New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 578 - Medical Assistance Rates Of Payment For Residential Treatment Facilities For Children And Youth › Section 578.8 - Computation of rate of payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The rate of
				payment shall consist of an operating cost per diem and a capital cost per
				diem, computed from allowable costs and subject to cost category standards. The
				rate year shall be the 12-month period from July 1st through June 30th. The
				rate of payment effective July 1, 1995 through June 30, 1996 shall be a
				continuance of the rate of payment effective July 1, 1994 through June 30,
				1995. The rate of payment effective July 1, 2011 through June 30, 2012, and
				July 1, 2012 through June 30, 2013, shall be a continuance of the rate of
				payment in effect on June 30, 2011, except to the extent necessary to adjust
				such payments pursuant to the provisions of section
				578.14(o) 
				of this Part.
(1) Allowable costs shall be
				determined from the cost report as submitted pursuant to section
				578.5  of this
				Part for the base year which is the fiscal year two years prior to the rate
				year, and are subject to principles of reimbursement pursuant to section
				578.14 
				of this Part. The commissioner may determine that a provider has inadequate
				cost experience for the base year and may select an alternate cost report
				period, in which case the costs will be adjusted to reflect the costs in the
				base year.
(2) Cost category
				standards (i.e., screens or the maximum amount that will be reimbursed for a
				specific expense or group of expenses) shall be considered when calculating the
				total reimbursable costs to be included in the operating component for
				reimbursable services for residential treatment facilities.
(i) A cost category standard shall be
				determined for combined administration, support and maintenance services.
				Reimbursable cost per diem shall be the lesser of the standard or the allowable
				administrative, support and maintenance cost per diem. The administration,
				support and maintenance services standard is computed separately for upstate
				and downstate facilities. The standard is computed from the base year using a
				combination of 50 percent of the average allowed per diem cost for the
				applicable region and 50 percent of the statewide average per diem cost, plus
				seven and one-half percent.
(ii)
				The reimbursable costs for the medical/clinical services including nursing,
				shall be the lesser of the allowable costs reported on the base year cost
				report or the medical/clinical screen multiplied by the FTE standard, as
				determined by the commissioner. The medical/clinical screen is computed
				separately for upstate and downstate facilities. The screen is computed from
				the base year using a combination of 50 percent of the average allowed per diem
				cost for the applicable region and 50 percent of the statewide average per diem
				cost, plus seven and one-half percent.
(iii) Downstate facilities are defined as
				those facilities in the following counties: Bronx, Kings, New York, Putnam,
				Queens, Richmond, Rockland, Westchester, Nassau and Suffolk. Upstate facilities
				are all those facilities located in the remaining counties of New York
				State.
(3) The purchase
				of health services category shall include all allowable costs pursuant to
				section
				578.14 
				of this Part as defined pursuant to section
				584.11(d) 
				of this Title. The services allowable in the purchase of health services
				category shall be approved by the commissioner.
(4) The allowable costs, as set forth in
				paragraph (1) of this subdivision, that meet the requirements stated in
				paragraphs (2) and (3) of this subdivision, shall be trended by the applicable
				Medicare inflation factor for hospitals and units excluded from the prospective
				payment system except for the rate periods effective July 1, 1996 through June
				30, 1997, and July 1, 2009 through June 30, 2010, where the inflation factor
				used to trend costs will be limited to the inflation factor for the first year
				of the two-year period. No trend shall be applied to allowable costs for the
				rate period effective July 1, 2013 through June 30, 2014, and July 1, 2014
				through December 31, 2014.
(5) The
				capital cost per diem shall be determined from the base year cost report as
				submitted pursuant to section
				578.5  of this
				Part, and subject to the principles of reimbursement pursuant to section
				578.14 
				of this Part.