N.Y. Comp. Codes R. & Regs. tit. 14 § 578.11

Current through Register Vol. 46, No. 45, November 2, 2024

Section 578.11 - Revisions to rates of payment

(a) The commissioner shall consider only those requests for revisions of certified rates which result in a fiscal impact of over one percent of the certified rate, and a minimum of $20,000; and which are based on:

(1) errors made by the Office of Mental Health in the calculation of the rate of payment;

(2) errors in the financial or statistical data submitted to the commissioner by a residential treatment facility;

(3) a substantially changed residential treatment facility determined to have a 20-percent change in certified capacity, or a major change in resident population or resident services, when such changes have been approved by the commissioner. Revisions to the rate may also be initiated by the commissioner pursuant to this subdivision;

(4) additional staffing required to meet accreditation standards of the Joint Commission on Accreditation of Hospitals, up to the full-time equivalent staffing standards approved by the commissioner;

(5) Federal- or State-mandated requirements resulting in increased costs;

(6) capital costs approved through the applicable provisions of the Mental Hygiene Law and Part 551 of this Title;

(7) family therapy expenses, as determined by the commissioner;

(8) nursing services for changes in nursing staff requirements, as determined by the commissioner;

(9) additional staffing and other than personal service expenses, subject to prior written approval from the appropriate regional office and the commissioner's designate, resulting from patients who have been diagnosed with Acquired Immune Deficiency Syndrome (AIDS). Approval for additional staffing and other personal service expenses shall be based on the necessity of such services for the safety and well being of patients and a determination that such expenses are within the appropriate budgetary guidelines.

(b) Request for revision of a certified rate of payment shall be sent to the commissioner by registered or certified mail and shall contain a detailed statement of the basis for the requested revision together with copies of any documentation a residential treatment facility wishes to submit.

(1) A request based upon the grounds set forth pursuant to paragraph (a)(1) or (2) of this section must be accompanied by a detailed statement of the corrected financial or statistical data certified pursuant to section 578.5(c)(2) of this Part.

(2) A request based upon the grounds set forth pursuant to paragraph (a)(1) or (2) of this section shall be submitted within 120 days of receipt by a residential treatment facility of the rate of payment computation sheet.

(3) A request for a revision pursuant to paragraph (a)(3), (4), (5), (6), (7), (8) or (9) of this section must be submitted within 60 days of the close of the rate of payment period in question.

(4) A request for a revision pursuant to paragraph (a)(6) of this section and consistent with this section shall be processed on a semi-annual basis, beginning July 1, 1990.

(c) The residential treatment facility shall be notified in writing of the determination of the request for revision of a certified rate of payment, including a statement of the reasons therefor.

(d) The affirmation or revision of a certified rate of payment resulting from a request for revision of a certified rate of payment shall be final unless within 30 days of receipt of such written determination a residential treatment facility requests a hearing on factual issues determined adversely to the residential treatment facility. Requests for a hearing, and the conduct thereof, shall be in accordance with the provisions of Part 503 of this Title.

(e) A revision to the rate of payment determined pursuant to paragraph (a)(1) or (2) of this section shall be effective on the first day for which the originally certified rate of payment was effective.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 578.11