PROS: ADOPTION OF RULE CHANGE

Although this is normally outside ACL’s bailiwick, we thought those of you who operate PROS programs would be interested in this final rule adoption effective today.  They deleted the Bolded Segment.

(ii) Medicaid may reimburse for services provided to a PROS participant in a given month in a clinic [only if the clinic provider and the PROS provider are not operated by the same sponsor, and] as long as the individual is not registered in the PROS clinical treatment component.

SO THAT IT NOW READS:

(ii) Medicaid may reimburse for services provided to a PROS participant in a given month in a clinic as long as the individual is not registered in the PROS clinical treatment component.

More detail below.

NOTICE OF ADOPTION
Office of Mental Health
Personalized Recovery Oriented Services (PROS)
I.D. No. OMH-43-19-00008-A Filing No. 27
Filing Date: 2020-01-13

Effective Date: January 29, 2020

NOTICE is hereby given of the following action:

Action taken: Amendment of Part 512 of Title 14 NYCRR.

Subject: Personalized Recovery Oriented Services (PROS).

Purpose: To allow PROS participants to receive Clinic Treatment from an article 31 Clinic operated by the same agency.
Text or summary was published in the October 23, 2019 issue of the Register, I.D. No. OMH-43-19-00008-P.
Final rule as compared with last published rule: No changes.

Personalized Recovery Oriented Services (PROS)

NOTICE is hereby given of the following proposed rule:
Proposed Action: This is a consensus rulemaking to amend Part 512.11 of Title 14 NYCRR.

Text of proposed rule: Text is deleted and added to subdivision (f)(ii) of section 512.11 of Title 14 NYCRR to read as follows:

(ii) Medicaid may reimburse for services provided to a PROS participant in a given month in a clinic [only if the clinic provider and the PROS provider are not operated by the same sponsor, and] as long as the individual is not registered in the PROS clinical treatment component.

RATIONALE:

The PROS regulations have been amended several times since they were originally promulgated in 2005. Section 512.11 of the Office of Mental Health (OMH) regulations currently prohibit co-enrollment in a PROS with Clinic Treatment and an Article 31 Clinic operated by the same sponsor. This means that PROS participants can choose to receive Clinical Treatment from the PROS, if it is available, or from an Article 31 elsewhere in the community operated by a different sponsor. As a result, this requires the individual to seek Clinic Treatment services through another agency, which can lead to less integrated services and restricts personal choice. Conversely, individuals receiving services at an Article 31 Clinic operated by the same sponsor agency cannot participate in PROS for rehabilitation (skill development) regardless of need and interest in goals that may related to employment, education, housing, etc. Therefore, Article 31 clients who are reluctant to give up their relationship with their therapist simply because the Article 31 Clinic is operated by the same sponsor may opt to forgo recommended rehabilitation services through the PROS. This co-enrollment restriction was intended to prevent duplication of services and, therefore, duplicative payments. This regulation was written at least twelve years ago, and since that time, there are multiple ways to ensure there is not a duplication of services which includes Care Management, an internal EHR (Electronic Health Record) shared by all agency programs, along with the agency tracking a person’s care. In addition, Managed Care Organizations have become key stakeholders as a payer of services and monitor a person’s rehabilitation and treatment. Job Impact Statement A Job Impact Statement is not submitted with this notice because the purpose of the amendment is to provide integrated services and increase the participants ability to stay with a current treatment provider. It is evident from the rule making that there will be no adverse impact on jobs and employment opportunities.

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