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for the accounting/tracking of the amount of COPS received. Level I COPS payment report willbe sent to each provider detailing the amount of Level I COPS that OMH has determined the providerreceived, as compared to their threshold for the program for the fiscal year, during the reconciliationprocess. Providers will have an opportunity to verify the data used to calculate the recovery amountby the OMH before implementation of the recovery by MMIS. Included in any notice of recovery ofoverpayment will be a description of the recovery process, as well as the date the request forrecovery would be sent to MMIS.b. Any Level I COPS revenue received in excess of the Level I COPS threshold must be kept in areserve account for future recovery by the OMH.c. An LGU or provider may appeal the COPS recovery amount by following the instructions on thereconciliation notification letter that is sent with the Level I COPS payment report.NOTE: If an overpayment occurs, the recovery process can be a one-time reduction to the first Medicaid paymentprocessed and paid after OMH notifies DOH, a check payable to NYSDOH for the full amount or a series of 10%reductions (or larger if you request a percentage increase) of future Medicaid checks. Keep in mind that interestwill be charge equal to prime-plus 2% on any unpaid balance beginning 90 days after the date that DOH isnotified by OMH.4. Level 1 COPS Reporting and Claiming:a. Article 31 and D&TC providers should account for Level I COPS on the Level I COPS cash basis.According to this accounting basis, Level I COPS is considered paid consistent with the date on theMedicaid check, and assumes that any retroactive Level I COPS rate changes are repatriated to theiroriginal payment date by the provider.b. Article 28 general hospitals should account for Level I COPS on the Level I COPS accrual basis.According to this accounting basis, Level I COPS is considered paid consistent with the descriptionprovided above for Article 31 and D&TC providers.c. Additional detail and examples of Level 1 COPS Reporting and Claiming is available at the first linkbelow in Resources.d. Please see Appendix DD of the Consolidated Budget Report (CBR) and Consolidated Fiscal Reports(CFR) manuals for budgeting and claiming guidelines. See link to Appendix DD below in Resources.5. Level 1 COPS Reallocations and Program Closure:a. The LGU may reallocate a portion of a Level I COPS provider’s allocation to one or more of theirother Level I COPS providers, limited to the level of Level I COPS underachievement experienced byall providers in the county.b. If the program associated with the Level I COPS closes, the LGU can request that the Level I COPSallocation be reallocated to another provider operating a Level I COPS qualifying program or that theLevel I COPS funding be converted to State Aid for $.50 on the dollar.Resources:1. COPS Level 1 Description (OMH Website) -http://www.omh.state.ny.us/omhweb/spguidelines/HTML/cops_level_1.html2. CBR/CCR Manual – Appendix DD - http://www.omh.state.ny.us/omhweb/cbr/manual.pdf#page=3513. NYS OMH Regulations – Part 592 Comprehensive Outpatient Programs - link not available4. NYS OMH Regulations – Part 599 Clinic Treatment Programs (supersedes Part 592 for Clinic TreatmentPrograms) http://www.omh.state.ny.us/omhweb/policy_and_regulations/Adoption/Part_599_20100630.html5. NYS Conference of Local Mental Hygiene Directors – Fiscal Brief – COPS -http://clmhd.org/resources/resources.aspx#637 (bit outdated now…)Date: May 1, 2011OMH Review: (none)
Business Process (what is it?)FISCAL OFFICER TRAINING MANUALCOMMUNITY SUPPORT PROGRAM SERVICES (CSP)Community Support Program (CSP) Medicaid is a NYS Office of Mental Health initiative for certain community-basedmental health programs.Office of Mental Health (OMH) maintains the responsibility for CSP Medicaid rate setting, as described in 14 New YorkCodes, Rules and Regulations (NYCRR) Part 588.14.Brief Description of Process: (how does it work?)CSP Medicaid is paid to providers by the Medicaid payment system (MMIS) as an add-on to certain outpatient rates(Clinic, Continuing Day Treatment (CDT), or Day Treatment) on a program specific basis. Therefore, each Medicaid visitto an outpatient program may include the base Medicaid payment, plus the CSP Medicaid payment (and some providersmay also receive a Comprehensive Outpatient Program Services (COPS) Medicaid payment or a Level II COPS feesupplement Medicaid payment). The CSP Medicaid revenue generated in the outpatient program is then used by theagency in the designated CSP programs.Frequency:CSP Medicaid rates are recalculated annually based on an updated three-year average of the number of Medicaid paidclaims.Instructions:1. CSP Medicaid Rates:a. The OMH maintains rate sheets to document CSP Medicaid rate calculations on a provider specificbasis.b. The CSP Medicaid rate is calculated by OMH, and is equal to the CSP base supplement funding forall CSP programs eligible for CSP Medicaid, divided by the product of (1) the estimated annualnumber of Medicaid paid claims that will generate CSP payments (this estimate represents the threeyearaverage of the Medicaid paid claims for the specific program that the CSP rate will be added to,for the three most recent fiscal years for which data is available) and (2) the CSP constant of 89%.The constant represents a vacancy factor built into the rate calculation methodology.c. The calculated CSP Medicaid rate is added to the standard base Medicaid rate that is already ineffect for the provider and the program. However, for Article 28 general hospitals, the CSP Medicaidrate is not added to Clinic or CDT collateral or group collateral type visits.d. Additional detail on the components of CSP rates is available at the first link below in Resources.2. CSP Medicaid Threshold:a. The maximum amount of CSP Medicaid revenue that a provider can retain on an annual basis isequal to that provider’s CSP Medicaid threshold. The CSP Medicaid threshold is equal to the fullannual amount of provider’s CSP base supplement funding.b. The CSP threshold can be found in the COPS/CSP Table in ALFS. The table reflects the annual CSPthreshold by provider as well as a breakout of the anticipated CSP revenue by CSP program.3. CSP Revenue Reconciliation:a. CSP received in a local fiscal year in excess of that year’s CSP threshold will be recouped by theState through MMIS (see Part 588.14(f)). A CSP payment report will be sent to each providerdetailing the amount of CSP that OMH has determined the provider received during the reconciliationprocess. Providers will have an opportunity to verify the data used to calculate the recovery amountby the OMH before implementation of the recovery by MMIS. Included in any notice of recovery ofoverpayment will be a description of the recovery process, as well as the date the request forrecovery would be sent to MMISb. Any CSP revenue received in excess of the CSP threshold must be kept in a reserve accountfor future recovery by the OMH (CSP Liability).
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2. NYS Uncompensated Care:https://w
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Funding expectancies cannot exceed
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Resources:SP Guidelines, Case Manag
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• Lodging/Respite/Hotel: Money us
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Fiscal activity related to Clinic-P
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At this time, CMS has not yet appro
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