OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
NOTICE OF ADOPTION
I.D No. MRD-51-08-00003-A
Filing No. 149
Filing Date. Feb. 10, 2009
Effective Date. Mar. 01, 2009
Article 16 Clinic Fee Setting
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of section 679.6 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 13.07, 13.09(b) and 43.02
Subject:
Article 16 Clinic Fee Setting.
Purpose:
Revise the schedule of clinic fees using a new base year.
Text or summary was published
in the December 17, 2008 issue of the Register, I.D. No. MRD-51-08-00003-P.
Final rule as compared with last published rule:
No changes.
Text of rule and any required statements and analyses may be obtained from:
Barbara Brundage, Director, Regulatory Affairs Unit, OMRDD, 44 Holland Avenue, Albany, New York 2229, (518) 474-1830, email: barbara.brundage@omr.state.ny.us
Additional matter required by statute:
Pursuant to the requirements of SEQRA and 14 NYCRR Part 602, OMRDD has filed a Negative Declaration with respect to this Action. OMRDD has determined that the action described herein will have no effect on the environment, and an E.I.S. is not needed.
Assessment of Public Comment
OMRDD received a total of three sets of comments regarding this proposed rule making. Comments were received from one clinic provider and two provider associations. It should be noted that both of the provider associations extended their appreciation for the work OMRDD had done so far regarding updating the fee schedules. They also thanked OMRDD for the increase in fees for clinics receiving the higher "B" fee.
The comments/questions and OMRDD's responses to them are as follows:
1. Comment: All three commentators stated that using 2004 or 2004/2005 as the base year creates significant difficulty for many Article 16 Clinics which converted from Joint Venture Clinics (JVC). This is because these clinics did not incur some of the continuing costs, such as Medicare and third party billing costs, for all twelve months of the base year. These commentators wanted to know if OMRDD would allow these clinics to submit a more recent CFR with a detailed explanation of significant cost differences if the clinics believe the first full 12 months of costs reported are not representative of their true costs of operation.
Response: The intent of the proposed regulation is to revise the schedule of fees to address more current costs using a new base year. While OMRDD tried to anticipate and address all circumstances, it recognizes that there may still be issues that occur as a result of the revised schedule. If there are serious or persistent issues brought to the attention of OMRDD, they will be assessed in terms of necessity for future regulatory action. It should be noted that reimbursement has not decreased for any Article 16 Clinic as a result of the new fee schedule which was important and a focal point for OMRDD.
2. Comment: One commentator reflected the fact that the proposed regulation does not have a mechanism for future rate reviews or adjustments.
Response: This is correct. The proposed regulation does not include a mechanism for future revision of fees. However, as has been historically demonstrated by various fee adjustment amendments promulgated over the years, OMRDD periodically reviews its fee structures and revises them.
3. Comment: Two commentators recommended that if there is a delay in replacing the fee methodology in this proposed regulation with an Ambulatory Patient Group (APG) methodology OMRDD revisit the fee calculation process using a subsequent base year or otherwise provide an opportunity for those clinics assigned the "A" fee to demonstrate the need for a "B" fee.
Response: While OMRDD does not anticipate a delay by OMRDD and the Department of Health in implementing the APG reimbursement methodology for Article 16 clinics, should an extensive delay occur, OMRDD will consider another fee restructuring using subsequent year CFRs for Article 16 clinics.
