N.Y. Comp. Codes R. & Regs. Tit. 10 § 86-4.39 - Computation of basic rates for methadone maintenance treatment services provided by free-standing ambulatory care facilities and hospital outpatient clinic services
(a) For
payments made pursuant to this section and pursuant to section 86- 1.11(h)(5)
of this Part, for methadone maintenance treatment services reimbursement shall
be based upon a fixed weekly payment per recipient.
(b) To be eligible to receive reimbursement
pursuant to this section, facilities must have an operating certificate issued
pursuant to Part 401 of this Title, and be certified to provide outpatient
methadone maintenance treatment services.
(c) The clinic services which shall be
provided to be eligible for reimbursement according to the price as established
by this section includes: urinalysis drug testing, dispensing of methadone,
medical supervision and arranging for appropriate laboratory tests for the
initial and annual physical examinations, preparation and monitoring of
treatment plans, maintenance of patient medical histories, prescribing
methadone dosage, counseling as prescribed in the patients' individual
treatment plan, and maintenance of records.
(d) The weekly price established pursuant to
this section shall be reimbursement for the following, as required by New York
State Office of Alcoholism and Substance Abuse Services in 10 NYCRR Part 1040:
(1) physician services, nursing services,
therapist services, technician services, nutrition services, health education
services, psychosocial services, care coordination services and other related
professional expenses directly incurred by the licensed facility;
(2) space occupancy and plant overhead
costs;
(3) all ancillary procedures
directly related to the provision of services with the exception of laboratory
and diagnostic tests other than urinalysis testing;
(4) all medical supplies and drugs directly
related to the provision of services; and
(5) administrative personnel, business
office, data processing recordkeeping, housekeeping, and other related facility
overhead expenses.
(e)
The methadone maintenance treatment service weekly price shall be established
using 1986 cost and statistical data for the factors listed in subdivision (d)
of this section reported by diagnostic and treatment centers and hospital-based
outpatient programs. Weekly visit utilization shall be based upon the average
daily census information compiled by the New York State Office of Alcoholism
and Substance Abuse Services. The price shall be trended forward in accordance
with subdivision (f) of this section in a manner consistent with the rate
period of the facility's other basic services. After the price has been trended
forward, the price shall be increased by adding the product of the estimated
statewide number of urinalysis tests per week per patient multiplied by the
current Medicaid reimbursement fee for urinalysis toxicology
screening.
(f) The commissioner
shall establish trend factors to project increases in the price during the
effective period of the reimbursement rates. The trend factors shall be
developed using available price indices including elements of the United States
Department of Labor consumer and producer price indices and special price
indices developed by the commissioner for this purpose. The projected trend
factors shall be updated on an annual basis, based upon current and available
data.
(g) The commissioner, in
consultation with the New York State Office of Alcoholism and Substance Abuse
Services, may add or delete health services from the methadone maintenance
treatment services contained in subdivision (c) of this section, if the
commissioner finds that the inclusion or deletion of such services is
appropriate based upon commonly accepted medical standards, current scientific
or medical literature, or the results of properly conducted medical or
scientific research. The commissioner shall notify participating providers of
such changes at least 60 days before such changes shall be effective.
(h) When such an addition or deletion is made
pursuant to subdivision (g) of this section, the price established pursuant to
subdivision (e) of this section shall be adjusted based upon an estimate of the
costs of such added or deleted services efficiently and economically provided
by general hospitals or diagnostic and treatment services.
Notes
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