[NYAPRS Enews] PROS Update: OMH Letter Clarifies Commitments to Providers

[Harvey Rosenthal]

NYAPRS Note: In the following letter to Occupations, a prominent
community mental health agency in Orange County that is an 'early
adopter' of the NYS Office of Mental Health's new Medicaid license, PROS
(Personalized Recovery Oriented Services), OMH:

*	affirmed its recent policy change to add some state aid to cover
non-Medicaid eligible services and/or people 
*	committed to taking 'administrative and legal' actions to assist
PROS providers in the event that federal audits disallow Medicaid
reimbursement for services OMH believes are reimbursable and
*	promised to restore full state aid funding to PROS programs
should the program ever be suspended or terminated.

As a result, Occupations did indeed go forward and is currently
operating a successful, energized PROS program.

 

Thursday, June 14, 2007

 

To address the PROS implementation concerns identified by your staff in
recent conversations with OMH Field and Central Office staff the
following policies regarding, State aid and PROS funding, potential
disallowances from Federal audits and possible changes on the Federal
level to Medicaid rehabilitation option rules will apply to programs
converting to the licensed PROS program (Part 512 NYCRR):

 

1.     Each licensed PROS program will receive State aid to assist with
the cost of providing services to those individuals who are not eligible
for Medicaid and/or to provide services that are not reimbursable by
Medicaid.  State aid will be provided to each licensed PROS program as
delineated in OMH's spending plan guidelines for the PROS program
initiative.

 

2.     The PROS initiative has been implemented pursuant to the State
Plan Amendment (SPA) which was approved under the Center for Medicaid
and Medicare (CMS) rehabilitation option.  14 NYCRR Part 512 was
promulgated to implement the PROS initiative in accordance with the SPA.
As a result, OMH does not expect Federal disallowances of Medicaid
against agencies that provide, document and bill for services in
accordance with Part 512.  If such disallowances occur, OMH will take
whatever administrative and legal actions are necessary to address the
situation.

 

3.     If the PROS program is suspended or terminated due to changes in
Federal requirements or other factors beyond the control of the PROS
provider, PROS licenses granted under Part 512 will be decertified and,
subject to available appropriation, OMH will restore State aid to the
County at the same levels which existed prior to the implementation of
PROS.  The PROS provider will be given an opportunity to transition the
PROS program back to the type of outpatient program(s) for which it was
licensed by OMH prior to the PROS program and at the capacity for which
they were previously licensed.

 

In conclusion, the positive energy and willingness of Occupations to
implement PROS despite the unavoidable but protracted delays are
evidence of your continued commitment to the improvement of services for
persons with mental illness.  Thank you again for your support and we
look forward to working together toward the continued successful
implementation of the PROS program at Occupations Inc.

 

Sincerely,

 

 

 

________________________                __________________________

Robert W. Myers, Ph.D.                        Martha Schaefer Hayes

        Sr. Deputy Commissioner      Deputy Commissioner, Chief Fiscal
Officer

        Division of Adult Services     Office of Financial Management

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://kilakwa.net/pipermail/nyaprs_kilakwa.net/attachments/20070724/a6730594/attachment.html>