14 CRR-NY 512.12NY-CRR
14 CRR-NY 512.12
14 CRR-NY 512.12
512.12 Rates of payment.
(a) Rates of payment shall be established on a prospective basis.
(b) Each rate of payment established pursuant to this section shall be a monthly rate determined by the commissioner and approved by the Division of the Budget.
(c) For purposes of this section, the Downstate Region shall mean the following counties: Bronx, Kings, New York, Queens, Richmond, Nassau, Putnam, Rockland, Suffolk and Westchester.
(d) For purposes of this section, the Upstate Region shall mean those counties of New York State that are not listed in subdivision (c) of this section.
(e) Effective April 1, 2015, the monthly base rate and component add-on schedules for PROS programs are as follows:
(1) Comprehensive PROS programs:
(i) for programs operated in the Downstate Region:
| Monthly Base Rate* | Component Add-On | |||||||
| Pre-Adm | Level 1 | Level 2 | Level 3 | Level 4 | Level 5 | IR | ORS | CT |
| 2-12 Units | 13-27 Units | 28-43 Units | 44-60 Units | 61+ Units | ||||
| $153.37 | $235.57 | $554.35 | $790.93 | $868.11 | $1,000.44 | $415.39 | $355.88 | $279.68 |
(ii) for programs operated in the Upstate Region:
| Monthly Base Rate* | Component Add-On | |||||||
| Pre-Adm | Level 1 | Level 2 | Level 3 | Level 4 | Level 5 | IR | ORS | CT |
| 2-12 Units | 13-27 Units | 28-43 Units | 44-60 Units | 61+ Units | ||||
| $140.35 | $214.53 | $504.24 | $719.77 | $787.94 | $910.24 | $377.55 | $324.80 | $254.63 |
*The Monthly Base Rate is determined by the total PROS units associated with a single PROS participant and his or her collateral(s) in a given month.
(2) Limited license PROS programs:
(i) for programs operated in the Downstate Region:
| Reimbursement Category | Monthly Fee |
| Intensive Rehabilitation | $475.16 |
| Ongoing Rehabilitation and Support | $391.95 |
(ii) for programs operated in the Upstate Region:
| Reimbursement Category | Monthly Fee |
| Intensive Rehabilitation | $432.06 |
| Ongoing Rehabilitation and Support | $355.88 |
(f) Hospital-based providers may receive an add-on to their monthly case payment that reflects their capital costs. The commissioner may impose a cap on the revenues generated from this rate add-on.
(1) For PROS programs operated by providers licensed pursuant to article 28 of the Public Health Law, there shall be added an allowance for the cost of capital, which shall be determined by the application of the principles of cost-finding for the Medicare program. No capital expenditure for which approval by the office is required under the applicable provisions of the Mental Hygiene Law or Part 551 of this Title shall be included in allowable capital costs for purposes of rate computation unless such approval has been secured.
(2) Allowable capital expenditures shall not include costs specifically excluded pursuant to section 2807-c of the Public Health Law.
(3) The capital payment per service month for a provider's PROS licensed outpatient mental health programs shall be determined by dividing all allowable capital costs of the provider's PROS programs, after deducting any exclusions, by the annual number of service months for all enrollees of the PROS program.
14 CRR-NY 512.12
Current through August 15, 2021
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IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.