2006 New York Code - State Reimbursement.

 
    §  368-a.  State  reimbursement.  1.  The  department shall review the
  expenditures made by social services districts  for  medical  assistance
  for  needy  persons,  and  the  administration  thereof,  before  making
  reimbursement. Before approving such expenditures for reimbursement, the
  department shall give due consideration to the results  of  the  reviews
  and audits conducted by the department of health pursuant to subdivision
  two  of section three hundred sixty-four. If approved by the department,
  such expenditures shall not be subject to  reimbursement  by  the  state
  pursuant  to  section  one  hundred fifty-three or any provision of this
  chapter other than this section, but shall be subject  to  reimbursement
  by  the state in accordance with this section and the regulations of the
  department, as follows:
    There shall be paid to each such district
    (a) the amount of federal funds, if any, properly received  or  to  be
  received on account of such expenditures;
    (b)  the  full amount expended on behalf of the department for medical
  assistance furnished under this title  to  eligible  patients  in  state
  institutions  for  the mentally disabled, in facilities or parts thereof
  for the care and treatment of drug dependent persons  operated  pursuant
  to the mental hygiene law and in other hospitals while such patients are
  on release from an institution in the state department of mental hygiene
  or  from  a  drug  abuse  treatment facility or part thereof operated in
  compliance with applicable provisions of law and supervised by the state
  division of substance abuse services, to  eligible  veterans  and  their
  dependents  in  that  part  of  the New York state home for veterans and
  their dependents at Oxford that has been approved pursuant to law  as  a
  nursing  home  and in a hospital while on release from that home for the
  purpose of receiving care in such hospital, in that  part  of  a  public
  institution operated for the care of the mentally disabled that has been
  approved  pursuant  to law as an intermediate care facility, to eligible
  veterans and their dependents in that part of the New  York  state  home
  for  veterans  and  their  dependents  at  Oxford that has been approved
  pursuant to law as an intermediate care facility and in a hospital while
  on release from such intermediate care facilities  for  the  purpose  of
  receiving  care  in  such  hospital, and for the administration thereof,
  after first deducting therefrom any federal funds properly  received  or
  to be received on account thereof;
    (c)  the  full  amount expended for medical assistance furnished under
  this title 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;
    (d) fifty per centum of the amount  expended  for  medical  assistance
  furnished  under  this  title  to  other  eligible  persons, and for the
  administration thereof, after  first  deducting  therefrom  any  federal
  funds properly received or to be received on account thereof.
    (e)  one  hundred percentum of the amount expended for the development
  of medical assistance data systems, after first deducting therefrom  any
  federal  funds  properly  received or to be received on account thereof.
  Such reimbursement shall be available  only  to  the  extent  that  such
  projects  have  received  federal approval and to the extent that claims
  for ninety percent federal aid have been approved.
    (f) The full amount expended on behalf of the department  for  medical
  assistance furnished to persons described in subdivision five of section
  three  hundred  sixty-five of this article, including the administration
  thereof, after first deducting  therefrom  any  federal  funds  properly
  received or to be received on account of such expenditures.
    (g)  Notwithstanding any other provision of law, reimbursement for the
  following services: care, treatment, maintenance and nursing services in
  nursing homes and health related care and services in intermediate  care
  facilities  provided in accordance with paragraph (b) of subdivision two
  of  section  three  hundred  sixty-five-a  of  this  title;  home health
  services provided in accordance with paragraph (d) of subdivision two of
  section three hundred sixty-five-a of this title; personal care services
  provided in accordance with paragraph (e) of subdivision two of  section
  three  hundred  sixty-five-a  of  this title; long term home health care
  programs services provided in  accordance  with  section  three  hundred
  sixty-seven-c  of  this title; and nursing home transition and diversion
  services provided in accordance with subdivision six-a of section  three
  hundred sixty-six of this title shall be made as follows:
    (i)  for services provided on or after January first, nineteen hundred
  eighty-four through December thirty-first, nineteen hundred eighty-four,
  seventy-two per centum after first deducting therefrom any federal funds
  properly received or to be received on account thereof;
    (ii) for services provided on or after January first, nineteen hundred
  eighty-five through December thirty-first, nineteen hundred eighty-five,
  seventy-six per centum after first deducting therefrom any federal funds
  properly received or to be received on account thereof; and
    (iii) for services  provided  on  or  after  January  first,  nineteen
  hundred   eighty-six   through   March  thirty-first,  nineteen  hundred
  ninety-four, eighty per  centum  after  first  deducting  therefrom  any
  federal funds properly received or to be received on account thereof;
    (iv)  for  services provided on or after April first, nineteen hundred
  ninety-four eighty-one  and  two  hundred  thirty-five  thousandths  per
  centum  after  first  deducting  therefrom  any  federal  funds properly
  received or to be received on account thereof.
    (h) (i) Beginning January first,  nineteen  hundred  eighty-four,  one
  hundred  per  centum  of  the amount expended for medical assistance for
  those individuals who are eligible pursuant  to  section  three  hundred
  sixty-six  of  this  article  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 budget after first deducting therefrom any federal funds
  properly received or to be received on account thereof.
    (ii) Notwithstanding any other provision of law to  the  contrary,  on
  and  after  the  effective  date of this subparagraph, the department of
  health shall make no further recovery or recoupment of monies that  were
  advanced  to  local  social  services  districts, during the period from
  April first, nineteen hundred ninety-two to the effective date  of  this
  subparagraph,  to  cover  the  medical assistance costs pursuant to this
  paragraph  for  rehabilitative  services  for  residents  of   community
  residences  licensed  or  operated by the office of mental health or for
  office of mental retardation and  developmental  disabilities  home  and
  community based waiver services.
    (i)  The  full amount expended on behalf of the department for medical
  assistance furnished  to  persons  described  in  subdivision  eight  of
  section   three  hundred  sixty-five  of  this  article,  including  the
  administration thereof, after  first  deducting  therefrom  any  federal
  funds properly received or to be received on account thereof.
    (j)  Notwithstanding  any  other  provision of law, but in conjunction
  with the provisions of paragraph (g) of subdivision one of this section,
  reimbursement for the  care  and  services  provided  to  those  persons
  eligible  pursuant to subparagraph seven of paragraph (a) of subdivision
  one  of  section  three  hundred  sixty-six  of  this  title  shall   be
  seventy-five  per  centum  after  first  deducting therefrom any federal
  funds properly received or to be received on account thereof.
    (k)  Notwithstanding  any other provision of law, reimbursement by the
  state for payments made, whether by the department on behalf of a social
  services district pursuant to section  three  hundred  sixty-seven-b  of
  this   article  or  by  a  social  services  district  directly,  for  a
  supplementary bad debt and charity care adjustment component of rates of
  payment determined in accordance with subdivision fourteen-a of  section
  twenty-eight  hundred  seven-c  of  the  public  health  law for general
  hospital  inpatient  hospital  services  provided  in  accordance   with
  paragraph  (b)  of subdivision two of section three hundred sixty-five-a
  of this article shall be limited to the amount of federal funds properly
  received or to be received on account of  such  expenditures;  provided,
  however,  that  reimbursement  shall  be  made by the state for the full
  amount expended for a supplementary bad debt and charity care adjustment
  for a general hospital operated by the state of New York or by the state
  university of New York, after  first  deducting  therefrom  any  federal
  funds   properly   received  or  to  be  received  on  account  of  such
  expenditure.
    (l) Effective January first, nineteen hundred ninety, one hundred  per
  centum   of  the  amount  expended  for  medical  assistance  for  those
  individuals who are eligible pursuant  to  paragraphs  (n)  and  (o)  of
  subdivision  four  of  section  three  hundred sixty-six of this article
  after first deducting therefrom any federal funds properly  received  or
  to be received on account thereof.
    (m)  Notwithstanding  any other provision of law, reimbursement by the
  state for payments made, whether by the department on behalf of a social
  services district pursuant to section  three  hundred  sixty-seven-b  of
  this   article  or  by  a  social  services  district  directly,  for  a
  supplementary low  income  patient  adjustment  component  of  rates  of
  payment  for  a  public  general  hospital determined in accordance with
  subdivision fourteen-d of section twenty-eight hundred  seven-c  of  the
  public  health  law  for  general  hospital  inpatient hospital services
  provided in accordance with paragraph (b) of subdivision two of  section
  three  hundred  sixty-five-a  of  this  article  shall be limited to the
  amount of federal funds properly received or to be received  on  account
  of  such  expenditures;  provided,  however, that reimbursement shall be
  made by the state for the full amount expended for a  supplementary  low
  income  patient  adjustment for a general hospital operated by the state
  of New York or  by  the  state  university  of  New  York,  after  first
  deducting  therefrom  any  federal  funds  properly  received  or  to be
  received on account of such expenditure.
    (n) Notwithstanding any inconsistent provision of  law,  reimbursement
  for  the  amount  expended  for  medical assistance furnished under this
  title to eligible persons pursuant to a statewide managed care  plan  or
  managed  care  demonstration program, or to eligible persons enrolled in
  any health maintenance organization or other entity authorized by law to
  furnish comprehensive health services  pursuant  to  a  plan,  shall  be
  reimbursed,  after  first deducting therefrom any federal funds properly
  received or to be received on account thereof, in  accordance  with  the
  following  schedule:  (i)  for  services  provided  for the period April
  first, nineteen hundred  ninety-four  to  March  thirty-first,  nineteen
  hundred   ninety-nine,   fifty-three   and  eight  hundred  seventy-five
  ten-thousandths percent thereof; and (ii) for services provided for  the
  period  April first, nineteen hundred ninety-nine to March thirty-first,
  two thousand three, fifty percent thereof.
    (o) Notwithstanding any other provision of law, reimbursement  by  the
  state for payments made, whether by the department on behalf of a social
  services  district  pursuant  to  section three hundred sixty-seven-b of
  this article  or  by  a  social  services  district  directly,  for  the
  component  of  rates  of  payment  for  a general hospital determined in
  accordance   with   paragraph  (s)  of  subdivision  eleven  of  section
  twenty-eight hundred seven-c  of  the  public  health  law  for  general
  hospital   inpatient  hospital  services  provided  in  accordance  with
  paragraph (b) of subdivision two of section three  hundred  sixty-five-a
  of  this  article shall be one hundred per centum of the amount expended
  for medical assistance, after  first  deducting  therefrom  any  federal
  funds   properly   received  or  to  be  received  on  account  of  such
  expenditure.
    (p) Notwithstanding any other provision of law, reimbursement  by  the
  state for payments made, whether by the department on behalf of a social
  services  district  pursuant  to  section three hundred sixty-seven-b of
  this article or by a social services district  directly,  for  a  public
  general  hospital  indigent care adjustment payment for a public general
  hospital determined in accordance with subdivision fourteen-f of section
  twenty-eight hundred seven-c  of  the  public  health  law  for  general
  hospital   inpatient  hospital  services  provided  in  accordance  with
  paragraph (b) of subdivision two of section three  hundred  sixty-five-a
  of this article shall be limited to the amount of federal funds properly
  received  or  to  be received on account of such expenditures; provided,
  however, that reimbursement shall be made by  the  state  for  the  full
  amount  expended  for a public general hospital indigent care adjustment
  for a general hospital operated by the state of New York or by the state
  university of New York, after  first  deducting  therefrom  any  federal
  funds   properly   received  or  to  be  received  on  account  of  such
  expenditure.
    * (q) Notwithstanding any inconsistent provision of  this  chapter  or
  any other provision of law to the contrary, reimbursement for the amount
  expended  for  medical assistance furnished under this title to eligible
  persons for services provided by a managed long term care plan, shall be
  based upon a  uniform  average  of  expenditures  reflecting  a  mix  of
  primary,  acute  and  long  term care services. Such uniform average, or
  averages, will be determined by the commissioner  of  health  and  shall
  reflect  the  mix  of  services  as  applied  to  the amounts calculated
  pursuant to applicable paragraphs (g) and (n) of this subdivision, after
  first deducting therefrom any federal funds properly received or  to  be
  received on account of such expenditure.
    * NB Repealed December 31, 2015
    * (r) Notwithstanding any other provision of law, reimbursement by the
  state  for  payments made, whether by the department of health on behalf
  of  a  social  services  district  pursuant  to  section  three  hundred
  sixty-seven-b  of  this title or by a social services district directly,
  for  medical  assistance  furnished  pursuant  to  the   provisions   of
  subparagraph  one  of paragraph (q) of subdivision four of section three
  hundred sixty-six of this title to children born on or before  September
  thirtieth,  nineteen  hundred  eighty-three,  shall be made for the full
  amount expended for such children, after first deducting  therefrom  any
  federal  funds  properly  received  or to be received on account of such
  expenditure.
    * NB Expired April 1, 2005
    * (s) Notwithstanding any other provision of law, reimbursement by the
  state for payments made, whether by the department of health  on  behalf
  of  a  social  services  district  pursuant  to  section  three  hundred
  sixty-seven-b of this title or by a social services  district  directly,
  for   medical   assistance  furnished  pursuant  to  the  provisions  of
  subparagraph one of paragraph (t) of subdivision four of  section  three
  hundred  sixty-six of this title to children, shall be made for the full
  amount expended for such children, after first deducting  therefrom  any
  federal  funds  properly  received  or to be received on account of such
  expenditure.
    * NB Expired April 1, 2005
    (t)  (i) for services provided on or after January first, two thousand
  three through December thirty-first, two thousand four, fifty percent of
  the amount expended for health care services under section three hundred
  sixty-nine-ee of this  article,  after  first  deducting  therefrom  any
  federal funds properly received or to be received on account thereof;
    (ii)  for  services  provided  on or after January first, two thousand
  five, through  September  thirtieth,  two  thousand  five,  seventy-five
  percent  of  the  amount expended for health care services under section
  three hundred sixty-nine-ee  of  this  article,  after  first  deducting
  therefrom  any  federal  funds  properly  received  or to be received on
  account thereof;
    (iii) for services provided on or after October  first,  two  thousand
  five,  through  December  thirty-first,  two thousand five, seventy-five
  percent  of  the  amount  expended  by  the  social  services   district
  consisting  of  the  city  of  New  York, and one hundred percent of the
  amount expended by all other social services districts, for health  care
  services  under  section  three  hundred  sixty-nine-ee of this article,
  after first deducting therefrom any federal funds properly  received  or
  to be received on account thereof; and
    (iv) for services provided on or after January first, two thousand six
  through  December  thirty-first,  two  thousand six, and thereafter, one
  hundred percent of the amount expended for health  care  services  under
  section  three  hundred  sixty-nine-ee  of  this  article,  after  first
  deducting therefrom  any  federal  funds  properly  received  or  to  be
  received on account thereof.
    (u)  Notwithstanding  any  other  provision  of  law,  the full amount
  expended for family  planning  services  provided  to  eligible  persons
  pursuant  to  subparagraph eleven of paragraph (a) of subdivision one of
  section three hundred sixty-six of this  title,  after  first  deducting
  therefrom  federal  funds properly received or to be received on account
  of such expenditures.
    (v)  One  hundred  per  centum  of  the  amount   expended   for   the
  administration of medical assistance furnished pursuant to subparagraphs
  twelve and thirteen of paragraph (a) of subdivision one of section three
  hundred sixty-six of this title, after first deducting any federal funds
  properly received or to be received on account of such expenditures.
    (w)   One   hundred   per  centum  of  the  amount  expended  for  the
  administration of medical assistance furnished pursuant to paragraph (v)
  of subdivision four of section three hundred sixty-six  of  this  title,
  after  first  deducting  any  federal  funds  properly received or to be
  received on account of such expenditures.
    (x) One hundred  percent  of  the  amount  expended  for  health  care
  services  as  determined in accordance with paragraph (c) of subdivision
  ten of section twenty-eight hundred seven-d of the  public  health  law,
  after  first  deducting therefrom any federal funds properly received or
  to be received on account thereof.
    2. (a) For the  purpose  of  state  reimbursement  under  this  title,
  expenditures  for administration of medical assistance for needy persons
  shall include expenditures for salaries of employees  of  local  welfare
  departments,  except  for  those  excluded  under  paragraph (b) of this
  subdivision; operation, maintenance and service costs;  and  such  other
  expenditures,  such as equipment costs, depreciation charges, and rental
  values, as may be approved by  the  department.  It  shall  not  include
  expenditures for capital additions or improvements.
    (b)  State  reimbursement shall not be made for any part of the salary
  of a social services official, or a chief executive officer of a  social
  services  department, whose qualifications do not conform to those fixed
  by the department, or a city or town service  officer;  nor  shall  such
  reimbursement  be made on the salary of a deputy commissioner, or deputy
  director or an employee, unless his  employment  is  necessary  for  the
  administration  of  medical assistance and his qualifications conform to
  those fixed by the department.
    (c) State reimbursement shall not be made for any part of  the  salary
  of  a  local medical director appointed after the effective date of this
  act whose qualifications do not conform to those established pursuant to
  section three hundred sixty-four of this title.
    (d) State reimbursement shall not be made for any part of the cost  of
  those  items  of care, services, supplies and equipment, and drugs which
  represent co-payment amounts for which a provider of medical  assistance
  is  authorized  to charge a recipient in accordance with subdivision six
  of section three hundred sixty-seven-a of this article.
    * 3.  For  the  purpose  of  state  reimbursement  for  personal  care
  services,  such  reimbursement  to  a  social services district shall be
  limited to expenditures for such district's allocation of the  statewide
  need  for  personal  care  services,  pursuant  to section three hundred
  sixty-seven-d of this chapter.
    * NB Expired March 31, 1985
    3. (a) Claims for state reimbursement shall be made in such  form  and
  manner  and  at  such times and for such periods as the department shall
  determine.
    (b) When certified by the department,  state  reimbursement  shall  be
  paid  from  the  state  treasury  upon  the  audit  and  warrant  of the
  comptroller out of funds made available therefor.
    (c) When the moneys allotted to the state by the federal department of
  health, education and welfare or other authorized federal agency for any
  quarter shall have been received  by  the  department  of  taxation  and
  finance,  the  department  shall,  as  soon  as possible, certify to the
  comptroller the amount to which each public welfare district is entitled
  for such quarter and such amount shall be paid out of the state treasury
  after  audit  by  the  comptroller  to  the  respective  public  welfare
  districts.
    (d) The department is authorized in its discretion to make advances to
  public  welfare  districts  in  anticipation  of the state reimbursement
  provided for in this section.
    4. Payment of state reimbursement and advances shall be  made  to  the
  fiscal  officer of the public welfare district entitled thereto pursuant
  to the provisions of this chapter.