N.Y. Comp. Codes R. & Regs. tit. 14 § 841.6

Current through Register Vol. 46, No. 25, June 18, 2024

Section 841.6 - Medical assistance payments for inpatient substance use disorder withdrawal and stabilization services

(a) The provisions of this section are applicable to programs certified as substance use disorder inpatient withdrawal and stabilization services pursuant to Part 816.

(b) Rates of Payment.

(1) Rates will be calculated using a cost-based fee methodology inclusive of operating costs and capital reimbursement. There shall be no capital add-on to these fees, nor any separate Medicaid reimbursement for capital costs.

(2) Fees will be established using a regression model based on the relationship between normalized cost and program capacity, recognizing both regional cost differentials and economies of scale. The calculated statewide fees based on program capacity, will then be adjusted using regional cost factors (based on the county in which the facility is located).

(3) Fees will be deemed to be inclusive of all service delivery costs and will be considered payment in full for fee-for-service Medicaid reimbursed services.

(4) Fee schedules used to determine rates will be posted on the Office website. Fee schedules used to determine rates include:

(i) Statewide OASAS Medically Supervised Inpatient Withdrawal (MSIW) fee chart based on bed size; and

(ii) Geographic region and regional cost factor chart.

(c) Bed size.

(1) New facilities: Bed size for new facilities used for the fee calculation shall be based on 80% of the certified capacity rounded to the nearest integer. After the first full year of operation, the fee calculation shall be revised based on 90% of certified capacity rounded to the nearest integer. If the certified capacity changes for any MSIW program, including programs that have been in operation for less than one year, the fee shall be revised based on 90% of the new certified capacity, effective on the date of the capacity change.

(2) Minimum and maximum standards: Facilities with fewer than six (6) beds shall use the six (6) bed fee. Facilities with an excess of 120 beds (meaning "bed size" as calculated above) shall use the 120-bed fee.

(d) Appeals of medically supervised inpatient withdrawal fees.

(1) Fee adjustment for underutilization. MSIW providers may request retroactive fee adjustments based on documented low service volume relative to certified capacity that resulted in an overall net loss in the program. These adjustments are approvable solely at the discretion of the Office and will require compelling justification relative to the program’s underutilization. MSIW beds that were used as "swing beds" for other programs (e.g., Medically Monitored Inpatient Withdrawal) do not constitute underutilization and will not justify a fee increase.

(2) Other items of appeal. MSIW providers may also request retroactive fee adjustments based on significant financial losses in the program that resulted from programmatic expenses that were significantly out of proportion to the established level of reimbursement. The provider must fully and properly demonstrate that the fee adjustment requested in the appeal is necessary to ensure efficient and economic operation of the facility. The final determination as to the extent, if any, of a fee adjustment shall be made solely at the discretion of the Office.

(e) Base year. From time to time, and at the discretion of the Office, the fee calculation may be revised using new base year data. The base year for new fee calculations will be the most recent, substantially complete Consolidated Fiscal Report period available at the time of the calculation.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 841.6

Amended New York State Register December 9, 2015/Volume XXXVII, Issue 49, eff. 11/20/2015

Adopted New York State Register January 26, 2022/Volume XLIV, Issue 04, eff. 1/26/2022