NY Soc Serv L § 368-A (2021)
2021 New York Laws SOS - Social Services Article 5 - Assistance and Care Title 11 - Medical Assistance for Needy Persons 368-A - State Reimbursement.

§  368-a.  State  reimbursement.  1.  The  department shall review the expenditures made by social services districts  for  medical  assistance for  needy  persons,  and  the  administration  thereof,  before  making reimbursement. Before approving such expenditures for reimbursement, the department shall give due consideration to the results  of  the  reviews and audits conducted by the department of health pursuant to subdivision two  of section three hundred sixty-four. If approved by the department, such expenditures shall not be subject to  reimbursement  by  the  state pursuant  to  section  one  hundred fifty-three or any provision of this chapter other than this section, but shall be subject  to  reimbursement by  the state in accordance with this section and the regulations of the department, as follows:   There shall be paid to each such district  (a) the amount of federal funds, if any, properly received  or  to  be received on account of such expenditures;  (b)  the  full amount expended on behalf of the department for medical assistance furnished under this title  to  eligible  patients  in  state institutions  for  the mentally disabled, in facilities or parts thereof for the care and treatment of drug dependent persons  operated  pursuant to the mental hygiene law and in other hospitals while such patients are on release from an institution in the state department of mental hygiene or  from  a  drug  abuse  treatment facility or part thereof operated in compliance with applicable provisions of law and supervised by the state division of substance abuse services, to  eligible  veterans  and  their dependents  in  that  part  of  the New York state home for veterans and their dependents at Oxford that has been approved pursuant to law  as  a nursing  home  and in a hospital while on release from that home for the purpose of receiving care in such hospital, in that  part  of  a  public institution operated for the care of the mentally disabled that has been approved  pursuant  to law as an intermediate care facility, to eligible veterans and their dependents in that part of the New  York  state  home for  veterans  and  their  dependents  at  Oxford that has been approved pursuant to law as an intermediate care facility and in a hospital while on release from such intermediate care facilities  for  the  purpose  of receiving  care  in  such  hospital, and for the administration thereof, after first deducting therefrom any federal funds properly  received  or to be received on account thereof;  (c)  the  full  amount expended for medical assistance furnished under this title to eligible Indians and members of their families residing on any Indian  reservation  in  this  state,  and  for  the  administration thereof,  after  first  deducting  therefrom  any federal funds properly received or to be received on account thereof;  (d) fifty per centum of the amount  expended  for  medical  assistance furnished  under  this  title  to  other  eligible  persons, and for the administration thereof, after  first  deducting  therefrom  any  federal funds properly received or to be received on account thereof.  (e)  one  hundred percentum of the amount expended for the development of medical assistance data systems, after first deducting therefrom  any federal  funds  properly  received or to be received on account thereof. Such reimbursement shall be available  only  to  the  extent  that  such projects  have  received  federal approval and to the extent that claims for ninety percent federal aid have been approved.  (f) The full amount expended on behalf of the department  for  medical assistance furnished to persons described in subdivision five of section three  hundred  sixty-five of this article, including the administration thereof, after first deducting  therefrom  any  federal  funds  properly received or to be received on account of such expenditures.  (g)  Notwithstanding any other provision of law, reimbursement for the following services: care, treatment, maintenance and nursing services in nursing homes and health related care and services in intermediate  care facilities  provided in accordance with paragraph (b) of subdivision two of  section  three  hundred  sixty-five-a  of  this  title;  home health services provided in accordance with paragraph (d) of subdivision two of section three hundred sixty-five-a of this title; personal care services provided in accordance with paragraph (e) of subdivision two of  section three  hundred  sixty-five-a  of  this title; long term home health care programs services provided in  accordance  with  section  three  hundred sixty-seven-c  of  this title; and nursing home transition and diversion services provided in accordance with subdivision six-a of section  three hundred sixty-six of this title shall be made as follows:  (i)  for services provided on or after January first, nineteen hundred eighty-four through December thirty-first, nineteen hundred eighty-four, seventy-two per centum after first deducting therefrom any federal funds properly received or to be received on account thereof;  (ii) for services provided on or after January first, nineteen hundred eighty-five through December thirty-first, nineteen hundred eighty-five, seventy-six per centum after first deducting therefrom any federal funds properly received or to be received on account thereof; and  (iii) for services  provided  on  or  after  January  first,  nineteen hundred   eighty-six   through   March  thirty-first,  nineteen  hundred ninety-four, eighty per  centum  after  first  deducting  therefrom  any federal funds properly received or to be received on account thereof;  (iv)  for  services provided on or after April first, nineteen hundred ninety-four eighty-one  and  two  hundred  thirty-five  thousandths  per centum  after  first  deducting  therefrom  any  federal  funds properly received or to be received on account thereof.  (h) (i) Beginning January first,  nineteen  hundred  eighty-four,  one hundred  per  centum  of  the amount expended for medical assistance for those individuals who are eligible pursuant  to  section  three  hundred sixty-six  of  this  article  as  a  result  of  a  mental disability as determined by the commissioner in consultation with the commissioner  of the  office  of  mental  health  and  the commissioner of the office for people with developmental disabilities and  with  the  approval  of  the director of the budget after first deducting therefrom any federal funds properly received or to be received on account thereof.  (ii)  Notwithstanding  any  other provision of law to the contrary, on and after the effective date of this  subparagraph,  the  department  of health  shall make no further recovery or recoupment of monies that were advanced to local social services  districts,  during  the  period  from April  first,  nineteen hundred ninety-two to the effective date of this subparagraph, to cover the medical assistance  costs  pursuant  to  this paragraph   for  rehabilitative  services  for  residents  of  community residences licensed or operated by the office of mental  health  or  for the office for people with developmental disabilities home and community based waiver services.  (i)  The  full amount expended on behalf of the department for medical assistance furnished  to  persons  described  in  subdivision  eight  of section   three  hundred  sixty-five  of  this  article,  including  the administration thereof, after  first  deducting  therefrom  any  federal funds properly received or to be received on account thereof.  (j)  Notwithstanding  any  other  provision of law, but in conjunction with the provisions of paragraph (g) of subdivision one of this section, reimbursement for the  care  and  services  provided  to  those  persons eligible  pursuant to subparagraph seven of paragraph (a) of subdivision one  of  section  three  hundred  sixty-six  of  this  title  shall   be  seventy-five  per  centum  after  first  deducting therefrom any federal funds properly received or to be received on account thereof.  (k)  Notwithstanding  any other provision of law, reimbursement by the state for payments made, whether by the department on behalf of a social services district pursuant to section  three  hundred  sixty-seven-b  of this   article  or  by  a  social  services  district  directly,  for  a supplementary bad debt and charity care adjustment component of rates of payment determined in accordance with subdivision fourteen-a of  section twenty-eight  hundred  seven-c  of  the  public  health  law for general hospital  inpatient  hospital  services  provided  in  accordance   with paragraph  (b)  of subdivision two of section three hundred sixty-five-a of this article shall be limited to the amount of federal funds properly received or to be received on account of  such  expenditures;  provided, however,  that  reimbursement  shall  be  made by the state for the full amount expended for a supplementary bad debt and charity care adjustment for a general hospital operated by the state of New York or by the state university of New York, after  first  deducting  therefrom  any  federal funds   properly   received  or  to  be  received  on  account  of  such expenditure.  (l) Effective January first, nineteen hundred ninety, one hundred  per centum   of  the  amount  expended  for  medical  assistance  for  those individuals who are eligible pursuant  to  paragraphs  (n)  and  (o)  of subdivision  four  of  section  three  hundred sixty-six of this article after first deducting therefrom any federal funds properly  received  or to be received on account thereof.  (m)  Notwithstanding  any other provision of law, reimbursement by the state for payments made, whether by the department on behalf of a social services district pursuant to section  three  hundred  sixty-seven-b  of this   article  or  by  a  social  services  district  directly,  for  a supplementary low  income  patient  adjustment  component  of  rates  of payment  for  a  public  general  hospital determined in accordance with subdivision fourteen-d of section twenty-eight hundred  seven-c  of  the public  health  law  for  general  hospital  inpatient hospital services provided in accordance with paragraph (b) of subdivision two of  section three  hundred  sixty-five-a  of  this  article  shall be limited to the amount of federal funds properly received or to be received  on  account of  such  expenditures;  provided,  however, that reimbursement shall be made by the state for the full amount expended for a  supplementary  low income  patient  adjustment for a general hospital operated by the state of New York or  by  the  state  university  of  New  York,  after  first deducting  therefrom  any  federal  funds  properly  received  or  to be received on account of such expenditure.  (n) Notwithstanding any inconsistent provision of  law,  reimbursement for  the  amount  expended  for  medical assistance furnished under this title to eligible persons pursuant to a statewide managed care  plan  or managed  care  demonstration program, or to eligible persons enrolled in any health maintenance organization or other entity authorized by law to furnish comprehensive health services  pursuant  to  a  plan,  shall  be reimbursed,  after  first deducting therefrom any federal funds properly received or to be received on account thereof, in  accordance  with  the following  schedule:  (i)  for  services  provided  for the period April first, nineteen hundred  ninety-four  to  March  thirty-first,  nineteen hundred   ninety-nine,   fifty-three   and  eight  hundred  seventy-five ten-thousandths percent thereof; and (ii) for services provided for  the period  April first, nineteen hundred ninety-nine to March thirty-first, two thousand three, fifty percent thereof.  (o) Notwithstanding any other provision of law, reimbursement  by  the state for payments made, whether by the department on behalf of a social  services  district  pursuant  to  section three hundred sixty-seven-b of this article  or  by  a  social  services  district  directly,  for  the component  of  rates  of  payment  for  a general hospital determined in accordance   with   paragraph  (s)  of  subdivision  eleven  of  section twenty-eight hundred seven-c  of  the  public  health  law  for  general hospital   inpatient  hospital  services  provided  in  accordance  with paragraph (b) of subdivision two of section three  hundred  sixty-five-a of  this  article shall be one hundred per centum of the amount expended for medical assistance, after  first  deducting  therefrom  any  federal funds   properly   received  or  to  be  received  on  account  of  such expenditure.  (p) Notwithstanding any other provision of law, reimbursement  by  the state for payments made, whether by the department on behalf of a social services  district  pursuant  to  section three hundred sixty-seven-b of this article or by a social services district  directly,  for  a  public general  hospital  indigent care adjustment payment for a public general hospital determined in accordance with subdivision fourteen-f of section twenty-eight hundred seven-c  of  the  public  health  law  for  general hospital   inpatient  hospital  services  provided  in  accordance  with paragraph (b) of subdivision two of section three  hundred  sixty-five-a of this article shall be limited to the amount of federal funds properly received  or  to  be received on account of such expenditures; provided, however, that reimbursement shall be made by  the  state  for  the  full amount  expended  for a public general hospital indigent care adjustment for a general hospital operated by the state of New York or by the state university of New York, after  first  deducting  therefrom  any  federal funds   properly   received  or  to  be  received  on  account  of  such expenditure.   * (q) Notwithstanding any inconsistent provision of  this  chapter  or any other provision of law to the contrary, reimbursement for the amount expended  for  medical assistance furnished under this title to eligible persons for services provided by a managed long term care plan, shall be based upon a  uniform  average  of  expenditures  reflecting  a  mix  of primary,  acute  and  long  term care services. Such uniform average, or averages, will be determined by the commissioner  of  health  and  shall reflect  the  mix  of  services  as  applied  to  the amounts calculated pursuant to applicable paragraphs (g) and (n) of this subdivision, after first deducting therefrom any federal funds properly received or  to  be received on account of such expenditure.   * NB Repealed December 31, 2024   * (r) Notwithstanding any other provision of law, reimbursement by the state  for  payments made, whether by the department of health on behalf of  a  social  services  district  pursuant  to  section  three  hundred sixty-seven-b  of  this title or by a social services district directly, for  medical  assistance  furnished  pursuant  to  the   provisions   of subparagraph  one  of paragraph (q) of subdivision four of section three hundred sixty-six of this title to children born on or before  September thirtieth,  nineteen  hundred  eighty-three,  shall be made for the full amount expended for such children, after first deducting  therefrom  any federal  funds  properly  received  or to be received on account of such expenditure.   * NB Expired April 1, 2005   * (s) Notwithstanding any other provision of law, reimbursement by the state for payments made, whether by the department of health  on  behalf of  a  social  services  district  pursuant  to  section  three  hundred sixty-seven-b of this title or by a social services  district  directly, for   medical   assistance  furnished  pursuant  to  the  provisions  of subparagraph one of paragraph (t) of subdivision four of  section  three  hundred  sixty-six of this title to children, shall be made for the full amount expended for such children, after first deducting  therefrom  any federal  funds  properly  received  or to be received on account of such expenditure.   * NB Expired April 1, 2005  (t)  (i) for services provided on or after January first, two thousand three through December thirty-first, two thousand four, fifty percent of the amount expended for health care services under section three hundred sixty-nine-ee of this  article,  after  first  deducting  therefrom  any federal funds properly received or to be received on account thereof;  (ii)  for  services  provided  on or after January first, two thousand five, through  September  thirtieth,  two  thousand  five,  seventy-five percent  of  the  amount expended for health care services under section three hundred sixty-nine-ee  of  this  article,  after  first  deducting therefrom  any  federal  funds  properly  received  or to be received on account thereof;  (iii) for services provided on or after October  first,  two  thousand five,  through  December  thirty-first,  two thousand five, seventy-five percent  of  the  amount  expended  by  the  social  services   district consisting  of  the  city  of  New  York, and one hundred percent of the amount expended by all other social services districts, for health  care services  under  section  three  hundred  sixty-nine-ee of this article, after first deducting therefrom any federal funds properly  received  or to be received on account thereof; and  (iv) for services provided on or after January first, two thousand six through  December  thirty-first,  two  thousand six, and thereafter, one hundred percent of the amount expended for health  care  services  under section  three  hundred  sixty-nine-ee  of  this  article,  after  first deducting therefrom  any  federal  funds  properly  received  or  to  be received on account thereof.  (u)  Notwithstanding  any  other  provision  of  law,  the full amount expended for family  planning  services  provided  to  eligible  persons pursuant  to  subparagraph eleven of paragraph (a) of subdivision one of section three hundred sixty-six of this  title,  after  first  deducting therefrom  federal  funds properly received or to be received on account of such expenditures.  (v)  One  hundred  per  centum  of  the  amount   expended   for   the administration of medical assistance furnished pursuant to subparagraphs twelve and thirteen of paragraph (a) of subdivision one of section three hundred sixty-six of this title, after first deducting any federal funds properly received or to be received on account of such expenditures.  (w)   One   hundred   per  centum  of  the  amount  expended  for  the administration of medical assistance furnished pursuant to paragraph (v) of subdivision four of section three hundred sixty-six  of  this  title, after  first  deducting  any  federal  funds  properly received or to be received on account of such expenditures.  (x) One hundred  percent  of  the  amount  expended  for  health  care services  as  determined in accordance with paragraph (c) of subdivision ten of section twenty-eight hundred seven-d of the  public  health  law, after  first  deducting therefrom any federal funds properly received or to be received on account thereof.  (y) One hundred  percent  of  the  amount  expended  for  health  care services as determined in accordance with paragraph (v-1) of subdivision four  of  section  three  hundred  sixty-six  of this title, after first deducting therefrom  any  federal  funds  properly  received  or  to  be received on account thereof.  (z)  One  hundred  percent  of  the  amount  expended  for health care services described in sections three  hundred  sixty-eight-d  and  three  hundred sixty-eight-e of this title, after first deducting therefrom any federal funds properly received or to be received on account thereof.   2.  (a)  For  the  purpose  of  state  reimbursement under this title, expenditures for administration of medical assistance for needy  persons shall  include  expenditures  for salaries of employees of local welfare departments, except for those  excluded  under  paragraph  (b)  of  this subdivision;  operation,  maintenance  and service costs; and such other expenditures, such as equipment costs, depreciation charges, and  rental values,  as  may  be  approved  by  the department. It shall not include expenditures for capital additions or improvements.  (b) State reimbursement shall not be made for any part of  the  salary of  a social services official, or a chief executive officer of a social services department, whose qualifications do not conform to those  fixed by  the  department,  or  a city or town service officer; nor shall such reimbursement be made on the salary of a deputy commissioner, or  deputy director  or  an  employee,  unless  his employment is necessary for the administration of medical assistance and his qualifications  conform  to those fixed by the department.  (c)  State  reimbursement shall not be made for any part of the salary of a local medical director appointed after the effective date  of  this act whose qualifications do not conform to those established pursuant to section three hundred sixty-four of this title.  (d)  State reimbursement shall not be made for any part of the cost of those items of care, services, supplies and equipment, and  drugs  which represent  co-payment amounts for which a provider of medical assistance is authorized to charge a recipient in accordance with  subdivision  six of section three hundred sixty-seven-a of this article.   * 3.  For  the  purpose  of  state  reimbursement  for  personal  care services, such reimbursement to a  social  services  district  shall  be limited  to expenditures for such district's allocation of the statewide need for personal care  services,  pursuant  to  section  three  hundred sixty-seven-d of this chapter.   * NB Expired March 31, 1985   3.  (a)  Claims for state reimbursement shall be made in such form and manner and at such times and for such periods as  the  department  shall determine.  (b)  When  certified  by  the department, state reimbursement shall be paid from  the  state  treasury  upon  the  audit  and  warrant  of  the comptroller out of funds made available therefor.  (c) When the moneys allotted to the state by the federal department of health, education and welfare or other authorized federal agency for any quarter  shall  have  been  received  by  the department of taxation and finance, the department shall, as  soon  as  possible,  certify  to  the comptroller the amount to which each public welfare district is entitled for such quarter and such amount shall be paid out of the state treasury after  audit  by  the  comptroller  to  the  respective  public  welfare districts.  (d) The department is authorized in its discretion to make advances to public welfare districts in  anticipation  of  the  state  reimbursement provided for in this section.   4.  Payment  of  state reimbursement and advances shall be made to the fiscal officer of the public welfare district entitled thereto  pursuant to the provisions of this chapter.