OMH-42-14-00002-EP Medical Assistance Payments for Community Rehabilitation Services Within Residential Programs for Adults, Children, Adolescents

10/22/14 N.Y. St. Reg. OMH-42-14-00002-EP

NEW YORK STATE REGISTER

VOLUME XXXVI, ISSUE 42

October 22, 2014

RULE MAKING ACTIVITIES

OFFICE OF MENTAL HEALTH

EMERGENCY/PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. OMH-42-14-00002-EP

Filing No. 863

Filing Date. Oct. 07, 2014

Effective Date. Oct. 07, 2014

Medical Assistance Payments for Community Rehabilitation Services Within Residential Programs for Adults, Children, Adolescents

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Proposed Action:

Amendment of Part 593 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 7.09, 31.04 and 43.02; Social Services Law, sections 364(3) and 364-a(1)

Finding of necessity for emergency rule:

Preservation of public health, public safety and general welfare.

Specific reasons underlying the finding of necessity:

The Centers for Medicare and Medicaid Services recently awarded New York State a “State Balancing Incentive Payment Program Grant” under Section 10202 of the Affordable Care Act. The Balancing Incentive Program (BIP) provides a financial incentive to stimulate greater access to non-institutionally based long-term services and supports. Under this proposal, during the grant period, OMH would use BIP funding to provide the financial support needed to help transition individuals to live in more integrated and independent community settings. This proposal allows for a payment rate add-on for community rehabilitation services provided on or after April 1, 2014, to individuals who were discharged directly from a State psychiatric center or a nursing home. Under this proposal, the equivalent of a 30 percent add-on would be paid for up to two years of community rehabilitation services provided to individuals who were discharged directly from a State psychiatric center or nursing home to a congregate residence. The equivalent of a 15 percent rate add-on would be paid for up to three years for community rehabilitation services provided to individuals who were discharged directly from a State psychiatric center or nursing home to an apartment residence. This rate add-on serves to incentivize providers of community rehabilitation services who serve individuals in a restrictive setting to move toward a less restrictive, more community-based setting. Since this proposed regulation has significant impact upon public health, safety and general welfare, the proposed rule warrants emergency filing.

Subject:

Medical Assistance Payments for Community Rehabilitation Services within Residential Programs for Adults, Children, Adolescents.

Purpose:

Provide enhancements to individuals transitioning to more independent community living through use of BIP funding.

Text of emergency/proposed rule:

A new subdivision (e) is added to Section 593.7 of Title 14 NYCRR to read as follows:

(e) In addition to the rates allowed in paragraph (1) of subdivision (c) of this section, for services provided on or after April 1, 2014, a provider shall receive the equivalent of an additional 30 percent rate add-on for up to two years for community rehabilitation services provided to individuals who were discharged directly from a State psychiatric center or nursing home to a congregate residence. A provider shall receive the equivalent of an additional 15 percent rate add-on for up to three years for community rehabilitation services provided to individuals who were discharged directly from a State psychiatric center or nursing home to an apartment residence.

This notice is intended:

to serve as both a notice of emergency adoption and a notice of proposed rule making. The emergency rule will expire January 4, 2015.

Text of rule and any required statements and analyses may be obtained from:

Sue Watson, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Regulatory Impact Statement

1. Statutory authority: Subdivision (b) of Section 7.09 of the Mental Hygiene Law grants the Commissioner of the Office of Mental Health (OMH) the authority and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.

Subdivision (a) of Section 31.04 of the Mental Hygiene Law empowers the Commissioner to issue regulations setting standards for licensed programs for the rendition of services for persons with mental illness.

Subdivision (a) of Section 43.02 of the Mental Hygiene Law provides that payments under the Medical Assistance Program for services approved by OMH shall be at rates certified by the Commissioner of Mental Health and approved by the Director of the Budget. Subdivision (b) of Section 43.02 of the Mental Hygiene Law gives the Commissioner authority to request from operators of facilities licensed by OMH such financial, statistical and program information as the Commissioner may determine to be necessary.

Sections 364(3) and 364-a(1) of the Social Services Law give OMH responsibility for establishing and maintaining standards for medical care and services in facilities under its jurisdiction, in accordance with cooperative arrangements with the Department of Health.

2. Legislative objectives: Articles 7, 31 and 43 of the Mental Hygiene Law reflect the Commissioner’s authority to establish regulations regarding mental health programs and establish rates of payments for services under the Medical Assistance program. Sections 364 and 364-a of the Social Services Law reflect the role of OMH regarding Medicaid reimbursed programs. The rule making furthers the Legislative intent under Article 7 by ensuring that the OMH fulfills its responsibility to assure the development of comprehensive plans, programs and services in the care, treatment, rehabilitation and training of persons with mental illness.

3. Needs and benefits: Recently, the Centers for Medicare and Medicaid Services awarded New York State a “State Balancing Incentive Payment Program Grant” under Section 10202 of the Affordable Care Act. The Balancing Incentive Program (BIP) provides a financial incentive to stimulate greater access to non-institutionally based long-term services and supports. Under this proposal, during the grant period OMH would use BIP funding to provide the financial support needed to help transition individuals to live in more integrated and independent settings in the community. This proposal allows for a payment rate add-on for community rehabilitation services provided on or after April 1, 2014, to individuals who were discharged directly from a State psychiatric center or a nursing home. Under this proposed rule, the equivalent of an additional 30 percent rate add-on would be paid for up to two years of community rehabilitation services provided to individuals who were discharged directly from a State psychiatric center or nursing home to a congregate residence. The equivalent of an additional 15 percent rate add-on would be paid for up to three years for community rehabilitation services provided to individuals who were discharged directly from a State psychiatric center or nursing home to an apartment residence. This rate add-on will serve to incentivize providers of community rehabilitation services who serve individuals in a restrictive setting to move toward a less restrictive, more community-based setting.

4. Costs:

(a) Cost to State government: BIP funds are 100 percent federal dollars and will be used to support increases in the rates paid to providers of community rehabilitation services to individuals who had been discharged directly from a State psychiatric center or nursing home to either a congregate residence or an apartment residence. This increase will be retroactive to services provided on or after April 1, 2014. BIP funds are projected to be available through September, 2015. OMH anticipates being able to continue to financially support the rate add-on beyond the BIP end date, subject to Federal financing participation.

(b) Cost to local government: These regulatory amendments are not expected to result in any additional costs to local government.

(c) Cost to regulated parties: These regulatory amendments are not expected to result in any additional costs to regulated parties.

5. Local government mandates: The regulation will not mandate any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.

6. Paperwork: This rule making should not result in an increase in paperwork requirements.

7. Duplication: The regulatory amendment does not duplicate existing State or federal requirements.

8. Alternatives: The only alternative would have been to continue with the current rate structure for community rehabilitation services. As the amendments serve to provide enhancements to assist individuals in their transition to more independent community living, and serve to reimburse providers for these services, that alternative was necessarily rejected.

9. Federal standards: The regulatory amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.

10. Compliance schedule: The regulatory amendment will become effective upon adoption.

Regulatory Flexibility Analysis

The amendments to Part 593 serve to provide enhancements to assist individuals in their transition to more independent community living, and to reimburse providers for these community rehabilitative services. As there will be no adverse economic impact on small business or local governments, a Regulatory Flexibility Analysis for Small Business and Local Governments has not been submitted with this notice.

Rural Area Flexibility Analysis

The amendments to Part 593 serve to provide enhancements to assist individuals in their transition to more independent community living, and to reimburse providers for these community rehabilitative services. As there will be no adverse economic impact on rural areas, a Rural Area Flexibility Analysis is not submitted with this notice.

Job Impact Statement

The amendments to Part 593 serve to provide enhancements to assist individuals in their transition to more independent community living, and to reimburse providers for these community rehabilitative services. It is apparent from the nature and purpose of the rule that it will not have an impact on jobs and employment opportunities; therefore, a Job Impact Statement for these amendments is not being submitted with this rule making.