OMH-28-09-00008-E Medical Assistance Payment for Outpatient Programs
7/15/09 N.Y. St. Reg. OMH-28-09-00008-E
NEW YORK STATE REGISTER
VOLUME XXXI, ISSUE 28
July 15, 2009
RULE MAKING ACTIVITIES
OFFICE OF MENTAL HEALTH
EMERGENCY RULE MAKING
I.D No. OMH-28-09-00008-E
Filing No. 748
Filing Date. Jun. 29, 2009
Effective Date. Jun. 29, 2009
Medical Assistance Payment for Outpatient Programs
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of Part 588 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 7.09, 31.04, 43.02; and Social Services Law, sections 364 and 364-a
Finding of necessity for emergency rule:
Preservation of general welfare.
Specific reasons underlying the finding of necessity:
The restoration of funds for continuing day treatment programs licensed solely under Article 31 of the Mental Hygiene Law are a result of the enacted 2009-2010 State budget. The reimbursement methodology restructuring was effective April 1, 2009.
Subject:
Medical Assistance Payment for Outpatient Programs.
Purpose:
To modify current reimbursement methodology for continuing day treatment programs and restore funding for certain programs.
Substance of emergency rule:
This rule will amend the provisions of 14 NYCRR Part 588, Medical Assistance Payment for Outpatient Programs that pertain to the reimbursement of continuing day treatment (CDT) programs. This rulemaking implements a change in the reimbursement methodology for services provided on or after April 1, 2009, and restores funding, effective April 1, 2009, for CDT programs licensed solely under Article 31 of the Mental Hygiene Law to the level which existed on December 31, 2008.
Overview
This rulemaking adjusts the current methodology for reimbursing CDT programs for persons with serious mental illness from one based upon hours of attendance in program to one utilizing a modified threshold approach for services provided on or after April 1, 2009. In addition, a reduction in fees paid to CDT programs for services provided on or after January 1, 2009, and prior to April 1, 2009, had been implemented. This rulemaking restores the funding, effective April 1, 2009, for CDT programs licensed solely under Article 31 to the December 31, 2008 level.
Requirements
Under current regulations, reimbursement methodology is based upon the number of hours of an individual's attendance. The rulemaking utilizes a modified threshold fee for reimbursement. Under a threshold fee, a provider receives a fee when an individual receives a reimbursable service, regardless of the duration of the visit. The regulation establishes a methodology in which there are two threshold fees-a half-day fee and a full-day fee. A half-day fee will be paid when an individual attends the program for at least 2 hours and receives at least one reimbursable service. A full-day fee will be paid when an individual attends the program for at least 4 hours and receives at least three reimbursable services. This modified threshold fee approach was delayed until April 1, 2009, to allow providers sufficient time to implement the system changes necessary to operate under the new reimbursement methodology.
Current regulations call for a different fee to be paid to providers based upon the number of hours of attendance, up to five hours, so long as at least one reimbursable service is provided during the visit. On average, individuals receive between two and three services during a five-hour visit. This regulation ensures that individuals will receive at least this level of service across all providers.
The rulemaking also continues the current pass-through methodology for reimbursing the capital costs of continuing day treatment programs operated by general hospitals, which allows for an add-on to the individual provider's fee based upon the capital costs incurred by the provider. The regulation also specifies that outpatient mental health services provided by general hospitals are not considered specialty services within the meaning of the Public Health Law.
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 September 26, 2009.
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, (518) 474-1331, email: cocbjdd@omh.state.ny.us
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 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 provision of services for persons with mental illness.
Subdivision (a) of Section 43.02 of the Mental Hygiene Law grants the Commissioner the power to set rates for facilities licensed under Article 31 of the Mental Hygiene Law.
Sections 364 and 364-a of the Social Services Law give the Office of Mental Health responsibility for establishing and maintaining standards for care and services eligible for Medicaid reimbursement in facilities under its jurisdiction, in accordance with cooperative arrangements with the Department of Health.
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 Part 588 are consistent with the goals and objectives of the Medicaid program to ensure that individuals with serious mental illness receive effective services to address their illness and that providers receive adequate reimbursement to pay for such care.
3. Needs and benefits: This rulemaking modifies the current methodology for reimbursing continuing day treatment programs for persons with serious mental illness from one based upon hours of attendance in program to one utilizing a modified threshold approach. The reimbursement methodology existing under current regulation continued until April 1, 2009, in order to allow providers sufficient time to implement the systems changes necessary to operate under the new reimbursement methodology. For services provided on or after April 1, 2009, providers will be reimbursed using a modified threshold fee.
Under a threshold fee, a provider receives a fee when an individual receives a reimbursable service, regardless of the duration of the visit. This rulemaking establishes a methodology in which there are two threshold fees-a half-day fee and a full-day fee. A half-day fee will be paid when an individual attends the program for at least 2 hours, and receives at least one reimbursable service. A full-day fee will be paid when an individual attends the program for at least 4 hours, and receives at least three reimbursable services.
Current regulations call for a different fee to be paid to providers based upon the number of hours of attendance, up to five hours, so long as at least one reimbursable service is provided during the visit. On average, individuals receive between two and three services during a five-hour visit. This rulemaking ensures that individuals will receive at least this level of service across all providers.
The rulemaking also continues the current methodology for reimbursing the capital costs of continuing day treatment programs operated by general hospitals, and specifies that outpatient mental health services provided by general hospitals are not considered specialty services within the meaning of the Public Health Law.
Under a previous rulemaking, a modest rate cut had been effectuated to continuing day treatment programs licensed under Article 31 for services provided on or after January 1, 2009, and prior to April 1, 2009. This rulemaking restores the funding for continuing day treatment programs licensed solely under Article 31 to the December 31, 2008 level, effective April 1, 2009.
4. Costs:
a) Costs to regulated parties: There are no costs to regulated parties as a result of this rulemaking.
b) Costs to State and Local government and the agency: There is an estimated $4 million Medicaid cost ($2 million of which is the State share) to restore the reductions to continuing day treatment programs licensed solely under Article 31 for the period April 1, 2009 through June 30, 2010. The funds necessary for this restoration were included in the enacted 2009-2010 State budget.
5. Local government mandates: These regulatory amendments will not involve or result in any additional imposition of duties or responsibilities upon county, city, town, village, school, or fire districts.
6. Paperwork: This rule should not substantially increase the paperwork requirements of affected providers.
7. Duplication: These regulatory amendments do not duplicate existing State or federal requirements.
8. Alternatives: The Office of Mental Health has proposed changes to the reimbursement methodology from hourly fees to half day/full day reimbursement, with a minimum number of services required for each reimbursement category. This simplifies the billing structure, while ensuring that individuals receive at least a standard level of services across providers. Consideration was given to not changing to a half day/full day reimbursement methodology, but the proposed methodology was determined to be preferable to the existing methodology due to the fact that it is less confusing, and more amenable to the establishment of a uniform standard for services. In addition, the rulemaking restores funding for continuing day treatment programs licensed solely under Article 31 to the level which existed on December 31, 2008. The only alternative would have been to not restore that funding, but to do so would be contrary to the enacted 2009-2010 State Budget.
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: This rulemaking is effective upon adoption.
Regulatory Flexibility Analysis
The rulemaking adjusts the methodology for reimbursement of continuing day treatment programs from one based upon hours of attendance in program to one utilizing a modified threshold approach for services provided on or after April 1, 2009. This modified threshold fee approach was delayed until April 1, 2009, to allow providers sufficient time to implement the system changes necessary to operate under the new reimbursement methodology. The rulemaking also restores the funding for continuing day treatment programs licensed solely under Article 31 to the level which existed on December 31, 2008, effective April 1, 2009, as per the enacted 2009-2010 State Budget. For these reasons, a regulatory flexibility analysis is not necessary and is, therefore, not being submitted with this rulemaking.
Rural Area Flexibility Analysis
A Rural Area Flexibility Analysis is not submitted with this notice because the rulemaking will not impose any adverse economic impact on rural areas. The rulemaking merely adjusts the methodology for reimbursement of continuing day treatment programs from one based upon hours of attendance in program to one utilizing a modified threshold approach for services provided on or after April 1, 2009. This modified threshold fee approach was delayed until April 1, 2009, to allow providers sufficient time to implement the system changes necessary to operate under the new reimbursement methodology. The rulemaking also restores the funding for continuing day treatment programs licensed solely under Article 31 to the level which existed on December 31, 2008, effective April 1, 2009. This restoration is consistent with the enacted 2009-2010 State Budget.
Job Impact Statement
A Job Impact Statement is not submitted with this notice because the rulemaking merely adjusts the methodology for reimbursement of continuing day treatment programs from one based upon hours of attendance in program to one utilizing a modified threshold approach for services provided on or after April 1, 2009. This modified threshold fee approach was delayed until April 1, 2009, to allow providers sufficient time to implement the system changes necessary to operate under the new reimbursement methodology. The rulemaking also restores the funding effective April 1, 2009, for continuing day treatment programs licensed solely under Article 31 to the level which existed on December 31, 2008, as per the enacted 2009-2010 State Budget. There will be no adverse impact on jobs and employment opportunities as a result of this rulemaking.
