N.Y. Comp. Codes R. & Regs. tit. 14 § 588.14

Current through Register Vol. 46, No. 43, October 23, 2024

Section 588.14 - Supplemental reimbursement for community support program services

(a) In addition to the medical assistance reimbursement rates available pursuant to Part 579 of this Title and section 588.13 of this Part, providers operating one or more outpatient programs licensed pursuant to Part 585 or 587 of this Title may be eligible to receive supplemental medical assistance reimbursement for community support program services in accordance with this section. For purposes of this section:

(1) community support program services means community-based services supported by State and local aid for local or unified services pursuant to article 41 of the Mental Hygiene Law, or community-based services supported by 100 percent State aid;

(2) local aid means local share of funds which support services for persons with mental illness, comprised of local tax levy funds or contributions from voluntary agencies; and

(3) State aid means State funds which support local or unified services for persons with mental illness, with or without matching local aid.

(b) A provider shall be eligible for supplemental reimbursement pursuant to this section if the provider:

(1) operates a clinic treatment program, continuing day treatment program or day treatment program licensed pursuant to Part 585 or 587 of this Title;

(2) directly provides community support program services pursuant to a contract with the local governmental unit or the Office of Mental Health;

(3) is not operated by the Office of Mental Health; and

(4) is not operated by a general hospital as defined in article 28 of the Public Health Law, that is also considered to be a voluntary agency as defined in article 41 of the Mental Hygiene Law.

(c) For purposes of this section, all providers operated by the New York City Health and Hospitals Corporation which are eligible for supplemental reimbursement pursuant to subdivision (b) of this section shall be considered, in combination, a single eligible provider.

(d) Supplemental reimbursement rates shall be calculated by the Office of Mental Health for each eligible provider. The supplemental reimbursement rate, effective November 1, 1997, shall be calculated as follows:

(1) Grants from State aid or local aid for community support program services for the local fiscal year ended in 1997 for upstate and Long Island-based providers, and for the local fiscal year ended in 1998 for New York City-based providers, will be estimated for each eligible provider. For purposes of this section, unless otherwise specified, such period shall be considered the base year. Such estimates shall not include:

(i) grants received pursuant to section 41.55 of the Mental Hygiene Law;

(ii) grants to housing programs;

(iii) any portion of grants to community support programs for services which are reimbursed by medical assistance during the base year;

(iv) any portion of grants to an eligible provider for community support program services which are delivered by another provider of service through a contract with the eligible provider;

(v) grants received from the Federal government;

(vi) any portion of grants to community support programs for services which are supported by contributions from voluntary agencies; or

(vii) any portion of grants determined by the Office of Mental Health to be eligible for continued State aid.

(2) Grants estimated pursuant to paragraph (1) of this subdivision shall be adjusted to reflect:

(i) the percentage of community support program services which are determined by the Office of Mental Health to be eligible for medical assistance reimbursement, consistent with Federal standards; and

(ii) the percentage of community support program services provided to recipients who are eligible for medical assistance.

(3) The combined total of clinic treatment, continuing day treatment, and day treatment units of service reimbursed by medical assistance shall be calculated for each provider for each of the three local fiscal years immediately prior to the base year. Such units of service shall exclude collateral, group collateral, and home visits provided by an outpatient program operated by a general hospital as defined in article 28 of the Public Health Law. The average of the three annual totals shall be calculated.

(4) Grants, as recalculated pursuant to paragraph (2) of this subdivision, shall be divided by the average annual units of service calculated pursuant to paragraph (3) of this subdivision. The community support program rate cap will be established by the Commissioner of Mental Health and approved by the Director of the Division of the Budget.

(5) The calculation pursuant to paragraph (4) of this subdivision shall be divided by 89 percent. Such calculation shall be the provider's supplemental reimbursement rate.

(6) On an annual basis, the Office of Mental Health shall re-evaluate the percentage used in the calculation pursuant to paragraph (5) of this subdivision. Upon modification of such percentage, all providers' supplemental rates shall be recalculated.

(7) On an annual basis, the Office of Mental Health shall conduct a review of the number of units of service calculated pursuant to paragraph (3) of this subdivision for each provider. For purposes of such analyses, the most recently completed local fiscal year shall be used as the base year. As appropriate, supplemental reimbursement rates shall be recalculated, including any recalculations pursuant to paragraph (6) of this subdivision.

(8) Rates calculated or recalculated pursuant to this section are subject to appeal by the local governmental unit, or by the provider with the approval of the local governmental unit. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such provider may request an appeal without the approval of the local governmental unit. Appeals pursuant to this paragraph shall be made within one year after receipt of initial notification of the most recent supplemental reimbursement rate calculation or recalculation.

(e) The supplemental reimbursement rate calculated pursuant to subdivision (d) of this section shall be added to the reimbursement rates for each clinic treatment, continuing day treatment, and day treatment program operated by the provider and licensed pursuant to Part 585 or 587 of this Title. In outpatient programs operated by a general hospital as defined in article 28 of the Public Health Law, the following visit categories shall not be eligible for the supplemental reimbursement rate:

(1) collateral and group collateral visits in clinic treatment and continuing day treatment programs; and

(2) collateral and home visits in day treatment programs.

(f) Supplemental payments which are in excess of 100 percent of the grants calculated pursuant to paragraph (d)(2) of this section will be subject to recovery by the Office of Mental Health through adjustment of future payments. In cases where recoveries are necessary, the Office of Mental Health may adjust the supplemental rate prospectively.

(g) If supplemental payments are less than the grants calculated pursuant to paragraph (d)(2) of this section, the Office of Mental Health shall, upon the request of the local governmental unit, amend the supplemental reimbursement rate to ensure maintenance of historical levels of funding for community support program services. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such provider may request a rate amendment without the approval of the local governmental unit. In the event that amendment of the supplemental reimbursement rate, consistent with the provisions of paragraph (d)(4) of this section, will not ensure the maintenance of historical levels of funding for community support program services, the State aid portion of the grants pursuant to paragraph (d)(2) of this section, commensurate with the shortfall, shall be allocated to the local governmental unit as State aid. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such State aid shall be allocated to the provider. State aid allocated pursuant to this subdivision shall be subject to the availability of appropriations in the Office of Mental Health's budget and the approval of the director of the State Division of the Budget.

(h) Providers in receipt of supplemental reimbursement pursuant to this section shall, at a minimum, maintain the level of provision of community support program services or the expenditures for such services, consistent with the level of such services provided in the most recent local fiscal year in which such services were supported by State or local aid, including any portion of grants which were supported by contributions from voluntary agencies. If a provider reduces the provision of community support program services or the expenditures for such services subsequent to the calculation of the supplemental reimbursement rate pursuant to subdivision (d) of this section, and such reduced services are not transferred to another provider, the supplemental reimbursement rate, upon the recommendation of the local governmental unit, shall be adjusted in proportion to the reduction in community support program services. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, the recommendation of the local governmental unit is not required. Commensurate with the service reduction, the State aid portion of grants pursuant to paragraph (d)(2) of this section shall be allocated to the local governmental unit as State aid, upon the request of the local governmental unit. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such State aid shall be allocated to the provider. State aid allocated pursuant to this paragraph shall be subject to the availability of appropriations in the Office of Mental Health's budget and the approval of the director of the State Division of the Budget.

(i) If a provider in receipt of supplemental reimbursement pursuant to this section transfers or closes one or more community support programs, or portions thereof, which were supported by grants included in the calculation of the supplemental reimbursement rate pursuant to paragraph (d)(4) of this section, such provider's supplemental reimbursement rate or grants shall be adjusted as follows:

(1) If a community support program, or a portion thereof, is transferred to another eligible provider within the same local governmental unit, the supplemental rate will be eliminated or recalculated for each eligible provider, upon the approval of the local governmental unit, commensurate with the new level of community support program services provided. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, the recommendation of the local governmental unit is not required. In the event that amendment of the supplemental reimbursement rate, consistent with the provisions of paragraph (d)(4) of this section, will not ensure the maintenance of historical levels of funding for community support program services, the State aid portion of the grants pursuant to paragraph (d)(2) of this section, commensurate with the shortfall, shall be allocated to the local governmental unit as State aid. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such State aid shall be allocated to the provider. State aid allocated pursuant to this paragraph shall be subject to the availability of appropriations in the Office of Mental Health's budget and the approval of the director of the State Division of the Budget.

(2) If a community support program, or a portion thereof, is transferred to another provider which is not eligible for supplemental reimbursement pursuant to subdivision (b) of this section, or is closed without transfer to another provider, the State aid portion of grants pursuant to paragraph (d)(2) of this section commensurate with the program transfer or closure shall be allocated, upon request by the local governmental unit, to the local governmental unit as State aid. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such State aid shall be allocated to the provider. State aid allocated pursuant to this paragraph shall be subject to the availability of appropriations in the Office of Mental Health's budget and the approval of the director of the State Division of the Budget.

(j) If a provider operating a clinic treatment program, continuing day treatment program or a day treatment program licensed pursuant to Part 585 or 587 of this Title subsequently closes all such programs, the State aid portion of grants pursuant to paragraph (d)(2) of this section shall be allocated, upon request by the local governmental unit, to the local governmental unit as State aid. If a provider offers community support program services solely pursuant to a contract with the Office of Mental Health, such State aid shall be allocated to the provider. State aid allocated pursuant to this subdivision shall be subject to the availability of appropriations in the Office of Mental Health's budget and the approval of the director of the State Division of the Budget.

(k) Providers in receipt of supplemental reimbursement pursuant to this section shall:

(1) assure that community support program services for recipients who are eligible for medical assistance are provided pursuant to the recommendation of a licensed practitioner, as defined in Part 587 of this Title, and that there is a process for maintaining any records of such recommendations; and

(2) submit to the Office of Mental Health or the local governmental unit, upon request, all cost, utilization, programmatic or clinical reports or documentation required.

(l) In the event that the local share of the supplemental medical assistance reimbursement commensurate with the grants described in paragraph (d)(4) of this section exceeds the estimated local tax levy portion of local aid, as described in paragraph (d)(2) of this section, for all eligible providers within the local governmental unit's jurisdiction, the State shall reimburse the local government for such excess, subject to the availability of appropriations in the Office of Mental Health's budget and the approval of the director of the State Division of the Budget.

(m) Receipt of supplemental reimbursement pursuant to this section shall not affect receipt of supplemental reimbursement available to a provider pursuant to Part 592 of this Title.

(n) Nothing in this section is intended to alter the existing role, responsibility or authority of local governmental units pursuant to article 41 of the Mental Hygiene Law.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 588.14