Article 31 Proposed Rule re: Uncompensated Care Funds
March 25, 2020
NYS Council members,
Following is important information impacting Article 31 Outpatient Clinics. As such we felt obliged to make you aware of it despite all the fires that are burning around you at this moment.
Since you are absolutely inundated right now, please rely on us to analyze the information (excerpted below and attached) while you deal with your day to day issues. We will be back to you shortly with more information regarding this Proposed Rule.
As NYS Council members heard from OMH leads during our February 2020 Annual Business Meeting and Lobby Day event, the state’s ability to increase rates for a range of services has been constrained by federal Upper Payment Limit (UPL) regulations. During the meeting OMH officials explained that the state was working on a number of ‘fixes’ to address this situation.
Attached please find one of the proposed fixes — a Proposed Rule Making issued by OMH related to Article 31 Outpatient Clinics and Uncompensated Care Funds. This Proposed Rule is Issued pursuant to the Indigent Care Program to ensure the appropriate allocation of uncompensated care funds which is one factor impacting our ability to remain compliant with federal UPL requirements.
Here is an excerpt from the Proposed Rule:
“…The State Completed an update to the Medicaid Upper Payment Limit for 2018 which identified Article 31 clinics with reimbursement exceeding average costs. The amendment will help to ensure that State resources are used for indigent care and such uncompensated care funds are not allocated to clinics with profits that do not require such resources. These proposed amendments are part of the agency’s periodic review, and will ensure that uncompensated care funds are allocated appropriately through the use of uniform and accurate data, are subject to allocation formulas, and are primarily targeted to subsidize clinics for losses incurred in serving low-income patients that qualify for assistance. These amendments also align and reinforce the goals of the regulation by ensuring fiscally solvent clinics are responsive to the needs of the communities and patient populations they serve.
In particular these amendments include (1) outlining the provider’s meeting such solvency thresholds, responsibility to ensure that no recipient who is otherwise appropriate for admission is denied access to services solely because the recipient does not have coverage or the means to pay the provider’s pay rates or sliding fee scale and (2) providing a mechanism for clinics not meeting established thresholds with such requirements, to shall ensure that no recipient who is otherwise appropriate for admission is denied access to services solely because the recipient does not have creditable coverage or the means to pay the provider’s private pay rates or sliding fee scale…”