OMH PROS Regs and Rate Hike Approved!

NYAPRS MEMBER ALERT*

We’re very pleased to tell you that the New York State Office of Mental Health’s revised PROS regulation changes and rate increases were approved this week. You can see them at http://www.omh.ny.gov/omhweb/policy_and_regulations/emergency/Part_512_20120911.pdf.

Personalized Recovery Oriented Services (PROS) is New York’s comprehensive recovery oriented Medicaid licensed program for individuals with psychiatric disabilities that was first implemented by Plattsburgh’s Behavioral Health Services North in 2006. “The goal of the program is to integrate treatment, support, and rehabilitation in a manner that facilitates the individual's recovery. Goals for individuals in the program are to: improve functioning, reduce inpatient utilization, reduce emergency services, reduce contact with the criminal justice system, increase employment, attain higher levels of education, and secure preferred housing” (OMH).

The regulations represent “an Emergency Adoption amending 14 NYCRR Part 512 (which) was filed with the Department of State on September 11, 2012. This rule updates and clarifies existing regulations and implements a fee adjustment for PROS programs. The Notice of Emergency Adoption/Proposed Rule Making will be published in the State Register on September 26, 2012, and the public comment period will commence at that time. The Emergency Adoption will be in effect until December 10, 2012.”

Estimates are that PROS programs statewide will see a total increase in the area of $6 million. The rate increases are retroactive to July. Note that there are rate increases in the lower 4 levels and decreases in the top levels of the basic Community Rehabilitation and Support program rates to incentivize more results in less ‘in program’ time. Note too that there are increases to the PROS Clinic (CT) rates. Here’s the rate excerpt from the regs:

Effective [April 1, 2011] July 1, 2012, the monthly base rate and component add‐on schedules for PROS programs are as follows:

(1) Comprehensive PROS programs:

(i) for programs operated in the Downstate Region:

Monthly Base Rate*

Component Add-On

Pre-Adm

Level 1 2-12 Units

Level 2 13-27 Units

Level 3 28-43 Units

Level 4 44-60 Units

Level 5 61+ Units

IR

ORS

CT

$153

[$204] $235

[$442]

$553

[$680] $789

[$884] $866

[$1,074] $998

$414

$355

$[242]

$279

(ii) for programs operated in the Upstate Region:

for programs operated in the Upstate Region:

Monthly Base Rate*

Component Add-On

Pre-Adm

Level 1 2-12 Units

Level 2 13-27 Units

Level 3 28-43 Units

Level 4 44-60 Units

Level 5 61+ Units

IR

ORS

CT

$140

[$186]

$214

[$402]

$503

[$619]

$718

[$803]

$786

[$977] $908

$377

$324

[$242]

$254

* The Monthly Base Rate is determined by the total PROS units associated with a single PROS participant and his or her collateral.

Great thanks are due to the state, to our own NYAPRS PROS Task Force and staff and to our colleagues at the Coalition, who have both long advocated for such changes!

The regulatory and rate changes, along with managed care readiness, will be front and center topics at our upcoming 3rd Annual PROS Implementation Academy, to be held November 15-16, 2012 at the Holiday Inn Wolf Road in Albany. For more details about this and past PROS Academy offerings, please go to http://www.nyaprs.org/conferences/pros-academy/pros-implementation-academy/index.cfm

*If you were a member, you’d have gotten this earlier!

Join NYAPRS at http://www.nyaprs.org/join-us/