New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter F - Finance; Claims for Reimbursement by Social Services Districts
Article 4 - Supplementary Assistance Reimbursement Claiming
Part 635 - Medical Assistance Reimbursement Claiming
Section 635.1 - Reimbursement for medical assistance (MA)

Universal Citation: 18 NY Comp Codes Rules and Regs § 635.1

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

(a) Reimbursement for services provided to recipients of MA shall be claimed on schedules and formats prescribed by the department and in accordance with instructions of the department. Any amounts which are federally reimbursable pursuant to title XIX of the Social Security Act or another Federal program or activity must be claimed in a manner that results in the greatest proportion of Federal participation or alternatively must be claimed in a manner that does not increase the amount of State reimbursement which would be available if Federal participation were also available.

(b) Expenditures made by social services districts for MA and its administration shall be subject to reimbursement by the State in accordance with section 368-a of the Social Services Law. Each district may claim:

(1) the amount of Federal funds, if any, properly received or to be received on account of such expenditures;

(2) the full amount expended for MA furnished to those State charges specified in paragraph (b) of subdivision one of section 368-a of the Social Services Law and for the administration thereof, after first deducting therefrom any Federal funds properly received or to be received on account thereof;

(3) the full amount expended for MA furnished to eligible Indians and members of their families residing on any Indian reservation in this State, and for the administration thereof, after first deducting therefrom any Federal funds properly received or to be received on account thereof;

(4) except as otherwise provided by the Social Services Law or by this Part, 50 percent of the amount expended for MA provided to other eligible persons, and the administration thereof, after first deducting therefrom any Federal funds properly received or to be received on account thereof;

(5) 100 percent of the amount expended for the development of MA data systems, after first deducting therefrom any Federal funds properly received or to be received on account thereof, provided that such reimbursement shall be available only to the extent that claims for 90 percent Federal aid have been approved;

(6) the full amount expended for MA furnished to eligible persons discharged, released or conditionally released from a State Department of Mental Hygiene facility if such person was a patient therein for a continuous period of five or more years prior to his or her discharge or release;

(7) reimbursement for the following services, after first deducting therefrom any Federal funds properly received or to be received on account thereof:

(i) care, treatment, maintenance and nursing services provided in nursing homes and health-related care and services provided in intermediate care facilities;

(ii) home health services, as defined in section 365-a (2)(d) of the Social Services Law;

(iii) personal care services, as defined in section 365-a (2)(e) of the Social Services Law; and

(iv) long-term home health care program services as follows:

(a) for services provided on or after January 1, 1984--72 percent;

(b) for services provided on or after January 1, 1985--76 percent; and

(8) beginning January 1, 1984, after first deducting therefrom any Federal funds properly received or to be received on account thereof, 100 percent of the amount expended for MA for those individuals who are eligible for such assistance as a result of a mental disability, as determined by the commissioner in consultation with the commissioner of the Office of Mental Health and the commissioner of the Office of Mental Retardation and Developmental Disabilities and with the approval of the director of the Division of the Budget; and

(9) the full amount expended for MA furnished to eligible persons who reside in residential care centers for adults operated by the Office of Mental Health, including the administration thereof, after first deducting therefrom any Federal funds properly received or to be received on account thereof.

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