What services are exempt from the reduction in accordance with statue

1. Payments whereby Federal law precludes such reduction, including:

  • Federally Qualified Health Center services;
  • Health services provided to Native Americans who reside on reservations and receive services at one of four tribal clinics affiliated with the federal Indian Health Program;
  • Supplemental Medical Insurance - Part A and Part B;
  • State Contribution for Prescription Drug Benefit (aka Medicare Part D payments);
  • Any local share cap payment required by the Federal medical assistance percentages (FMAP) increase legislation;
  • Required payments related to the School Supportive Health Services Program and Preschool Supportive Health Services Program settlement agreement;
  • Hospice services; and Services provided to American citizen repatriates
  • Court orders and judgments

2. Payments that are funded exclusively with federal and/or local funds, including:

  • Upper payment limit payments to non-state owned or operated governmental providers certified under Article 28 of the NYS Public Health Law;
  • Certified public expenditure payments to the NYC Health and Hospital Corporation;
  • Certain disproportionate share payments to non-state operated or owned governmental hospitals; and
  • Services provided to inmates of local correctional facilities

3. Other Payments Excluded:

  • Any reductions related to payments pursuant to Article 32, Article 31 and Article 16 of the mental hygiene law are exempt from the 2% reduction; with the exception of:
    • Hospital based and Freestanding Methadone Maintenance Treatment Programs (MMTP) - 2% Reduction applies
    • All services provided in an Article 28 hospital (including mental health and substance abuse) - 2% Reduction applies
    • However, Outpatient and CPEP programs operated by Art 28 hospitals are Exempt
  • Administration Costs paid to local governments, contractors, and other such entities - Exempt
  • Early Intervention - Exempt
  • DOH TBI Waiver - Exempt
  • Care at Home (CAH) I, II - Exempt
  • Nursing Home Transition Diversion Waiver (NHTD) - Exempt