2014 New York Laws
MHY - Mental Hygiene
Title E - GENERAL PROVISIONS
Article 41 - (41.01 - 41.57) LOCAL SERVICES
41.36 - Community residential facilities.

41.36 Community residential facilities.
(a) As used in this section:
1. "Community  residential  facility"  means  any  facility subject to
  licensure by the office for people with developmental disabilities which
  provides a supervised residence  or  residential  respite  services  for
  individuals  with mental disabilities. Such term does not include family
  care homes.
2. "Reimbursable services" means  services,  other  than  intermediate
  care  services, comprehensive medicaid case management and personal care
  services for which funding is available under Title XIX of  the  federal
  social  security  act,  provided  at  a  community  residential facility
  described  by  regulations  of   the   commissioner   of   developmental
  disabilities  for  which  fees  or  rates  may  be paid to a provider of
  services pursuant to this section.
3. "Income"  means  revenues  received  by  a  provider  of   services
  incidental  to  the  operation  of  a community residential facility and
  includes:
(i) revenues received from other units  of  state,  local  or  federal
  government  in  consideration  for  the  provision of care to a mentally
  disabled person, excluding that portion  of  such  revenue  specifically
  intended  to  offset  capital  costs  and  that  portion of such revenue
  received pursuant to Title XIX of the federal  social  security  act  as
  payment  for  personal  care  services  or  comprehensive  medicaid case
  management services;
(ii) charges received from residents or on  their  behalf  from  third
  party insurers or medical assistance programs; and
(iii)   other  funds  received  in  the  operation  of  the  community
  residential facility.
4. "Provider of services" means a local government,  voluntary  agency
  or  other  entity  or  person  that  provides reimbursable services at a
  community residential facility.
5. "Commissioner"   means   the    commissioner    of    developmental
  disabilities.
(b)  The  commissioner  shall  establish,  by  rules  or  regulations,
  descriptive listings of reimbursable services at  community  residential
  facilities for which payments may be made pursuant to this section. Such
  services  shall include direct care and support staff services, housing,
  administrative services and other than personal services.
(c) The commissioner shall establish  standards  for  programs  funded
  under  this  section  and  shall  by  rule or regulation, subject to the
  approval of the director of the budget, establish fees or rates at least
  annually for each reimbursable  service  to  be  paid  to  providers  of
  services. Fees or rates may be varied for geographic or other reasons.
(d)  Each  local  governmental  unit shall include in its annual local
  plan a review of existing  community  residential  facilities  providing
  reimbursable  services and a recommendation of anticipated needs for the
  development of such facilities, consistent with  the  needs  of  persons
  with  developmental  disabilities  within  the jurisdiction of the local
  governmental unit.
(e) Notwithstanding any inconsistent provision of  this  chapter,  the
  commissioner  may, from monies appropriated by the legislature for state
  aid for services provided pursuant to this article, grant state aid  for
  the operation of a community residential facility through the payment of
  fees or rates for reimbursable services provided at such facility.
(f)  Providers  of  services may apply to the commissioner pursuant to
  this section to receive payment of fees or rates for  the  provision  of
  reimbursable services at community residential facilities.

(g)  The commissioner may, after consideration of the service needs of
  the area in which a community residential facility is  to  operate,  the
  capacity  of  the  facility  to  meet  those  needs, the availability of
  services in the  area,  the  annual  comprehensive  plan  of  the  local
  governmental  unit,  the  recommendations of the local governmental unit
  and the availability  or  resources  therefor,  grant  state  aid  to  a
  provider  of  services for the payment of fees or rates for reimbursable
  services, subject to the provisions of subdivision (h) of this section.
(h) Payments for reimbursable services  shall  be  made  monthly.  The
  commissioner  shall each month advance to providers of services an equal
  monthly proration of fees or rates which may be  paid  for  reimbursable
  services  estimated  to  be provided during the fee or rate period, from
  which shall be deducted income received during the preceding months  and
  rent  charged  clients.  At  the  end  of  each  fee  or rate period, an
  adjustment shall  be  made  so  that  payments  of  fees  or  rates  for
  reimbursable services provided during the fee or rate period shall equal
  fees  or rates for reimbursable services provided during the fee or rate
  period less income received and the rent charged clients as required  in
  this subdivision.
(i)  No  client  shall be denied services because of inability to pay.
  Voluntary agencies and local governments  may  charge  clients  for  the
  provision  of  reimbursable services and shall charge rent in accordance
  with the client's ability to pay and the availability to the  client  of
  health insurance or other third party reimbursement for the provision of
  such  services.  Charge  and  rental schedules shall be developed by the
  commissioner and approved by the director of the budget. Providers shall
  bill third party insurers and other state or local agencies directly  if
  payments  are available from such parties and report to the commissioner
  claims made against them and any  billings  of  clients  for  whom  such
  reimbursement  is not available. Providers shall make reasonable efforts
  to collect such billings.  In  the  event  payment  of  charges  is  not
  received  after such efforts, the provider shall assign the commissioner
  the right to enforce the claim and receive payment. Every  effort  shall
  be made to assure that the process of collection of charges from clients
  does not interfere with the therapeutic program.
(j)  Providers  of  service  shall  be reimbursed for capital costs in
  accordance with the provisions of this section.
(k) Payments pursuant to this section shall be made in lieu  of  state
  aid  for operating costs payable pursuant to any other provision of this
  article.
(l) The operator of a community residential facility may appeal to the
  commissioner  or  his  designee  for  reconsideration  of  his  decision
  regarding authorization of payments to the facility and establishment of
  fees  or  rates  for reimbursable services provided at the facility. The
  commissioner,  after  hearing  such  appeal  or  consideration  of   the
  recommendations of his designee, may amend such decision, subject to the
  approval of the director of the budget.
(m) The commissioner shall issue regulations as necessary to implement
  the  provisions  of this section. Public hearings shall be held prior to
  final issuance of such regulations.
(n) The commissioner shall  establish  a  procedure,  subject  to  the
  approval  of  the state comptroller, whereby payments in addition to the
  client's personal allowance may be made to providers of services for one
  or more of the following needs of clients residing in  such  facilities,
  limited  to  two  hundred  fifty  dollars  per  client per year and paid
  semi-annually in the manner specified by such procedures:
1. Replacement of necessary clothing;
2. Personal requirements and incidental needs of clients;

3. Recreational and cultural activities of clients. Such payments  may
  be  made  from  monies appropriated to the office for this purpose. Such
  payments shall be audited by  the  office  pursuant  to  an  audit  plan
  approved by the comptroller.
(o)  Notwithstanding  any  inconsistent provision of this article, the
  commissioner may reimburse voluntary agencies for the reasonable cost of
  rental of a community residential facility less any income received from
  a state or federal agency or third party insurer which  is  specifically
  intended  to  offset  the  cost  of  rental of the facility or housing a
  client at the facility, subject to the  availability  of  appropriations
  therefor  and  the commissioner's certification of the reasonableness of
  the rental cost, with the approval of the director of the budget.