§ 368-A — State reimbursement

New York § 368-A

• Jurisdiction: New York
• Law SOS: Social Services
• Title 11: Medical Assistance For Needy Persons
• Art. 5: Assistance and Care

Text

§ 368-a. State reimbursement. 1. The department shall review the\nexpenditures made by social services districts for medical assistance\nfor needy persons, and the administration thereof, before making\nreimbursement. Before approving such expenditures for reimbursement, the\ndepartment shall give due consideration to the results of the reviews\nand audits conducted by the department of health pursuant to subdivision\ntwo of section three hundred sixty-four. If approved by the department,\nsuch expenditures shall not be subject to reimbursement by the state\npursuant to section one hundred fifty-three or any provision of this\nchapter other than this section, but shall be subject to reimbursement\nby the state in accordance with this section and the regulations of the\ndepartment, as follows:\n There shall be paid to each such district\n (a) the amount of federal funds, if any, properly received or to be\nreceived on account of such expenditures;\n (b) the full amount expended on behalf of the department for medical\nassistance furnished under this title to eligible patients in state\ninstitutions for the mentally disabled, in facilities or parts thereof\nfor the care and treatment of drug dependent persons operated pursuant\nto the mental hygiene law and in other hospitals while such patients are\non release from an institution in the state department of mental hygiene\nor from a drug abuse treatment facility or part thereof operated in\ncompliance with applicable provisions of law and supervised by the state\ndivision of substance abuse services, to eligible veterans and their\ndependents in that part of the New York state home for veterans and\ntheir dependents at Oxford that has been approved pursuant to law as a\nnursing home and in a hospital while on release from that home for the\npurpose of receiving care in such hospital, in that part of a public\ninstitution operated for the care of the mentally disabled that has been\napproved pursuant to law as an intermediate care facility, to eligible\nveterans and their dependents in that part of the New York state home\nfor veterans and their dependents at Oxford that has been approved\npursuant to law as an intermediate care facility and in a hospital while\non release from such intermediate care facilities for the purpose of\nreceiving care in such hospital, and for the administration thereof,\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof;\n (c) the full amount expended for medical assistance furnished under\nthis title to eligible Indians and members of their families residing on\nany Indian reservation in this state, and for the administration\nthereof, after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof;\n (d) fifty per centum of the amount expended for medical assistance\nfurnished under this title to other eligible persons, and for the\nadministration thereof, after first deducting therefrom any federal\nfunds properly received or to be received on account thereof.\n (e) one hundred percentum of the amount expended for the development\nof medical assistance data systems, after first deducting therefrom any\nfederal funds properly received or to be received on account thereof.\nSuch reimbursement shall be available only to the extent that such\nprojects have received federal approval and to the extent that claims\nfor ninety percent federal aid have been approved.\n (f) The full amount expended on behalf of the department for medical\nassistance furnished to persons described in subdivision five of section\nthree hundred sixty-five of this article, including the administration\nthereof, after first deducting therefrom any federal funds properly\nreceived or to be received on account of such expenditures.\n (g) Notwithstanding any other provision of law, reimbursement for the\nfollowing services: care, treatment, maintenance and nursing services in\nnursing homes and health related care and services in intermediate care\nfacilities provided in accordance with paragraph (b) of subdivision two\nof section three hundred sixty-five-a of this title; home health\nservices provided in accordance with paragraph (d) of subdivision two of\nsection three hundred sixty-five-a of this title; personal care services\nprovided in accordance with paragraph (e) of subdivision two of section\nthree hundred sixty-five-a of this title; long term home health care\nprograms services provided in accordance with section three hundred\nsixty-seven-c of this title; and nursing home transition and diversion\nservices provided in accordance with subdivision six-a of section three\nhundred sixty-six of this title shall be made as follows:\n (i) for services provided on or after January first, nineteen hundred\neighty-four through December thirty-first, nineteen hundred eighty-four,\nseventy-two per centum after first deducting therefrom any federal funds\nproperly received or to be received on account thereof;\n (ii) for services provided on or after January first, nineteen hundred\neighty-five through December thirty-first, nineteen hundred eighty-five,\nseventy-six per centum after first deducting therefrom any federal funds\nproperly received or to be received on account thereof; and\n (iii) for services provided on or after January first, nineteen\nhundred eighty-six through March thirty-first, nineteen hundred\nninety-four, eighty per centum after first deducting therefrom any\nfederal funds properly received or to be received on account thereof;\n (iv) for services provided on or after April first, nineteen hundred\nninety-four eighty-one and two hundred thirty-five thousandths per\ncentum after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof.\n (h) (i) Beginning January first, nineteen hundred eighty-four, one\nhundred per centum of the amount expended for medical assistance for\nthose individuals who are eligible pursuant to section three hundred\nsixty-six of this article as a result of a mental disability as\ndetermined by the commissioner in consultation with the commissioner of\nthe office of mental health and the commissioner of the office for\npeople with developmental disabilities and with the approval of the\ndirector of the budget after first deducting therefrom any federal funds\nproperly received or to be received on account thereof.\n (ii) Notwithstanding any other provision of law to the contrary, on\nand after the effective date of this subparagraph, the department of\nhealth shall make no further recovery or recoupment of monies that were\nadvanced to local social services districts, during the period from\nApril first, nineteen hundred ninety-two to the effective date of this\nsubparagraph, to cover the medical assistance costs pursuant to this\nparagraph for rehabilitative services for residents of community\nresidences licensed or operated by the office of mental health or for\nthe office for people with developmental disabilities home and community\nbased waiver services.\n (i) The full amount expended on behalf of the department for medical\nassistance furnished to persons described in subdivision eight of\nsection three hundred sixty-five of this article, including the\nadministration thereof, after first deducting therefrom any federal\nfunds properly received or to be received on account thereof.\n (j) Notwithstanding any other provision of law, but in conjunction\nwith the provisions of paragraph (g) of subdivision one of this section,\nreimbursement for the care and services provided to those persons\neligible pursuant to subparagraph seven of paragraph (a) of subdivision\none of section three hundred sixty-six of this title shall be\nseventy-five per centum after first deducting therefrom any federal\nfunds properly received or to be received on account thereof.\n (k) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for a\nsupplementary bad debt and charity care adjustment component of rates of\npayment determined in accordance with subdivision fourteen-a of section\ntwenty-eight hundred seven-c of the public health law for general\nhospital inpatient hospital services provided in accordance with\nparagraph (b) of subdivision two of section three hundred sixty-five-a\nof this article shall be limited to the amount of federal funds properly\nreceived or to be received on account of such expenditures; provided,\nhowever, that reimbursement shall be made by the state for the full\namount expended for a supplementary bad debt and charity care adjustment\nfor a general hospital operated by the state of New York or by the state\nuniversity of New York, after first deducting therefrom any federal\nfunds properly received or to be received on account of such\nexpenditure.\n (l) Effective January first, nineteen hundred ninety, one hundred per\ncentum of the amount expended for medical assistance for those\nindividuals who are eligible pursuant to paragraphs (n) and (o) of\nsubdivision four of section three hundred sixty-six of this article\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof.\n (m) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for a\nsupplementary low income patient adjustment component of rates of\npayment for a public general hospital determined in accordance with\nsubdivision fourteen-d of section twenty-eight hundred seven-c of the\npublic health law for general hospital inpatient hospital services\nprovided in accordance with paragraph (b) of subdivision two of section\nthree hundred sixty-five-a of this article shall be limited to the\namount of federal funds properly received or to be received on account\nof such expenditures; provided, however, that reimbursement shall be\nmade by the state for the full amount expended for a supplementary low\nincome patient adjustment for a general hospital operated by the state\nof New York or by the state university of New York, after first\ndeducting therefrom any federal funds properly received or to be\nreceived on account of such expenditure.\n (n) Notwithstanding any inconsistent provision of law, reimbursement\nfor the amount expended for medical assistance furnished under this\ntitle to eligible persons pursuant to a statewide managed care plan or\nmanaged care demonstration program, or to eligible persons enrolled in\nany health maintenance organization or other entity authorized by law to\nfurnish comprehensive health services pursuant to a plan, shall be\nreimbursed, after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof, in accordance with the\nfollowing schedule: (i) for services provided for the period April\nfirst, nineteen hundred ninety-four to March thirty-first, nineteen\nhundred ninety-nine, fifty-three and eight hundred seventy-five\nten-thousandths percent thereof; and (ii) for services provided for the\nperiod April first, nineteen hundred ninety-nine to March thirty-first,\ntwo thousand three, fifty percent thereof.\n (o) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for the\ncomponent of rates of payment for a general hospital determined in\naccordance with paragraph (s) of subdivision eleven of section\ntwenty-eight hundred seven-c of the public health law for general\nhospital inpatient hospital services provided in accordance with\nparagraph (b) of subdivision two of section three hundred sixty-five-a\nof this article shall be one hundred per centum of the amount expended\nfor medical assistance, after first deducting therefrom any federal\nfunds properly received or to be received on account of such\nexpenditure.\n (p) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for a public\ngeneral hospital indigent care adjustment payment for a public general\nhospital determined in accordance with subdivision fourteen-f of section\ntwenty-eight hundred seven-c of the public health law for general\nhospital inpatient hospital services provided in accordance with\nparagraph (b) of subdivision two of section three hundred sixty-five-a\nof this article shall be limited to the amount of federal funds properly\nreceived or to be received on account of such expenditures; provided,\nhowever, that reimbursement shall be made by the state for the full\namount expended for a public general hospital indigent care adjustment\nfor a general hospital operated by the state of New York or by the state\nuniversity of New York, after first deducting therefrom any federal\nfunds properly received or to be received on account of such\nexpenditure.\n * (q) Notwithstanding any inconsistent provision of this chapter or\nany other provision of law to the contrary, reimbursement for the amount\nexpended for medical assistance furnished under this title to eligible\npersons for services provided by a managed long term care plan, shall be\nbased upon a uniform average of expenditures reflecting a mix of\nprimary, acute and long term care services. Such uniform average, or\naverages, will be determined by the commissioner of health and shall\nreflect the mix of services as applied to the amounts calculated\npursuant to applicable paragraphs (g) and (n) of this subdivision, after\nfirst deducting therefrom any federal funds properly received or to be\nreceived on account of such expenditure.\n * NB Repealed December 31, 2029\n * (r) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department of health on behalf\nof a social services district pursuant to section three hundred\nsixty-seven-b of this title or by a social services district directly,\nfor medical assistance furnished pursuant to the provisions of\nsubparagraph one of paragraph (q) of subdivision four of section three\nhundred sixty-six of this title to children born on or before September\nthirtieth, nineteen hundred eighty-three, shall be made for the full\namount expended for such children, after first deducting therefrom any\nfederal funds properly received or to be received on account of such\nexpenditure.\n * NB Expired April 1, 2005\n * (s) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department of health on behalf\nof a social services district pursuant to section three hundred\nsixty-seven-b of this title or by a social services district directly,\nfor medical assistance furnished pursuant to the provisions of\nsubparagraph one of paragraph (t) of subdivision four of section three\nhundred sixty-six of this title to children, shall be made for the full\namount expended for such children, after first deducting therefrom any\nfederal funds properly received or to be received on account of such\nexpenditure.\n * NB Expired April 1, 2005\n (t) (i) for services provided on or after January first, two thousand\nthree through December thirty-first, two thousand four, fifty percent of\nthe amount expended for health care services under section three hundred\nsixty-nine-ee of this article, after first deducting therefrom any\nfederal funds properly received or to be received on account thereof;\n (ii) for services provided on or after January first, two thousand\nfive, through September thirtieth, two thousand five, seventy-five\npercent of the amount expended for health care services under section\nthree hundred sixty-nine-ee of this article, after first deducting\ntherefrom any federal funds properly received or to be received on\naccount thereof;\n (iii) for services provided on or after October first, two thousand\nfive, through December thirty-first, two thousand five, seventy-five\npercent of the amount expended by the social services district\nconsisting of the city of New York, and one hundred percent of the\namount expended by all other social services districts, for health care\nservices under section three hundred sixty-nine-ee of this article,\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof; and\n (iv) for services provided on or after January first, two thousand six\nthrough December thirty-first, two thousand six, and thereafter, one\nhundred percent of the amount expended for health care services under\nsection three hundred sixty-nine-ee of this article, after first\ndeducting therefrom any federal funds properly received or to be\nreceived on account thereof.\n (u) Notwithstanding any other provision of law, the full amount\nexpended for family planning services provided to eligible persons\npursuant to subparagraph eleven of paragraph (a) of subdivision one of\nsection three hundred sixty-six of this title, after first deducting\ntherefrom federal funds properly received or to be received on account\nof such expenditures.\n (v) One hundred per centum of the amount expended for the\nadministration of medical assistance furnished pursuant to subparagraphs\ntwelve and thirteen of paragraph (a) of subdivision one of section three\nhundred sixty-six of this title, after first deducting any federal funds\nproperly received or to be received on account of such expenditures.\n (w) One hundred per centum of the amount expended for the\nadministration of medical assistance furnished pursuant to paragraph (v)\nof subdivision four of section three hundred sixty-six of this title,\nafter first deducting any federal funds properly received or to be\nreceived on account of such expenditures.\n (x) One hundred percent of the amount expended for health care\nservices as determined in accordance with paragraph (c) of subdivision\nten of section twenty-eight hundred seven-d of the public health law,\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof.\n (y) One hundred percent of the amount expended for health care\nservices as determined in accordance with paragraph (v-1) of subdivision\nfour of section three hundred sixty-six of this title, after first\ndeducting therefrom any federal funds properly received or to be\nreceived on account thereof.\n (z) One hundred percent of the amount expended for health care\nservices described in sections three hundred sixty-eight-d and three\nhundred sixty-eight-e of this title, after first deducting therefrom any\nfederal funds properly received or to be received on account thereof.\n 2. (a) For the purpose of state reimbursement under this title,\nexpenditures for administration of medical assistance for needy persons\nshall include expenditures for salaries of employees of local welfare\ndepartments, except for those excluded under paragraph (b) of this\nsubdivision; operation, maintenance and service costs; and such other\nexpenditures, such as equipment costs, depreciation charges, and rental\nvalues, as may be approved by the department. It shall not include\nexpenditures for capital additions or improvements.\n (b) State reimbursement shall not be made for any part of the salary\nof a social services official, or a chief executive officer of a social\nservices department, whose qualifications do not conform to those fixed\nby the department, or a city or town service officer; nor shall such\nreimbursement be made on the salary of a deputy commissioner, or deputy\ndirector or an employee, unless his employment is necessary for the\nadministration of medical assistance and his qualifications conform to\nthose fixed by the department.\n (c) State reimbursement shall not be made for any part of the salary\nof a local medical director appointed after the effective date of this\nact whose qualifications do not conform to those established pursuant to\nsection three hundred sixty-four of this title.\n (d) State reimbursement shall not be made for any part of the cost of\nthose items of care, services, supplies and equipment, and drugs which\nrepresent co-payment amounts for which a provider of medical assistance\nis authorized to charge a recipient in accordance with subdivision six\nof section three hundred sixty-seven-a of this article.\n * 3. For the purpose of state reimbursement for personal care\nservices, such reimbursement to a social services district shall be\nlimited to expenditures for such district's allocation of the statewide\nneed for personal care services, pursuant to section three hundred\nsixty-seven-d of this chapter.\n * NB Expired March 31, 1985\n 3. (a) Claims for state reimbursement shall be made in such form and\nmanner and at such times and for such periods as the department shall\ndetermine.\n (b) When certified by the department, state reimbursement shall be\npaid from the state treasury upon the audit and warrant of the\ncomptroller out of funds made available therefor.\n (c) When the moneys allotted to the state by the federal department of\nhealth, education and welfare or other authorized federal agency for any\nquarter shall have been received by the department of taxation and\nfinance, the department shall, as soon as possible, certify to the\ncomptroller the amount to which each public welfare district is entitled\nfor such quarter and such amount shall be paid out of the state treasury\nafter audit by the comptroller to the respective public welfare\ndistricts.\n (d) The department is authorized in its discretion to make advances to\npublic welfare districts in anticipation of the state reimbursement\nprovided for in this section.\n 4. Payment of state reimbursement and advances shall be made to the\nfiscal officer of the public welfare district entitled thereto pursuant\nto the provisions of this chapter.\n