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