N.Y. Comp. Codes R. & Regs. tit. 14 § 679.9

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

Section 679.9 - Transition to full APG payment methodology

(a) Clinic treatment facilities will transition to full payment under the APG reimbursement methodology over a multi-year period beginning on July 1, 2011. Reimbursement during this transition period shall consist of a blended payment comprised of:

(1) a partial operating payment determined by the clinic's average operating payment under the pre-existing reimbursement methodology (average legacy fee); plus

(2) a complementary partial operating payment calculated under the APG reimbursement methodology; plus

(3) a capital cost component, if any.

(b) The average legacy fee shall be established for each clinic treatment facility as follows:

(1) Counts of paid visits for each clinic and visit type under the pre-existing reimbursement methodology (i.e., "full," "brief," "group," "collateral," "intake," and "diagnostic/evaluation" visit types) shall be determined for service dates between April 1, 2009 and March 31, 2010. OPWDD reserves the right to adjust this look-back period to accommodate instances wherein a clinic was not certified by OPWDD for the entire year.

(2) Each clinic's total operating payment by visit type shall be determined by multiplying the count of paid visits for the visit type determined in paragraph (1) of this subdivision by the operating component of its fee (i.e., full fee minus its capital cost component) in effect on June 30, 2011 for the same visit type. OPWDD may adjust these results to prevent a clinic from incurring a decrease or increase in Medicaid reimbursement disproportionate to that of the clinics within its peer group.

(3) The total operating payments by visit type determined in paragraph (2) of this subdivision shall be summed and then divided by the clinic's total paid visits across all visit types.

(c) Payment will be made pursuant to the transition phase-in schedule outlined in this subdivision.

(1) The first phase shall begin on July 1, 2011 and end on June 30, 2012. Payment for services provided during the first phase shall reflect a blend of 75 percent clinic average legacy fee, 25 percent operating payment calculated under APG reimbursement methodology, plus capital add-on, if any.

(2) The second phase shall be a twelve month period beginning July 1, 2012. Payment for services provided during this phase shall reflect a blend of 50 percent clinic average legacy fee, 50 percent operating payment calculated under APG reimbursement methodology, plus capital add-on, if any.

(3) The third phase shall be a six month period beginning July 1, 2013. Payment for services provided during this phase shall reflect a blend of 25 percent clinic average legacy fee, 75 percent operating payment calculated under APG reimbursement methodology, plus capital add-on, if any.

(d) Payment for all services provided on or after January 1, 2014 shall be based in total on the APG reimbursement methodology.

(e) Clinic treatment facilities that begin operation on or after July 1, 2011 shall be reimbursed in accordance with the transition phase-in schedule identified in subdivision (c) of this section except that the average of the legacy fees for all clinic treatment facilities shall be used in the payment calculation, instead of the clinic-specific average legacy fee.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 679.9

Amended New York State Register March 30, 2016/Volume XXXVIII, Issue 13, eff.4/1/2016

Amended New York State Register April 20, 2016/Volume XXXVIII, Issue 16, eff.4/20/2016

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016