N.Y. Mental Hyg. Law § 41.36

§ 41.36 Community residential facilities.\n (a) As used in this section:\n 1. "Community residential facility" means any facility subject to\nlicensure by the office for people with developmental disabilities which\nprovides a supervised residence or residential respite services for\nindividuals with mental disabilities. Such term does not include family\ncare homes.\n 2. "Reimbursable services" means services, other than intermediate\ncare services, comprehensive medicaid case management and personal care\nservices for which funding is available under Title XIX of the federal\nsocial security act, provided at a community residential facility\ndescribed by regulations of the commissioner of developmental\ndisabilities for which fees or rates may be paid to a provider of\nservices pursuant to this section.\n 3. "Income" means revenues received by a provider of services\nincidental to the operation of a community residential facility and\nincludes:\n (i) revenues received from other units of state, local or federal\ngovernment in consideration for the provision of care to a mentally\ndisabled person, excluding that portion of such revenue specifically\nintended to offset capital costs and that portion of such revenue\nreceived pursuant to Title XIX of the federal social security act as\npayment for personal care services or comprehensive medicaid case\nmanagement services;\n (ii) charges received from residents or on their behalf from third\nparty insurers or medical assistance programs; and\n (iii) other funds received in the operation of the community\nresidential facility.\n 4. "Provider of services" means a local government, voluntary agency\nor other entity or person that provides reimbursable services at a\ncommunity residential facility.\n 5. "Commissioner" means the commissioner of developmental\ndisabilities.\n (b) The commissioner shall establish, by rules or regulations,\ndescriptive listings of reimbursable services at community residential\nfacilities for which payments may be made pursuant to this section. Such\nservices shall include direct care and support staff services, housing,\nadministrative services and other than personal services.\n (c) The commissioner shall establish standards for programs funded\nunder this section and shall by rule or regulation, subject to the\napproval of the director of the budget, establish fees or rates at least\nannually for each reimbursable service to be paid to providers of\nservices. Fees or rates may be varied for geographic or other reasons.\n (d) Each local governmental unit shall include in its annual local\nplan a review of existing community residential facilities providing\nreimbursable services and a recommendation of anticipated needs for the\ndevelopment of such facilities, consistent with the needs of persons\nwith developmental disabilities within the jurisdiction of the local\ngovernmental unit.\n (e) Notwithstanding any inconsistent provision of this chapter, the\ncommissioner may, from monies appropriated by the legislature for state\naid for services provided pursuant to this article, grant state aid for\nthe operation of a community residential facility through the payment of\nfees or rates for reimbursable services provided at such facility.\n (f) Providers of services may apply to the commissioner pursuant to\nthis section to receive payment of fees or rates for the provision of\nreimbursable services at community residential facilities.\n (g) The commissioner may, after consideration of the service needs of\nthe area in which a community residential facility is to operate, the\ncapacity of the facility to meet those needs, the availability of\nservices in the area, the annual comprehensive plan of the local\ngovernmental unit, the recommendations of the local governmental unit\nand the availability or resources therefor, grant state aid to a\nprovider of services for the payment of fees or rates for reimbursable\nservices, subject to the provisions of subdivision (h) of this section.\n (h) Payments for reimbursable services shall be made monthly. The\ncommissioner shall each month advance to providers of services an equal\nmonthly proration of fees or rates which may be paid for reimbursable\nservices estimated to be provided during the fee or rate period, from\nwhich shall be deducted income received during the preceding months and\nrent charged clients. At the end of each fee or rate period, an\nadjustment shall be made so that payments of fees or rates for\nreimbursable services provided during the fee or rate period shall equal\nfees or rates for reimbursable services provided during the fee or rate\nperiod less income received and the rent charged clients as required in\nthis subdivision.\n (i) No client shall be denied services because of inability to pay.\nVoluntary agencies and local governments may charge clients for the\nprovision of reimbursable services and shall charge rent in accordance\nwith the client's ability to pay and the availability to the client of\nhealth insurance or other third party reimbursement for the provision of\nsuch services. Charge and rental schedules shall be developed by the\ncommissioner and approved by the director of the budget. Providers shall\nbill third party insurers and other state or local agencies directly if\npayments are available from such parties and report to the commissioner\nclaims made against them and any billings of clients for whom such\nreimbursement is not available. Providers shall make reasonable efforts\nto collect such billings. In the event payment of charges is not\nreceived after such efforts, the provider shall assign the commissioner\nthe right to enforce the claim and receive payment. Every effort shall\nbe made to assure that the process of collection of charges from clients\ndoes not interfere with the therapeutic program.\n (j) Providers of service shall be reimbursed for capital costs in\naccordance with the provisions of this section.\n (k) Payments pursuant to this section shall be made in lieu of state\naid for operating costs payable pursuant to any other provision of this\narticle.\n (l) The operator of a community residential facility may appeal to the\ncommissioner or his designee for reconsideration of his decision\nregarding authorization of payments to the facility and establishment of\nfees or rates for reimbursable services provided at the facility. The\ncommissioner, after hearing such appeal or consideration of the\nrecommendations of his designee, may amend such decision, subject to the\napproval of the director of the budget.\n (m) The commissioner shall issue regulations as necessary to implement\nthe provisions of this section. Public hearings shall be held prior to\nfinal issuance of such regulations.\n (n) The commissioner shall establish a procedure, subject to the\napproval of the state comptroller, whereby payments in addition to the\nclient's personal allowance may be made to providers of services for one\nor more of the following needs of clients residing in such facilities,\nlimited to two hundred fifty dollars per client per year and paid\nsemi-annually in the manner specified by such procedures:\n 1. Replacement of necessary clothing;\n 2. Personal requirements and incidental needs of clients;\n 3. Recreational and cultural activities of clients. Such payments may\nbe made from monies appropriated to the office for this purpose. Such\npayments shall be audited by the office pursuant to an audit plan\napproved by the comptroller.\n (o) Notwithstanding any inconsistent provision of this article, the\ncommissioner may reimburse voluntary agencies for the reasonable cost of\nrental of a community residential facility less any income received from\na state or federal agency or third party insurer which is specifically\nintended to offset the cost of rental of the facility or housing a\nclient at the facility, subject to the availability of appropriations\ntherefor and the commissioner's certification of the reasonableness of\nthe rental cost, with the approval of the director of the budget.\n