N.Y. Social Services Law § 368-a: 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 for

people with 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

the office for people with 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, 2029

* (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.

(y) One hundred percent of the amount expended for health care

services as determined in accordance with paragraph (v-1) of subdivision

four of section three hundred sixty-six of this title, after first

deducting therefrom any federal funds properly received or to be

received on account thereof.

(z) One hundred percent of the amount expended for health care

services described in sections three hundred sixty-eight-d and three

hundred sixty-eight-e of this title, 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.