N.Y. Comp. Codes R. & Regs. tit. 14 § 841.8

Current through Register Vol. 46, No. 45, November 2, 2024

Section 841.8 - Medical assistance payments for substance use disorder inpatient rehabilitation services

(a) The provisions of this section are applicable to programs certified under Part 818.

(b) Rates of Payment.

(1) Rates will be calculated using a cost-based fee methodology inclusive of operating costs and capital reimbursement. There shall be no capital add-on to these fees, nor any separate Medicaid reimbursement for capital costs.

(2) Fees will be established using a regression model based on the relationship between normalized cost and program capacity, recognizing both regional cost differentials and economies of scale. The calculated statewide fees based on program capacity, will then be adjusted using regional cost factors (based on the county in which the facility is located). Geographic region and regional cost factor charts will be posted on the OASAS website.

(3) Fees will be deemed to be inclusive of all service delivery costs and will be considered payment in full for fee-for-service Medicaid reimbursed services.

(4) Fee schedules used to determine rates will be posted on the Office website. Schedules used to determine fees include:

(i) statewide OASAS Freestanding Inpatient Rehabilitation fee chart based on bed size; and

(ii) geographic region and regional cost factor chart.

(c) Bed size.

(1) For existing and new inpatient rehabilitation facilities, the bed size will be based on the certified capacity of the program site.

(2) If the certified bed size changes, the fee will be revised accordingly and will be effective on the date of the bed size change.

(3) Facilities with fewer than 14 certified beds will use the 14-bed fee. Facilities with 120 or more certified beds will use the 120-bed fee.

(4) Bed size is determined at certification and listed on the program operating certificate issued by the Office.

(d) Base year. From time to time, and at the discretion of the Office, the fees may be revised using new base year data. The base year for new fee calculations will be the most recent, substantially complete Consolidated Fiscal Report period available at the time of the calculation.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 841.8

Amended New York State Register December 9, 2015/Volume XXXVII, Issue 49, eff. 11/20/2015

Adopted New York State Register January 26, 2022/Volume XLIV, Issue 04, eff. 1/26/2022