or approved extended due date and continuing until the first day of the month in which the reports are received by the Office. If the eligible provider fails to file the required financial and statistical reports by the end of the rate period during which the reports were due, such reduction may be increased in each subsequent month by up to ten (10) percent until receipt of the required information. All funds shall be returned to the provider once the provider is determined by the Office to be in compliance.

(8) Revocation of operating certificate. If, after a period of noncompliance resulting in reduced Medicaid payments, the Office determines that a program will likely be unable to meet its financial obligations, the Office may request the program voluntarily surrender its operating certificate or take action to revoke the operating certificate in accordance with this Title.

(c) Record keeping. An eligible provider shall furnish to the Office any information that it may request regarding payments claimed by the provider for furnishing services.

(d) Billing.

(1) The eligible provider shall levy no additional charges to patients for services paid for by the Medicaid Program.

(2) Claims for payment by the Medicaid Program shall be submitted at rates and/or fees established by the Office and approved by the Director of the Budget. Such billings shall be net of any individual or third-party liability.

(3) Claims shall be submitted only for services which were actually furnished to eligible persons and for which documentation of medical necessity is available at the time the services were furnished.

(4) Claims shall be submitted on officially authorized claim forms in formats and in accordance with the Department of Health standards and procedures for claims submission.

(5) All information provided in relation to any claim for payment shall be true, accurate and complete.

(e) Compliance with general medical assistance program requirements. Each eligible provider shall comply with all applicable medical assistance program requirements of the Department of Health.

(f) Calculation of allowable costs.

(1) General. To be considered as allowable, costs must be properly chargeable to necessary patient care as determined by the Office and rendered in accordance with the operating, financial and reporting requirements of the Office pursuant to this Title, and as such may be amended from time to time. The allowability of costs shall be determined in accordance with the following:
(i) Except where specific rules concerning allowability of costs are stated herein, the Office shall use as its major determining factor in deciding on the allowability of costs, the most recent edition of the Medicare Provider Reimbursement Manual, commonly referred to as HIM15, published by the U.S. Department of Health and Human Services' Centers for Medicaid and Medicare Services.

(ii) Where specific rules stated herein or in HIM15 are silent concerning the allowability of costs, the Office shall determine allowability of costs based on reasonableness and relationship to patient care and generally accepted accounting principles.

(2) Services. Allowable operating costs shall include the costs of all services necessary to meet the operating requirements of the Office pursuant to this Title and the special needs of the patient population to be served by an eligible provider.

(3) Capital expenditures. No capital expenditures for which approval by the Office is required in accordance with this Part shall be included in allowable capital costs for purposes of computation of the rate of payment unless such approval shall have been secured. Reimbursement for capital and start-up costs will be limited to those costs determined by the Office to be both reasonable and necessary.

(g) Application Procedures. To qualify for medical assistance payments, an eligible provider, with a current operating certificate issued by the office, shall apply for enrollment as a Medicaid provider on application forms as required by the NYS Department of Health.

(h) Approval of rates. Payment rates established in accordance with the provisions of this Part will remain in effect until such time as they are revised with the approval of the NYS Division of the Budget and the Centers for Medicare and Medicaid Services (where Federal share is applicable).

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