fiscal officers training manual - New York State Conference of Local ...

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7. NYS Department of Health Medicaid Updates:http://www.health.state.ny.us/health_care/medicaid/program/update/main.htm8. NYS Office of the Medicaid Inspector General (OMIG): http://www.omig.state.ny.us/data/Date: May 1, 2011OMH Review: (none)OASAS Review: (none)OPWDD Review: (none)
Business Process (what is it?)FISCAL OFFICER TRAINING MANUALCOMPREHENSIVE OUTPATIENT PROGRAM SERVICES (COPS)Level I Comprehensive Outpatient Program Services (Level I COPS) is a program which enables a provider of licensedmental health outpatient services to be eligible to receive supplemental medical assistance reimbursement (Level I COPSMedicaid revenue – or simply Level I COPS) in exchange for the provision of enhanced outpatient services in accordancewith 14 New York Codes, Rules and Regulations (NYCRR) Part 592 (the Level I COPS regulations). The LocalGovernmental Unit (LGU) is responsible for ensuring the Level I COPS providers under its jurisdiction provide theenhanced outpatient services consistent with Level I COPS regulations, including a written agreement with designatedproviders, as required by 14 NYCRR Part 592.6 and 592.7.Brief Description of Process: (how does it work?)Level I COPS is paid to providers through the Medicaid payment system. Specifically, by Computer Sciences Corporation(CSC) – the State’s Medicaid paying agent, through the Medicaid Management Information System (MMIS), by way of aprovider and program-specific Level I COPS Medicaid rate add-on (the Level I COPS rate).Level I COPS payments are covered 50% by federal Medicaid and 50% by the State share of Medicaid. Historically, OMHhas recognized state savings by converting State Aid for outpatient mental health programs to Medicaid as part of COPSfunding.Frequency:Level I COPS rates are recalculated for each provider every year based on an updated three year average of Medicaidpaid claims. Rate sheets delineating rate, funding and thresholds are sent to the provider with a notification letter. A copyof the notification letter is sent to the County Mental Health Director.Instructions:1. Level 1 COPS Rates:a. The specifics of each provider’s Level I COPS program are contained in their Level I COPS ratesheet, which is maintained by the Office of Mental Health Comprehensive Outpatient ProgramServices/Community Support Program (OMH COPS/CSP) Rate Setting Unit.b. The Level I COPS rate is calculated by OMH, and is equal to the total Level I COPS funding asdetermined by the LGU (see Part 592.8(c)) for that particular outpatient program, divided by theproduct of (1) the three year average of paid Medicaid claims, from the three most recent fiscal yearsfor which data is available (Data Source: MMIS), (2) 90.9% (the Level I COPS constant – a vacancyfactor to increase the rate), and (3) the provider and program-specific Medicare/Medicaid crossover(crossover) percentage.c. This Level I COPS rate is then added to the Medicaid rates already in effect for that provider, for thatprogram. However, for Article 28 general hospitals, Level I COPS is not added to the clinic collateralor group collateral rate codes, or the CDT collateral or group collateral rate codes.d. Additional detail on the components of COPS rates is available at the first link below in Resources.2. Level 1 COPS Threshold:a. The amount of Level I COPS a provider can retain in any local fiscal year, for a particular Level ICOPS program, is equal to that program’s Level I COPS threshold. The Level I COPS threshold is aprovider and program-specific amount, and is equal to no more than the full annual amount of theLevel I COPS base supplement funding for that program, plus 10%.b. Level I COPS Thresholds for current and prior years are populated in ALFS. The LGU should ensureits subcontracted providers have the correct Level I COPS threshold for budgeting purposes.c. All Clinic services rendered on or after July 1, 2008 will no longer be subject to the Level I COPSReconciliation process. All other programs are subject to the Level I COPS Reconciliation process.3. Level 1 COPS Revenue Reconciliation:a. Level I COPS received in a local fiscal year in excess of that year’s Level I COPS threshold will berecouped by the State through MMIS (see Part 592.4(f)). The LGU or its providers are responsible
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Funding expectancies cannot exceed
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