N.Y. Comp. Codes R. & Regs. tit. 14 § 512.20

Current through Register Vol. 46, No. 43, October 23, 2024

Section 512.20 - Target population services

(a) Individuals who are target population members as defined in Section 512.4 of this Part must meet the standard eligibility criteria for enroll- ment in PROS in accordance with Section 512.7 of this Part.

(b) Effective April 1, 2014, the following additional provisions shall apply to PROS providers that are providing services to target population members.

(1) Reimbursement for services to target population members who are in continuous pre-admission status is limited to four consecutive months, whether or not the individual is ultimately admitted to the program. Programs will be reimbursed for pre-admission services for target population members at the existing pre-admission rate plus 25 percent.

(2) Medicaid may reimburse the Intensive Rehabilitation (IR) component add-on for up to 50 percent of a provider's total number of monthly base rate bills submitted annually. IR services provided to target population members shall not count toward the 50 percent limitation for Medicaid reimbursement.

(3) The following Community Rehabilitation and Support (CRS) services will offer an enhanced reimbursement when delivered off site, on separate days, to target population members:

(i) Basic skills living training;

(ii) Benefits and financial management;

(iii) Community living exploration;

(iv) Information and education regarding self help; and

(v) Wellness self management.

(4) If two or three of the identified CRS services are delivered off site to target population members in a calendar month, programs will be reimbursed at the base rate plus $135.33 (upstate) or $150.37 (downstate), effective April 1, 2015. If four or more of the identified CRS services are delivered off site to target population members in a calendar month, programs will be reimbursed at the base rate plus $270.67 (upstate) or $300.73 (downstate), effective April 1, 2015.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 512.20

Adopted, New York State Register November 12, 2014/Volume XXXVI, Issue 45, eff.11/12/2014

Amended New York State Register September 2, 2015/Volume XXXVII, Issue 35, eff.9/2/2015