N.Y. Comp. Codes R. & Regs. tit. 14 § 841.9

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

Section 841.9 - Medical assistance payments for residential services

(a) The provisions of this section are applicable to programs certified to provide residential services under Part 820.

(b) The program's services are provided in three elements: Stabilization, rehabilitation, and reintegration. Only elements that are approved for federal financial participation are eligible for Medicaid reimbursement. Each reimbursable element shall have regional fees established and posted on the website of the Office. The regions include Downstate and Upstate. The Downstate region shall consist of New York City, as well as the counties of Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, and Dutchess. Upstate shall consist of all other counties in the state. Any annual or periodic fee adjustments shall be published on the Office's website. The initial fees shall be effective July 1, 2016.

(c) Allowable treatment costs shall be determined by the application of principles developed for determining reasonable cost payments for direct and indirect costs. Room and board related costs are not included in the rate.

(d) The fee development methodology shall consider each component of provider cost, as necessary to comply with requirements regarding economy, efficiency, and quality of care. Provider enrollment and retention will be reviewed periodically to ensure that access to care and adequacy of payments are maintained. The fee development methodology will primarily consist of provider cost modeling, though provider compensation studies, cost data, available funding, and comparable fees of other States residential Medicaid programs may be considered as well. The fees shall be established using the ratio of the calculated or estimated total annual allowable provider cost to the estimated annual billable per diem units.

(e) Periodic fee updates may be performed using provider cost modeling, reported actual cost, and/or any of the factors listed in the prior paragraph. Fee updates will require federal approval and will be posted to the Office website.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 841.9

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