New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 5 - Procedures and Forms
Part 540 - Authorization Of Medical Care
Section 540.13 - Concurrent payments to hospitals

Universal Citation: 18 NY Comp Codes Rules and Regs ยง 540.13

Current through Register Vol. 46, No. 39, September 25, 2024

(a) To insure timely payment, while providing for transition to a fee for services rendered payment system under the medical assistance program the commissioner shall implement, for a limited period, a concurrent payment system for any eligible nongovernmental general hospital requesting participation to effectuate such transition. Eligible applicants must have:

(1) participated in a limited multi-hospital reimbursement demonstration project; and

(2) been receiving, in lieu of payment for services rendered, fixed weekly payments pursuant to a contractual agreement, during calendar years 1981 and 1982 or their contractual predecessors in a limited multi-hospital reimbursement demonstration project must have; and

(3) more than 25 percent of the patients serviced by the hospital eligible for medical assistance.

(b) Prior to the commencement of payments made pursuant to this section, the commissioner shall submit for approval by the director of the budget a schedule detailing the methodology and specific time period necessary to effectuate transition to a fee for service rendered payment system prior to the end of December 31, 1985.

(c) Payment shall be made biweekly under the concurrent payment system.

(d) The department shall compute the payment amount to equal 1/26 of the hospital's imputed or certified revenue cap, as defined in section 2807-a of the Public Health Law, adjusted for overpayments or underpayments received by the hospital during the concurrent payment period, or a previous period.

(e) Payment shall be made two weeks after the end of each biweekly period.

(f) The department shall review the concurrent payment at the beginning of each quarter and adjust it to reflect any changes by the Department of Health to the inpatient revenue cap or portion allocated for medical assistance payments.

(g) The hospital shall maintain cost, charge and statistical data necessary to accurately complete cost reports on a timely basis, in accordance with standards set by the Department of Social Services and the Department of Health.

(h) Within 15 months after each calendar year, the department shall reconcile the amounts paid pursuant to the concurrent payment system with the amounts of payment that would have been made for services rendered during the calendar year and billed to the department prior to the date of reconciliation. For services provided to Medicaid recipients during the period to be reconciled where such cases are open at the time of reconciliation, payments will be made on a services rendered basis and excluded from reconciled concurrent payment amounts. Nothing shall prohibit the department from performing a reconciliation at any other time as it may determine.

(i) The hospital shall be liable for all overpayments identified pursuant to the reconciliation.

(j) The department may withhold any overpayment, including overpayments arising from the concurrent payment system, from future payments made to the hospital under the medical assistance program.

(k) The hospital must submit its claims in a format acceptable to the Medicaid management information system within the time frame set forth in section 540.6 of this Part.

(l) The department may lower or eliminate the concurrent payment for noncompliance with the provisions of this section.

(m) During any biweekly period prior to May 1, 1983, the department may pay both contractual payments due to the hospital and concurrent payments, but in no event shall the biweekly payment exceed the amount specified in subdivision (d) of this section.

(n) The department shall not make concurrent payment after December 31, 1985.

(o) The department shall adjust concurrent payments to the hospital consistent with the schedule approved by the director of the budget pursuant to subdivision (b) of this section, in order to facilitate transition to a fee for service rendered payment system for such hospital.

(p) This section shall be effective only for so long as Federal financial participation is available for the concurrent payments.

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