OMH-30-14-00018-EP Medical Assistance Payment for Outpatient Programs and COPS

7/30/14 N.Y. St. Reg. OMH-30-14-00018-EP

NEW YORK STATE REGISTER

VOLUME XXXVI, ISSUE 30

July 30, 2014

RULE MAKING ACTIVITIES

OFFICE OF MENTAL HEALTH

EMERGENCY/PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. OMH-30-14-00018-EP

Filing No. 635

Filing Date. Jul. 15, 2014

Effective Date. Jul. 15, 2014

Medical Assistance Payment for Outpatient Programs and COPS

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

Proposed Action:

Amendment of Part 588; and repeal of Part 592 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 7.09, 31.04 and 43.02

Finding of necessity for emergency rule:

Preservation of public health, public safety and general welfare.

Specific reasons underlying the finding of necessity:

The purpose of the proposed rule is two-fold. The rule implements an increase in the Medicaid fees paid to all OMH-licensed day treatment programs serving children and repeals 14 NYCRR Part 592 – Comprehensive Outpatient Programs (“COPS”). The Centers for Medicare and Medicaid Services mandated COPS funding to cease effective October 1, 2013; this rule making increases Medicaid fees paid to day treatment programs effective October 1, 2013. This increase will preserve program funding and will enable day treatment programs to continue to provide treatment to children in need of services. Since this proposed regulation has significant impact upon public health, safety and general welfare, the proposed rule warrants emergency filing.

Subject:

Medical Assistance Payment for Outpatient Programs and COPS.

Purpose:

Amend Part 588 by increasing Medicaid fees paid to OMH-licensed day treatment programs for children and repeal outdated rule.

Text of emergency/proposed rule:

1. Subdivision (c) of Section 588.13 of Title 14 NYCRR is amended to read as follows:

(c) Effective [April 1, 2011] October 1, 2013, 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	[$78.61] $98.26
Half day	at least 3 hours	[39.31] 49.14
Brief day	at least 1 hour	[26.21] 32.76
Collateral	at least 30 minutes	[26.21] 32.76
Home	at least 30 minutes	[78.61] 98.26
Crisis	at least 30 minutes	[78.61] 98.26
Preadmission – full day	at least 5 hours	[78.61] 98.26
Preadmission – half day	at least 3 hours	[39.31] 49.14

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

Full day	at least 5 hours	[$75.99] $94.99
Half day	at least 3 hours	[37.99] 47.49
Brief day	at least 1 hour	[25.29] 31.61
Collateral	at least 30 minutes	[25.29] 31.61
Home	at least 30 minutes	[75.99] 94.99
Crisis	at least 30 minutes	[75.99] 94.99
Preadmission – full day	at least 5 hours	[75.99] 94.99
Preadmission – half day	at least 3 hours	[37.99] 47.49

2. 14 NYCRR Part 592 is repealed.

This notice is intended:

to serve as both a notice of emergency adoption and a notice of proposed rule making. The emergency rule will expire October 12, 2014.

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, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Regulatory Impact Statement

1. Statutory Authority: Sections 7.09 and 31.04 of the Mental Hygiene Law give the Commissioner of the Office of Mental Health the power and responsibility to plan, establish, license, and evaluate programs and services for the benefit of individuals diagnosed with mental illness, and to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.

Section 43.02 of the Mental Hygiene Law provides that payments under the Medical Assistance Program for outpatient 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 the Budget.

Section 43.02(b) of the Mental Hygiene Law gives the Commissioner the authority to request from operators of facilities licensed by the Office of Mental Health such financial, statistical and program information as the Commissioner may determine to be necessary.

2. Legislative Objectives: Articles 7 and 31 of the Mental Hygiene Law reflect the authority of the Commissioner to establish regulations regarding mental health programs. Day treatment programs for children are licensed by the Office of Mental Health (OMH) as outpatient programs serving children with a diagnosis of emotional disturbance. The goals of outpatient treatment for children are to reduce symptoms and improve functioning while allowing children to stay in their natural environments and providing ongoing support to the child and his or her family. A day treatment program serving children provides treatment designed to stabilize a child’s adjustment to educational settings, prepare a child for a return to educational settings, and ensure that he or she has received the necessary educational services to move to independent living. The proposed rule furthers the legislative intent under Article 7 by assuring the delivery of mental health services to children with serious emotional disturbance and facilitating financing procedures and mechanisms to support such a service delivery system.

3. Needs and Benefits: The reason for the rule making is two-fold. First, the proposed amendments increase the Medicaid fees paid to all OMH-licensed day treatment programs serving children, effective October 1, 2013. Second, the proposed amendments repeal 14 NYCRR Part 592, OMH’s regulation regarding Comprehensive Outpatient Programs (COPS).

The Centers for Medicare and Medicaid Services (CMS) mandated COPS funding to cease effective October 1, 2013. The increase in Medicaid fees reflects reinvestment of a portion of the State share of Medicaid associated with the COPS supplement, as contained in this year’s Aid to Localities Budget, in order to provide adequate funding for day treatment services. The balance of the State share of Medicaid associated with the COPS supplement will be used for State aid payments to such programs to minimize the operating deficits caused by the elimination of the COPS supplement. The revised fees have been approved by the Director of the Division of Budget. It is anticipated that the increase in Medicaid fees paid to day treatment programs serving children will provide assistance with regard to program viability and enable these programs to continue to serve children in need of mental health services.

14 NYCRR Part 592 was created in 1991, and established the standards for supplemental reimbursement under the Medical Assistance Program for comprehensive outpatient programs for adults with mental illness and children with serious emotional disturbance. As the funding for COPS ceased effective October 1, 2013, the Part is no longer necessary and will only serve to confuse providers of service if it is not repealed. Therefore, this rule making will repeal this Part.

4. Costs:

(a) Cost to State government: These regulatory amendments are expected to result in a cost of $2.13 million to State government, which will be covered by a reinvestment of a portion of the State share of Medicaid associated with the COPS supplement. This was included in OMH’s Aid to Localities Budget and approved by the Division of the Budget.

(b) Cost to local government: These regulatory amendments are not expected to result in any additional costs to local government.

(c) Cost to regulated parties: These regulatory amendments are not expected to result in any additional costs to regulated parties.

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 result in an increase in the paperwork requirements of providers.

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

8. Alternatives: The only alternative to the regulatory amendment would be inaction. This alternative was rejected due to the need for OMH to comply with the requirements of CMS to eliminate COPS funding. Further, inaction would have caused a reduction of funding to day treatment programs, which could have resulted in a reduction of services for children in these programs.

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 will be effective upon adoption, and shall be deemed to have been effective on and after October 1, 2013.

Regulatory Flexibility Analysis

The proposed rule serves a dual purpose. The first is to increase the Medicaid fees paid to all OMH-licensed day treatment programs serving children, effective October 1, 2013. The second is to repeal 14 NYCRR Part 592 (Comprehensive Outpatient Programs – “COPS”) as it is no longer necessary and would only serve to confuse providers of service if it was not repealed. As there will be no adverse economic impact on small business or local governments, a Regulatory Flexibility Analysis for Small Business and Local Governments has not been submitted with this notice.

Rural Area Flexibility Analysis

The proposed rule serves a dual purpose. The first is to increase the Medicaid fees paid to all OMH-licensed day treatment programs serving children, effective October 1, 2013. The second is to repeal 14 NYCRR Part 592 (Comprehensive Outpatient Programs – “COPS”) as it is no longer necessary and would only serve to confuse providers of service if it was not repealed. The proposed rule will not impose any adverse economic impact on rural areas; therefore, a Rural Area Flexibility Analysis is not submitted with this notice.

Job Impact Statement

This proposed rule serves a dual purpose. The first is to increase the Medicaid fees paid to all OMH-licensed day treatment programs serving children, effective October 1, 2013. The second is to repeal 14 NYCRR Part 592 (Comprehensive Outpatient Programs – “COPS”) as it is no longer necessary and would only serve to confuse providers of service if it was not repealed. It is apparent from the nature and purpose of the rule that it will not have an impact on jobs and employment opportunities; therefore, a Job Impact Statement for these amendments is not being submitted with this rule making.