N.Y. Comp. Codes R. & Regs. tit. 14 § 577.9

Current through Register Vol. 46, No. 45, November 2, 2024

Section 577.9 - Revisions to rates

(a) The commissioner may consider only those requests for revisions to certified rates which are based on:

(1) errors made by the Office of Mental Health in the calculation of the rate;

(2) errors in the financial or statistical data submitted to the commissioner by the hospital;

(3) significant changes in the overall operating costs of a hospital resulting from the implementation of substantial changes in programs or services approved for implementation under applicable provisions of the Mental Hygiene Law, Part 366, Part 551, and Part 1010 of this Title; and

(4) significant changes in the overall capital costs of a hospital resulting from substantial capital projects approved under applicable provisions of the Mental Hygiene Law, Part 366, Part 551, and Part 1010 of this Title.

(b) Request for revision of a certified rate shall be sent to the commissioner by registered or certified mail and shall contain a detailed statement of the basis for the requested revision together with copies of any documentation the hospital wishes to submit.

(1) A request based upon the grounds set forth in paragraph (a)(2) of this section must be accompanied by a detailed statement of the corrected financial or statistical data certified in accordance with the requirements of section 577.5(b)(2) of this Part.

(2) A request based upon the grounds set forth in paragraph (a)(1) or (2) of this section must be submitted within 120 days of receipt by the hospital of the rate computation sheet.

(3) A request based upon the grounds set forth in paragraph (a)(3) or (4) of this section must be submitted within 60 days of the end of the rate year.

(c) The hospital shall be notified in writing of the determination of the request for revision of a certified rate, including a statement of the reasons therefor.

(d)

(1) The affirmation or revision of the certified rates resulting from such determination shall be final unless within 30 days of receipt of such written determination the hospital requests administrative review of the determination. Request for administration review of a determination to affirm or revise the certified rate shall be sent to the commissioner by registered or certified mail and shall contain a detailed statement of the hospital's objections to the determination, along with copies of any additional documentation the hospital wishes to submit.

(2) The hospital shall be notified in writing of the determination after administrative review including a statement of the reasons therefor. The determination after administrative reviews shall be final and any rate revision resulting therefrom shall be implemented in accordance with subdivision (g) of this section.

(e) [Reserved]

(f) Within 30 days of receipt of the final determination after administrative review, the hospital may request a hearing on factual issues determined adversely to the hospital in the administrative review. Requests for hearing, and the conduct thereof, shall be in accordance with the provisions of Part 503 of this Title.

(g)

(1) Revisions to rates determined in accordance with the provisions of paragraph (a)(1) or (2) of this section shall be effective on the first day for which the originally certified rate was effective.

(2) Revisions to rates determined in accordance with the provisions of paragraph (a)(3) or (4) of this section shall be effective on the first day of the calendar month following 30 days after receipt by the commissioner of the request and documentation or 30 days after implementation of changes in programs or services or completion of capital projects, whichever is later.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 577.9

Amended, New York State Register March 19, 2014/Volume XXXVI, Issue 11, eff. 3/19/2014