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

FISCAL OFFICER TRAINING MANUALUNCOMPENSATED CARE REPORTBusiness Process: (what is it?)As part of the Clinic and Ambulatory Restructuring project, New York State has submitted a federal Medicaid waiverrequest to establish an uncompensated care funding pool for mental health clinics that is jointly funded by the state andfederal government. Assuming the waiver is approved, the pool will offset a portion of losses from uncompensated careexperienced by Diagnostic and Treatment Centers licensed by DOH and Mental health clinics licensed by OMH that arenot affiliated with hospitals or directly operated by OMH.Brief Description of Process: (how does it work?)Payments from the uncompensated care pool will be made in accordance with payment rules established by the OMHand DOH. Agencies that do not submit annual data for each of their clinic locations by the dates established by OMH willbe excluded from the pool for that year.Pending approval of the waiver request, periodic partial payments from the pool will be made by the Department ofHealth. After a transition period for mental health clinics (described below), payments from the pool will be based onannual data from two years prior.Units of Service by Payor and Program/Site is be used to determine the eligibility for possible payments through theUncompensated Care Pool.The percent of uncompensated care paid by the pool is dependent on the total funds in the pool and the total volume ofallowable uncompensated care visits. To be eligible for an allocation of funds from the pool, a mental health clinic mustdemonstrate that a minimum of five percent of total clinic visits during the applicable period were for visits covered by theuncompensated care pool.Mental health clinics qualifying for a distribution from the fund will need to provide OMH with assurances that it undertookreasonable efforts to maintain financial support from community and public funding sources and made reasonable effortsto collect payments for services from third-party insurance payers, governmental payers and self-paying patients. This issubject to audit. OMH anticipates that visits can be counted toward uncompensated care volume if they meet the certaineligibility conditions.Frequency:Agencies submit annual data for each of their clinic locations. Beginning with calendar year 2011-2012 for July-June CFRfilers and 2012 for calendar year CFR filers, uncompensated care data will be required as part of the CFR ScheduleOMH-4.Instructions:The CFR Schedule OMH-4 is used to determine the eligibility for possible payments through the Uncompensated CarePool.This schedule must be completed based on the date of service rendered and only for services provided during thereporting period. For the purposes of this schedule, a visit is defined as including all procedures provided to a patient onthe same day, and is referred to as a threshold visit.