N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-4.39

Current through Register Vol. 46, No. 51, December 18, 2024

Section 86-4.39 - Computation of basic rates for methadone maintenance treatment services provided by free-standing ambulatory care facilities and hospital outpatient clinic services

(a) For payments made pursuant to this section and pursuant to section 86- 1.11(h)(5) of this Part, for methadone maintenance treatment services reimbursement shall be based upon a fixed weekly payment per recipient.

(b) To be eligible to receive reimbursement pursuant to this section, facilities must have an operating certificate issued pursuant to Part 401 of this Title, and be certified to provide outpatient methadone maintenance treatment services.

(c) The clinic services which shall be provided to be eligible for reimbursement according to the price as established by this section includes: urinalysis drug testing, dispensing of methadone, medical supervision and arranging for appropriate laboratory tests for the initial and annual physical examinations, preparation and monitoring of treatment plans, maintenance of patient medical histories, prescribing methadone dosage, counseling as prescribed in the patients' individual treatment plan, and maintenance of records.

(d) The weekly price established pursuant to this section shall be reimbursement for the following, as required by New York State Office of Alcoholism and Substance Abuse Services in 10 NYCRR Part 1040:

(1) physician services, nursing services, therapist services, technician services, nutrition services, health education services, psychosocial services, care coordination services and other related professional expenses directly incurred by the licensed facility;

(2) space occupancy and plant overhead costs;

(3) all ancillary procedures directly related to the provision of services with the exception of laboratory and diagnostic tests other than urinalysis testing;

(4) all medical supplies and drugs directly related to the provision of services; and

(5) administrative personnel, business office, data processing recordkeeping, housekeeping, and other related facility overhead expenses.

(e) The methadone maintenance treatment service weekly price shall be established using 1986 cost and statistical data for the factors listed in subdivision (d) of this section reported by diagnostic and treatment centers and hospital-based outpatient programs. Weekly visit utilization shall be based upon the average daily census information compiled by the New York State Office of Alcoholism and Substance Abuse Services. The price shall be trended forward in accordance with subdivision (f) of this section in a manner consistent with the rate period of the facility's other basic services. After the price has been trended forward, the price shall be increased by adding the product of the estimated statewide number of urinalysis tests per week per patient multiplied by the current Medicaid reimbursement fee for urinalysis toxicology screening.

(f) The commissioner shall establish trend factors to project increases in the price during the effective period of the reimbursement rates. The trend factors shall be developed using available price indices including elements of the United States Department of Labor consumer and producer price indices and special price indices developed by the commissioner for this purpose. The projected trend factors shall be updated on an annual basis, based upon current and available data.

(g) The commissioner, in consultation with the New York State Office of Alcoholism and Substance Abuse Services, may add or delete health services from the methadone maintenance treatment services contained in subdivision (c) of this section, if the commissioner finds that the inclusion or deletion of such services is appropriate based upon commonly accepted medical standards, current scientific or medical literature, or the results of properly conducted medical or scientific research. The commissioner shall notify participating providers of such changes at least 60 days before such changes shall be effective.

(h) When such an addition or deletion is made pursuant to subdivision (g) of this section, the price established pursuant to subdivision (e) of this section shall be adjusted based upon an estimate of the costs of such added or deleted services efficiently and economically provided by general hospitals or diagnostic and treatment services.

(i) For financial reporting purposes and statistical reporting purposes, facilities which provide services pursuant to subdivision (c) of this section must comply as appropriate with the standards established for said reporting in section 86-1.3 or 86-4.3 of this Part.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-4.39