N.Y. Social Services Law Section 364-G
Medical assistance capitation rate demonstration project


1.

The department and the county of Monroe are authorized to participate in the “Monroe County Medicap Plan” research and demonstration project, for the purpose of testing the feasibility of converting from a fee for service payment system to a capitation payment system as a means of financing health care services for medicaid recipients residing in Monroe county.

2.

The department shall undertake the research and demonstration project authorized by this section only if it has determined that there is a reasonable expectation that the total cost of benefits under such project would be less than the total cost of benefits if the project was not in effect.

3.

Expenditures made in connection with the research and demonstration project authorized by this section shall be subject to state reimbursement in accordance with a schedule of reimbursable amounts approved by the department, the department of health and the director of the budget.

4.

The department shall, in a manner to be decided upon by the commissioner, determine what portion of the total expenditures made under the research and demonstration project authorized by this section are attributable to the provision of the services specified in paragraph (g) of subdivision one of § 368-A (State reimbursement)section three hundred sixty-eight-a of this title, and shall ensure that the increased state reimbursement available for such services shall be provided.

5.

Notwithstanding any inconsistent provision of this chapter or any other law to the contrary, the commissioner may, subject to the approval of the director of the budget, apply for appropriate waivers of federal law and regulation, and shall be authorized to waive any provisions of sections three hundred sixty-six, three hundred sixty-seven-b and three hundred sixty-eight-a of this title and accompanying regulations of the department, consistent with waivers approved by the federal department of health and human services, when such action would be necessary to assist in promoting the objectives of this section; provided, however, that in the event that the research and demonstration project authorized by this section requires a waiver of article twenty-eight or forty-four of the public health law or accompanying regulations of the department of health, the project shall be conducted jointly with the department of health, and the commissioner of health may waive such provisions of the public health law or department of health regulations with the approval of the commissioner and the director of the budget.

6.

Every person eligible for or receiving medical assistance who resides in the county of Monroe shall participate in the demonstration project authorized by this section except for good cause as defined by the commissioner in regulation.

7.

Notwithstanding any inconsistent provisions of this section, participation in the project authorized by this section shall not affect a recipient’s medical assistance eligibility or the scope of available medical services to which he or she is entitled.

8.

The department and the county of Monroe shall jointly submit to the governor and the legislature a long term care capitation implementation plan by March thirty-first, nineteen hundred eighty-five.

9.

Providers participating in the research and demonstration project authorized by this section shall submit reports to the commissioner, at such times as he may require, evaluating the results of such project.

10.

The department shall submit to the governor and the legislature an interim report and a final report evaluating the project’s impact on medicaid costs, access to services, quality of services rendered and any other subjects which the commissioner shall deem relevant. The interim report shall be due January first, nineteen hundred eighty-six and the final report shall be due at the conclusion of the project.

11.

This section shall be effective if, and as long as, federal financial participation is available for expenditures made for the project conducted pursuant to the provisions of this section. * NB Expired March 31, 1988 per sub 11

Source: Section 364-G — Medical assistance capitation rate demonstration project, https://www.­nysenate.­gov/legislation/laws/SOS/364-G (updated Sep. 22, 2014; accessed Jul. 13, 2024).

363
Declaration of objects
363‑A
Federal aid
363‑B
Agreements for federal determination of eligibility of aged, blind and disabled persons for medical assistance
363‑C
Medicaid management
363‑D
Provider compliance program
363‑E
Medicaid plan, applications for waivers and plan amendments
363‑F
Electronic visit verification for personal care and home health providers
364
Responsibility for standards
364‑A
Cooperation of state departments
364‑B
Residential and medical care placement demonstration projects
364‑C
National long term care channeling demonstration project
364‑D
Medical assistance research and demonstration projects
364‑E
Aid to families with dependent children homemaker/home health aide demonstration projects
364‑F
Primary care case management programs
364‑G
Medical assistance capitation rate demonstration project
364‑H
Foster family care demonstration programs for elderly or disabled persons
364‑I
Medical assistance presumptive eligibility program
364‑J
Managed care programs
364‑J‑2
Transitional supplemental payments
364‑JJ
Special advisory review panel on Medicaid managed care
364‑KK
Condition of Participation
364‑M
Statewide patient centered medical home program
364‑N
Diabetes and chronic disease self-management pilot program
365
Responsibility for assistance
365‑A
Character and adequacy of assistance
365‑B
Local medical plans: professional directors
365‑C
Medical advisory committee
365‑D
Medicaid evidence based benefit review advisory committee
365‑E
Optional or continued membership in entities offering comprehensive health services plans
365‑F
Consumer directed personal assistance program
365‑G
Utilization review for certain care, services and supplies
365‑H
Provision and reimbursement of transportation costs
365‑J
Advisory opinions
365‑K
Provision of prenatal care services
365‑L
Health homes
365‑M
Administration and management of behavioral health services
365‑N
Department of health assumption of program administration
365‑O
Provision and coverage of services for living organ donors
365‑P
Doulas for Medicaid
366
Eligibility
366‑A
Applications for assistance
366‑B
Penalties for fraudulent practices
366‑C
Treatment of income and resources of institutionalized persons
366‑D
Medical assistance provider
366‑E
Certified home health agency medicare billing
366‑F
Persons acting in concert with a medical assistance provider
366‑G
Newborn enrollment for medical assistance
366‑H
Automated system
366‑I
Long-term care financing demonstration program
367
Authorization for hospital care
367‑A
Payments
367‑B
Medical assistance information and payment system
367‑C
Payment for long term home health care programs
367‑D
Personal care need determination
367‑E
Payment for AIDS home care programs
367‑F
Partnership for long term care program
367‑G
Authorization and provision of personal emergency response services
367‑H
Payment for assisted living programs
367‑I
Personal care services provider assessments
367‑O
Health insurance demonstration programs
367‑P
Responsibilities of local districts for personal care services, home care services and private duty nursing
367‑P*2
Payment for limited home care services agencies
367‑Q
Personal care services worker recruitment and retention program
367‑R
Private duty nursing services worker recruitment and retention program
367‑S
Long term care demonstration program
367‑S*2
Emergency medical transportation services
367‑T
Payment for emergency physician services
367‑U
Payment for home telehealth services
367‑V
County long-term care financing demonstration program
367‑W
Health care and mental hygiene worker bonuses
367‑X
Payment for violence prevention programs
368
Quarterly estimates
368‑A
State reimbursement
368‑B
State reimbursement to local health districts
368‑C
Audit of state rates of payment to providers of health care services
368‑D
Reimbursement to public school districts and state operated/state supported schools which operate pursuant to article eighty-five, eighty...
368‑E
Reimbursement to counties for pre-school children with handicapping conditions
368‑F
Reimbursement of costs under the early intervention program
369
Application of other provisions

Accessed:
Jul. 13, 2024

Last modified:
Sep. 22, 2014

§ 364-G’s source at nysenate​.gov

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