PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of Part 512 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)
Subject:
Personalized Recovery Oriented Services (PROS).
Purpose:
Provide enhancements to individuals transitioning to more independent community living; reimburse providers for enhanced services.
Text of final rule:
1. A new subdivision (an) is added to Section 512.4 of Title 14 NYCRR to read as follows:
(an) Target population member means an individual who has received long-term supports and services for at least six (6) months while living in an adult home, nursing home as defined in Section 2801 of the Public Health Law, State-operated community residence, or as an inpatient in a State psychiatric center, and is currently living in a more independent, integrated community setting, provided, however, that an individual shall be a considered a target population member for no longer than 12 consecutive calendar months following discharge from one of the aforementioned settings.
2. A new Section 512.20 is added to Title 14 NYCRR to read as follows:
§ 512.20 Target population services.
(a) Individuals who are target population members as defined in Section 512.4 of this Part must meet the standard eligibility criteria for enrollment in PROS in accordance with Section 512.7 of this Part.
(b) Effective April 1, 2014, the following additional provisions shall apply to PROS providers that are providing services to target population members.
(1) Reimbursement for services to target population members who are in continuous pre-admission status is limited to four consecutive months, whether or not the individual is ultimately admitted to the program. Programs will be reimbursed for pre-admission services for target population members at the existing pre-admission rate plus 25 percent.
(2) Medicaid may reimburse the Intensive Rehabilitation (IR) component add-on for up to 50 percent of a provider’s total number of monthly base rate bills submitted annually. IR services provided to target population members shall not count toward the 50 percent limitation for Medicaid reimbursement.
(3) The following Community Rehabilitation and Support (CRS) services will offer an enhanced reimbursement when delivered off site, on separate days, to target population members:
(i) Basic skills living training;
(ii) Benefits and financial management;
(iii) Community living exploration;
(iv) Information and education regarding self help; and
(v) Wellness self management.
(4) If two or three of the identified CRS services are delivered off site to target population members in a calendar month, programs will be reimbursed at the base rate plus $135 (upstate) or $150 (downstate). If four or more of the identified CRS services are delivered off site to target population members in a calendar month, programs will be reimbursed at the base rate plus $270 (upstate) or $300 (downstate).
Final rule as compared with last published rule:
Nonsubstantive changes were made in sections 512.4(an) and 512.20.
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, (518) 474-1331, email: Sue.Watson@omh.ny.gov
Revised Regulatory Impact Statement
A revised Regulatory Impact Statement (RIS) is not included with this notice as the changes made to the final adopted rule do not necessitate a change to the RIS. The revisions are non-substantive and are intended to clarify OMH’s intent and improve readability. The definition of target population member has been modified to clarify that individuals who had received long-term supports and services for at least six (6) months while living in a State-operated community residence and who are currently living in a more independent, integrated community setting, are considered to be members of the target population. This is in addition to those individuals who had received long-term supports and services for at least six (6) months while living in an adult home, nursing home as defined in Section 2801 of the Public Health Law, or as an inpatient in a State psychiatric center, and who are currently living in a more independent, integrated community setting. The wordsmithing changes made in Section 512.20, “Target Population Services”, are merely intended to improve readability.
Revised Regulatory Flexibility Analysis
A revised Regulatory Flexibility Analysis for Small Businesses and Local Governments is not included with this notice as the changes made to the final adopted rule are non-substantive and are intended to clarify OMH’s intent and improve readability. The definition of target population member has been modified to clarify that individuals who had received long-term supports and services for at least six (6) months while living in a State-operated community residence and who are currently living in a more independent, integrated community setting, are considered to be members of the target population. This is in addition to those individuals who had received long-term supports and services for at least six (6) months while living in an adult home, nursing home as defined in Section 2801 of the Public Health Law, or as an inpatient in a State psychiatric center, and who are currently living in a more independent, integrated community setting. The wordsmithing changes made in Section 512.20, “Target Population Services”, are merely intended to improve readability. The amendments will not have an adverse economic impact upon small businesses or local governments.
Revised Rural Area Flexibility Analysis
A revised Rural Area Flexibility Analysis is not included with this notice as the changes made to the final adopted rule are non-substantive and are intended to clarify OMH’s intent and improve readability. The definition of target population member has been modified to clarify that individuals who had received long-term supports and services for at least six (6) months while living in a State-operated community residence and who are currently living in a more independent, integrated community setting, are considered to be members of the target population. This is in addition to those individuals who had received long-term supports and services for at least six (6) months while living in an adult home, nursing home as defined in Section 2801 of the Public Health Law, or as an inpatient in a State psychiatric center, and who are currently living in a more independent, integrated community setting. The wordsmithing changes made in Section 512.20, “Target Population Services”, are merely intended to improve readability. The amendments will not impose any adverse economic impact on rural areas.
Revised Job Impact Statement
A revised Job Impact Statement is not included with this notice as the changes made to the final adopted rule are non-substantive and are intended to clarify OMH’s intent and improve readability. The definition of target population member has been modified to clarify that individuals who had received long-term supports and services for at least six (6) months while living in a State-operated community residence and who are currently living in a more independent, integrated community setting, are considered to be members of the target population. This is in addition to those individuals who had received long-term supports and services for at least six (6) months while living in an adult home, nursing home as defined in Section 2801 of the Public Health Law, or as an inpatient in a State psychiatric center, and who are currently living in a more independent, integrated community setting. The wordsmithing changes made in Section 512.20, “Target Population Services”, are merely intended to improve readability. As is evident from the subject matter, the amendments to 14 NYCRR Part 512 will not have any impact on jobs and employment opportunities.
Initial Review of Rule
As a rule that does not require a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2019, which is no later than the 5th year after the year in which this rule is being adopted
