2023 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, 2029
* (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.