New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 4 - Supplementary Assistance Reimbursement Claiming › Part 635 - Medical Assistance Reimbursement Claiming › Section 635.1 - Reimbursement for medical assistance (MA)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reimbursement for services provided to
			 recipients of MA shall be claimed on schedules and formats prescribed by the
			 department and in accordance with instructions of the department. Any amounts
			 which are federally reimbursable pursuant to title XIX of the Social Security
			 Act or another Federal program or activity must be claimed in a manner that
			 results in the greatest proportion of Federal participation or alternatively
			 must be claimed in a manner that does not increase the amount of State
			 reimbursement which would be available if Federal participation were also
			 available.
(b) Expenditures made by
			 social services districts for MA and its administration shall be subject to
			 reimbursement by the State in accordance with section 368-a  of the Social Services Law. Each
			 district may claim:
(1) the amount of Federal
			 funds, if any, properly received or to be received on account of such
			 expenditures;
(2) the full amount
			 expended for MA furnished to those State charges specified in paragraph (b) of
			 subdivision one of section 368-a  of the Social Services Law and for
			 the administration thereof, after first deducting therefrom any Federal funds
			 properly received or to be received on account thereof;
(3) the full amount expended for MA furnished
			 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;
(4) except as
			 otherwise provided by the Social Services Law or by this Part, 50 percent of
			 the amount expended for MA provided to other eligible persons, and the
			 administration thereof, after first deducting therefrom any Federal funds
			 properly received or to be received on account thereof;
(5) 100 percent of the amount expended for
			 the development of MA data systems, after first deducting therefrom any Federal
			 funds properly received or to be received on account thereof, provided that
			 such reimbursement shall be available only to the extent that claims for 90
			 percent Federal aid have been approved;
(6) the full amount expended for MA furnished
			 to eligible persons discharged, released or conditionally released from a State
			 Department of Mental Hygiene facility if such person was a patient therein for
			 a continuous period of five or more years prior to his or her discharge or
			 release;
(7) reimbursement for the
			 following services, after first deducting therefrom any Federal funds properly
			 received or to be received on account thereof:
(i) care, treatment, maintenance and nursing
			 services provided in nursing homes and health-related care and services
			 provided in intermediate care facilities;
(ii) home health services, as defined in
			 section 365-a (2)(d)  of the Social
			 Services Law;
(iii) personal care
			 services, as defined in section 365-a (2)(e)  of the Social
			 Services Law; and
(iv) long-term
			 home health care program services as follows:
(a) for services provided on or after January
			 1, 1984--72 percent;
(b) for
			 services provided on or after January 1, 1985--76 percent; and
(c) for services provided on or after January
			 1, 1986--80 percent;
(8) beginning January 1, 1984, after first
			 deducting therefrom any Federal funds properly received or to be received on
			 account thereof, 100 percent of the amount expended for MA for those
			 individuals who are eligible for such assistance 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
			 of Mental Retardation and Developmental Disabilities and with the approval of
			 the director of the Division of the Budget; and
(9) the full amount expended for MA furnished
			 to eligible persons who reside in residential care centers for adults operated
			 by the Office of Mental Health, including the administration thereof, after
			 first deducting therefrom any Federal funds properly received or to be received
			 on account thereof.