Vital Access Program and Providers
NY-ADR
11/19/14 N.Y. St. Reg. OMH-46-14-00005-EP
NEW YORK STATE REGISTER
VOLUME XXXVI, ISSUE 46
November 19, 2014
RULE MAKING ACTIVITIES
OFFICE OF MENTAL HEALTH
EMERGENCY/PROPOSED RULE MAKING
NO HEARING(S) SCHEDULED
I.D No. OMH-46-14-00005-EP
Filing No. 927
Filing Date. Nov. 04, 2014
Effective Date. Nov. 04, 2014
Vital Access Program and Providers
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Proposed Action:
Addition of Part 530 to Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 7.09, 31.02, 43.02; L. 2014, ch. 53
Finding of necessity for emergency rule:
Preservation of public health, public safety and general welfare.
Specific reasons underlying the finding of necessity:
Chapter 53 of the Laws of 2014 provides for the Commissioners of Health and Mental Hygiene to make available funds to certain designated providers of health and behavioral health services which might be endangered due to shifting demographics and changes in health care financing (Medicaid managed care and Affordable Care Act). The Vital Access Program allows for supplemental funding and/or a temporary rate or fee adjustment that is available to providers of mental health services that are determined by the Commissioner to be essential to the availability of mental health services in a geographic or economic region of the State, but in financial jeopardy due to their payer mix or geographic isolation. This rule making establishes the process by which providers of mental health clinic services may be designated as Vital Access Providers to receive the above-mentioned funding. This proposal has significant impact upon public health, safety and general welfare, since without the Vital Access Program funding, providers of clinic services could be at financial risk, and individuals in need of mental health clinic services would be at risk of not receiving the services they need. Therefore, the rule is being adopted on an emergency basis until such time as it is promulgated through the normal Notice of Proposed Rule Making process, consistent with the State Administrative Procedure Act.
Subject:
Vital Access Program and Providers.
Purpose:
To establish a process by which providers may be designated as Vital Access Providers to receive supplemental funding.
Text of emergency/proposed rule:
PART 530
VITAL ACCESS PROGRAM and PROVIDERS
530.1 Background and Intent.
The purpose of this Part is to provide a means to support the stability and geographic distribution of mental health clinic services throughout all geographic and economic regions of the State. A designation of Vital Access Provider denotes the Commissioner’s determination to ensure patient access to a provider’s essential services otherwise jeopardized by the provider’s payer mix or geographic isolation.
530.2 Legal Base.
(a) Section 7.09 of the Mental Hygiene Law authorizes the Commissioner to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.
(b) Section 31.02 of the Mental Hygiene Law authorizes the Commissioner to issue operating certificates for the provision of inpatient and outpatient mental health services.
(c) Section 43.02 of the Mental Hygiene Law authorizes the Office to establish rates or methods of payment for services at facilities subject to licensure or certification by the Office.
(d) Chapter 53 of the Laws of 2014 authorizes the Commissioner to provide special funding to certain designated providers.
530.3 Definitions.
(a) Vital Access Program (“VAP”) means a program of supplemental funding and/or temporary rate or fee adjustments available to providers of mental health services that are determined by the Commissioner to be essential to the availability of mental health services in a geographic or economic region of the State but in financial jeopardy due to their payer mix or geographic isolation.
(b) Vital Access Provider means a provider of mental health clinic services that is licensed under Article 31 of the Mental Hygiene Law and that is designated by the Commissioner as eligible for participation in the Vital Access Program. It does not include a provider that is licensed under Article 28 of the Public Health Law.
530.4 Vital Access Program.
(a) The Commissioner may accept applications from licensed providers of mental health clinic services requesting designation as a Vital Access Provider eligible to receive supplemental funding or a temporary rate adjustment. The Commissioner may give priority to providers serving regions or populations in the State that he or she shall determine are in special need of services. Such applications must sufficiently demonstrate that:
(1) The provider is essential to maintaining access to the mental health services it is authorized to provide to individuals with mental illness who reside in the geographic or economic region of the State served by the provider;
(2) The provider is in financial jeopardy due to payer mix or geographic isolation;
(3) The additional resources provided by supplemental funding or a rate or fee adjustment will achieve one or more of the following:
(i) protect or enhance access to care;
(ii) protect or enhance quality of care;
(iii) improve the cost effectiveness of the delivery of health care services; or
(iv) otherwise protect or enhance the health care delivery system, as determined by the Commissioner.
(b) Application.
(1) The written application required pursuant to subdivision (a) of this Section shall be submitted to the Commissioner at least sixty (60) days prior to the requested effective date of the designation as a Vital Access Provider and shall include a proposed budget to achieve the goals identified in the application.
(2) The Commissioner may require that applications submitted pursuant to this Section be submitted in response to, and in accordance with, a Request For Applications or a Request For Proposals issued by the Office.
(c) Reimbursement.
A provider that is designated as a Vital Access Provider shall be eligible to receive supplemental funding or a temporary rate or fee adjustment.
(d) Conditions on Approval.
(1) Any temporary rate adjustment issued pursuant to this section shall be in effect for a specified period of time of no more than three years, as determined by the Commissioner, based upon review and approval of a specific plan of action to achieve one or more of the goals set forth in paragraph (3) of this section. At the end of the specified timeframe, the provider shall be reimbursed in accordance with the otherwise applicable rate-setting methodology or fee schedule pertaining to such provider.
(2) The Commissioner may establish, as a condition of designation as a Vital Access Provider benchmarks, goals and standards to be achieved, and may require such periodic reports as he or she shall determine to be necessary to ensure their achievement. A determination by the Commissioner of a failure to demonstrate satisfactory progress in achieving such benchmarks, goals and standard shall be a basis for revoking the provider’s designation as a Vital Access Provider, and terminating the supplemental funding or temporary rate or fee adjustment prior to the end of the specified timeframe.
(3) No portion of the funds received pursuant to this Part shall be used for the payment of any prior debt or obligation incurred by the designated provider, or for any purpose not related to the purposes set forth in this Part.
This notice is intended:
to serve as both a notice of emergency adoption and a notice of proposed rule making. The emergency rule will expire February 1, 2015.
Text of rule and any required statements and analyses may be obtained from:
Sue Watson, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, (518) 474-1331, email: [email protected]
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
45 days after publication of this notice.
Regulatory Impact Statement
1. Statutory Authority: Section 7.09 of the Mental Hygiene Law grants the Commissioner of the Office of Mental Health (Office) the authority and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.
Section 31.02 of the Mental Hygiene Law authorizes the Commissioner to issue operating certificates for the provision of inpatient and outpatient mental health services.
Section 43.02 of the Mental Hygiene Law authorizes the Office to establish rates or methods of payment for services at facilities subject to licensure or certification by the Office.
Chapter 53 of the Laws of 2014 authorizes the Commissioner to provide special funding to certain designated providers.
2. Legislative Objectives: Articles 7, 31 and 43 of the Mental Hygiene Law reflect the Commissioner’s authority to establish regulations regarding mental health programs and establish rates of payments for services under the Medical Assistance program. The rule making furthers the Legislative intent under Article 7 by ensuring that the Office fulfills its responsibility to assure the development of comprehensive plans, programs and services in the care, treatment, rehabilitation and training of persons with mental illness.
3. Needs and Benefits: The Vital Access Program (“VAP”) allows for supplemental funding and/or a temporary rate or fee adjustment that is available to providers of mental health services that are determined by the Commissioner to be essential to the availability of mental health services in a geographic or economic region of the State, but in financial jeopardy due to their payer mix or geographic isolation. This rule making establishes the process by which providers may be designated as Vital Access Providers to receive the above-mentioned funding.
4. Costs:
(a) Cost to State government: These regulatory amendments are expected to result in a cost of $30 million Gross Medicaid in the 2014-2015 State fiscal year and $15 million Gross Medicaid in the 2015-2016 State fiscal year.
(b) Cost to local government: These regulatory amendments are not expected to result in any additional costs to local government.
(c) Cost to regulated parties: These regulatory amendments are not expected to result in any additional costs to regulated parties.
5. Local Government Mandates: The regulation will not mandate any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.
6. Paperwork: This rule making will result in paperwork requirements associated with the written application for VAP approval, which may include preparing responses to a Request for Applications or Request for Proposals issued by the Office.
7. Duplication: The regulatory amendment does not duplicate existing State or Federal requirements.
8. Alternatives: The only alternative would have been inaction. As that would have resulted in those entities otherwise considered to be Vital Access Providers to be unable to receive the funding available through the Vital Access Program, that alternative was necessarily rejected.
9. Federal Standards: The regulatory amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.
10. Compliance Schedule: The regulatory amendment will become effective upon adoption.
Regulatory Flexibility Analysis
The Vital Access Program (“VAP”) allows for supplemental funding and/or a temporary rate or fee adjustment that is available to providers of mental health services that are determined by the Commissioner to be essential to the availability of mental health services in a geographic or economic region of the State, but in financial jeopardy due to their payer mix or geographic isolation. This rule making establishes the process by which providers of mental health clinic services may be designated as Vital Access Providers to receive the above-mentioned funding. As there will be no adverse economic impact on small businesses or local governments as a result of these amendments, a regulatory flexibility analysis is not submitted with this notice.
Rural Area Flexibility Analysis
The Vital Access Program (“VAP”) allows for supplemental funding and/or a temporary rate or fee adjustment that is available to providers of mental health services that are determined by the Commissioner to be essential to the availability of mental health services in a geographic or economic region of the State, but in financial jeopardy due to their payer mix or geographic isolation. This rule making establishes the process by which providers of mental health clinic services may be designated as Vital Access Providers to receive the above-mentioned funding. As there will be no adverse economic impact on rural areas, a rural area flexibility analysis is not submitted with this notice.
Job Impact Statement
A Job Impact Statement is not submitted with this notice because it is evident from the subject matter that there will be no adverse impact on jobs and employment opportunities as a result of these amendments. The new 14 NYCRR Part 530 establishes the process by which providers of mental health clinic services may be designated as Vital Access Providers to receive supplemental funding and/or a temporary rate or fee adjustment consistent with the Vital Access Program (VAP).
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