OMH-09-09-00003-A Medical Assistance Payments for Community Rehabilitation Services Within Residential Programs for Adults, Children & Adolescents

5/20/09 N.Y. St. Reg. OMH-09-09-00003-A

NEW YORK STATE REGISTER

VOLUME XXXI, ISSUE 20

May 20, 2009

RULE MAKING ACTIVITIES

OFFICE OF MENTAL HEALTH

NOTICE OF ADOPTION

 

I.D No. OMH-09-09-00003-A

Filing No. 496

Filing Date. May. 05, 2009

Effective Date. May. 20, 2009

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:

Action taken:

Amendment of Part 593 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 7.09, 31.04 and 43.02

Subject:

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

Purpose:

To clarify that services provided by CREDIT programs do not qualify as rehabilitative and are not eligible for Medicaid payments.

Text or summary was published

in the March 4, 2009 issue of the Register, I.D. No. OMH-09-09-00003-P.

Final rule as compared with last published rule:

No changes.

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

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

Assessment of Public Comment

Issue: Community Residences for Eating Disorder Integrated Treatment (CREDIT) programs should not be ineligible for Medicaid reimbursement. Excluding CREDIT from Medicaid could be medically and financially devastating for individuals who lack sufficient income to pay for care.

Response: Housing for individuals with mental illness is not covered by Medicaid. While there are some rehabilitative services covered by Medicaid for individuals living in community residences with up to 16 beds, such services are not covered anywhere else for the agency's population. The CREDIT program is a new model of service, and in these difficult fiscal times, committing scarce Medicaid dollars to this model is premature. Individuals with eating disorders who receive Medicaid will continue to be eligible to receive the full scope of services available under the Medicaid State Plan to address their needs.

Issue: The legislation under which the CREDIT program was established did not intend to exclude the program from Medicaid.

Response: While there may have been no intent to exclude CREDIT from being a Medicaid-reimbursable service when the legislation was enacted, there was no appropriation made to include the program as a Medicaid service.

Issue: If a residential level of care is deemed appropriate for treatment and Medicaid enrollees are prevented from having this level of care, adverse outcomes could result. This could ultimately lead to increased costs for the Medicaid program with higher cost hospitalizations for the excluded Medicaid population.

Response: While on an individual basis that might be the case, it is impossible to project how often this would occur, and, therefore, impossible to project any savings to offset the cost of providing Medicaid reimbursement for these services. As indicated above, there was no funding included in the budget to include the program as a Medicaid service.

Issue: The regulation's purpose was to clarify that services provided by CREDIT programs do not qualify as rehabilitative. Therefore, the implication is that a prohibition on Medicaid reimbursement is already in existence. If that is the case, the regulation is redundant and unnecessary. In addition, the regulation could be problematic if, in the future, the State seeks to amend the State Medicaid Plan should it be determined that CREDIT programs should be eligible for Medicaid reimbursement.

Response: It is OMH's preference to avoid any confusion or ambiguity by specifically stating that these services are not included within the scope of services reimbursed under Part 593.