OMH-23-11-00007-E Implementation of Medicaid Fee Reductions in Various OMH-Licensed Programs

6/8/11 N.Y. St. Reg. OMH-23-11-00007-E

NEW YORK STATE REGISTER

VOLUME XXXIII, ISSUE 23

June 08, 2011

RULE MAKING ACTIVITIES

OFFICE OF MENTAL HEALTH

EMERGENCY RULE MAKING

 

I.D No. OMH-23-11-00007-E

Filing No. 457

Filing Date. May. 23, 2011

Effective Date. May. 23, 2011

Implementation of Medicaid Fee Reductions in Various OMH-Licensed Programs

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

Action taken:

Amendment of Parts 512, 588 and 591 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 7.09, 43.01 and 43.02

Finding of necessity for emergency rule:

Preservation of general welfare.

Specific reasons underlying the finding of necessity:

The rulemaking serves to implement Medicaid fee reductions for various programs licensed by the Office of Mental Health (Personalized Recovery Oriented Services, Day Treatment, Partial Hospitalization, Intensive Psychiatric Rehabilitation Treatment, and Comprehensive Psychiatric Emergency Programs). The reduction in rates for these non-State operated programs is part of a continuation of the 1.1% reduction in State Medicaid expenditures for mental health programs, and is consistent with the 2011-2012 enacted State budget. As the rate reductions are effective as of April 1, 2011, the rule has been deemed to warrant emergency filing.

Subject:

Implementation of Medicaid fee reductions in various OMH-licensed programs.

Purpose:

To reduce rates for various non-State-operated programs consistent with the 2011-2012 enacted State budget.

Text of emergency rule:

1. Subdivision (e) of Section 512.12 of Title 14 NYCRR is amended to read as follows:

(e) Effective April 1, [2008] 2011, the monthly base rate and component add-on schedules for PROS programs are as follows:

(1) Comprehensive PROS Programs:

(i) for programs operated in the Downstate Region:

Monthly Base Rate*						Component Add-On
Pre-Adm	Level 1 2-12 Units	Level 2 13-27 Units	Level 3 28-43 Units	Level 4 44-60 Units	Level 5 61+ Units	IR	ORS	CT
$[155] 153	$[206] 204	$[447] 442	$[687] 680	$[894] 884	$[1,086] 1,074	$[419] 414	$[359] 355	$[244.51] 242

* The Monthly Base Rate is determined by the total PROS units associated with a single PROS participant and his or her collateral(s) in a given month.

(ii) for programs operated in the Upstate Region:

Monthly Base Rate*						Component Add-On
Pre-Adm	Level 1 2-12 Units	Level 2 13-27 Units	Level 3 28-43 Units	Level 4 44-60 Units	Level 5 61+ Units	IR	ORS	CT
$[141] 140	$[188] 186	$[407] 402	$[625] 619	$[812] 803	$[988] 977	$[381] 377	$[327] 324	$[244.51] 242

* The Monthly Base Rate is determined by the total PROS units associated with a single PROS participant and his or her collateral(s) in a given month.

(2) Limited license PROS programs:

(i) for programs operated in the Downstate Region:

Reimbursement Category	Monthly Fee
Intensive Rehabilitation	$[479] 474
Ongoing Rehabilitation and Support	$[395] 391

(ii) for programs operated in the Upstate Region:

Reimbursement Category	Monthly Fee
Intensive Rehabilitation	$[436] 431
Ongoing Rehabilitation and Support	$[359] 355

2. Subdivisions (c), (e) and (f) of Section 588.13 of Title 14 NYCRR are amended to read as follows:

(c) [Reimbursement] Effective April 1, 2011, reimbursement under the medical assistance program for day treatment programs serving children licensed solely pursuant to article 31 of the Mental Hygiene Law, and Part 587 of this Title shall be in accordance with the following fee schedule.

(1) For programs operated in Bronx, Kings, New York, Queens and Richmond Counties:

Full day	at least 5 hours	$[79.48] 78.61
Half day	at least 3 hours	[39.75] 39.31
Brief day	at least 1 hour	[26.50] 26.21
Collateral	at least 30 minutes	[26.50] 26.21
Home	at least 30 minutes	[79.48] 78.61
Crisis	at least 30 minutes	[79.48] 78.61
Preadmission - full day	at least 5 hours	[79.48] 78.61
Preadmission - half day	at least 3 hours	[39.75] 39.31

(2) For programs operated in other than Bronx, Kings, New York, Queens and Richmond Counties:

Full day	at least 5 hours	$[76.84] 75.99
Half day	at least 3 hours	[38.41] 37.99
Brief day	at least 1 hour	[25.57] 25.29
Collateral	at least 30 minutes	[25.57] 25.29
Home	at least 30 minutes	[76.84] 75.99
Crisis	at least 30 minutes	[76.84] 75.99
Preadmission - full day	at least 5 hours	[76.84] 75.99
Preadmission - half day	at least 3 hours	[38.41] 37.99

(e) [Reimbursement] Effective April 1, 2011, reimbursement under the medical assistance program for regular, collateral, and crisis visits to all non-State operated partial hospitalization programs licensed pursuant to article 31 of the Mental Hygiene Law and Part 587 of this Title shall be in accordance with the following fee schedule.

(1) For programs located in Nassau and Suffolk counties, the fee shall be $[23.39] 23.13 for each service hour.

(2) For programs located in New York City, the fee shall be $[30.71] 30.37 for each service hour.

(3) For programs located in the counties included in the region of New York State designated by the Office of Mental Health as the Hudson River Region, the fee shall be $[25.81] 25.53 for each service hour.

(4) For programs located in the counties in the region of New York State designated by the Office of Mental Health as the Central Region, the fee shall be $[17.70] 17.51 for each service hour.

(5) For programs located in the counties included in the region of New York State designated by the Office of Mental Health as the Western Region, the fee shall be $[21.94] 21.70 for each service hour.

(f) [Reimbursement] Effective April 1, 2011, reimbursement under the medical assistance program for on-site and off-site visits for all non-State operated intensive psychiatric rehabilitation treatment programs licensed pursuant to article 31 of the Mental Hygiene Law and Part 587 of this Title shall be at $[25.20] 24.92 for each service hour.

3. Section 591.5 of 14 NYCRR Part 591 is amended to read as follows:

[Reimbursement] Effective April 1, 2011, reimbursement for comprehensive psychiatric emergency programs under the medical assistance program shall be in accordance with the following fee schedule:

Brief emergency visit	$[84.64] 83.71
Full emergency visit	[497.06] 491.59
Crisis outreach service visit	[497.06] 491.59
Interim crisis service visit	[497.06] 491.59

This notice is intended

to serve only as a notice of emergency adoption. This agency intends to adopt this emergency rule as a permanent rule and will publish a notice of proposed rule making in the State Register at some future date. The emergency rule will expire August 20, 2011.

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]

Regulatory Impact Statement

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

Section 43.01 of the Mental Hygiene Law gives the Commissioner of Mental Health the authority to set rates for outpatient services at facilities operated by the Office of Mental Health.

Section 43.02 of the Mental Hygiene Law provides that payments under the Medical Assistance Programs for services at facilities licensed by the Office of Mental Health shall be at rates certified by the Commissioner of Mental Health and approved by the Director of Budget.

2. Legislative objectives: Articles 7 and 31 of the Mental Hygiene Law reflect the Commissioner’s authority to establish regulations regarding mental health programs. The amendments to 14 NYCRR Part 512, Part 588 and Part 591 are made in accordance with the 2011-2012 enacted State Budget (Chapter 59 of the Laws of 2011).

3. Needs and benefits: The amendments to Part 512, Part 588 and Part 591 are necessary to implement Medicaid fee reductions for Office of Mental Health-licensed programs including: Personalized Recovery Oriented Services (PROS) Programs, Day Treatment Programs, Partial Hospitalization Programs, Intensive Psychiatric Rehabilitation Treatment Programs, and Comprehensive Psychiatric Emergency Programs. These amendments are required to implement a continuation of the 1.1% reduction to Medicaid, as required by the enacted State budget. These rate decreases have been approved by the Director of the Division of the Budget and are effective as of April 1, 2011.

4. Costs:

a) Costs to state government: These regulatory amendments will not result in any additional costs to State government. It is estimated that the total savings to the State share of Medicaid will be $421,150.

b) Costs to local government: These regulatory amendments will not result in any additional costs to local government other than in their status as a provider of mental health services. Such costs are addressed under 4(c) "Costs to regulated parties".

c) Costs to regulated parties: These regulatory amendments will not result in any additional costs to regulated parties, but will reduce the rates paid under the Medical Assistance Program for the programs listed above. Currently there are a total of 61 PROS Programs, 31 Day Treatment Programs, 35 Partial Hospitalization Programs, 15 Intensive Psychiatric Rehabilitation Treatment Programs, and 21 Comprehensive Psychiatric Emergency Programs. The estimated full annual impact of these rate changes is as follows: PROS: $377,924; Day Treatment: $196,888; Partial Hospitalization: $68,004; Intensive Psychiatric Rehabilitation Treatment: $95,222; and Comprehensive Psychiatric Emergency Programs: $104,262 - resulting in total Medicaid reduction of $842,300.

5. Local government mandates: These regulatory amendments will not result in any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.

6. Paperwork: This rule should not increase the paperwork requirements of affected providers.

7. Duplication: These regulatory amendments do not duplicate existing State or federal requirements.

8. Alternatives: As noted above, this amendment is consistent with the 2011-2012 enacted State budget. The reduction in rates for these non-State operated programs is part of a continuation of the 1.1% reduction in State Medicaid expenditures for mental health programs, and reflects the serious fiscal condition of the State. The only alternative to the regulatory amendment would be to make further budgetary cuts to other programs which would have the potential to put those providers at financial risk. Therefore, that alternative was not considered.

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

10. Compliance schedule: These regulatory amendments are effective immediately. The rate adjustment is considered effective as of April 1, 2011.

Regulatory Flexibility Analysis

The rulemaking serves to implement Medicaid fee reductions for various programs licensed by the Office of Mental Health (Personalized Recovery Oriented Services, Day Treatment, Partial Hospitalization, Intensive Psychiatric Rehabilitation Treatment, and Comprehensive Psychiatric Emergency Programs). The reduction in rates for these non-State operated programs is a continuation of the 1.1% reduction in State Medicaid expenditures for mental health programs. These proposed changes are consistent with the 2011-2012 enacted State budget and reflect the serious fiscal condition of the State. As there will be no adverse economic impact on small businesses or local governments, a regulatory flexibility analysis is not submitted with this notice.

Rural Area Flexibility Analysis

A Rural Area Flexibility Analysis is not submitted with this notice because the rulemaking, which serves to implement Medicaid fee reductions for various programs licensed by the Office of Mental Health, will not impose any adverse economic impact on rural areas. The reduction in rates for these non-State operated programs (Personalized Recovery Oriented Services, Day Treatment, Partial Hospitalization, Intensive Psychiatric Rehabilitation Treatment, and Comprehensive Psychiatric Emergency Programs) is part of a continuation of the 1.1% reduction in State Medicaid expenditures for mental health programs. These proposed changes are consistent with the 2011-2012 enacted State budget and reflect the serious fiscal condition of the State.

Job Impact Statement

A Job Impact Statement is not submitted with this notice because the rulemaking, which serves to implement Medicaid fee reductions for various programs licensed by the Office of Mental Health, will have no impact upon jobs and employment opportunities. The reduction in rates for these non-State operated programs (Personalized Recovery Oriented Services, Day Treatment, Partial Hospitalization, Intensive Psychiatric Rehabilitation Treatment, and Comprehensive Psychiatric Emergency Programs) is part of a continuation of the 1.1% reduction in State Medicaid expenditures for mental health programs. These proposed changes are consistent with the 2011-2012 enacted State budget and reflect the serious fiscal condition of the State.