§ 368-a. State reimbursement. 1. The department shall review the
expenditures made by social services districts for medical assistance
for needy persons, and the administration thereof, before making
reimbursement. Before approving such expenditures for reimbursement, the
department shall give due consideration to the results of the reviews
and audits conducted by the department of health pursuant to subdivision
two of section three hundred sixty-four. If approved by the department,
such expenditures shall not be subject to reimbursement by the state
pursuant to section one hundred fifty-three or any provision of this
chapter other than this section, but shall be subject to reimbursement
by the state in accordance with this section and the regulations of the
department, as follows:

There shall be paid to each such district

(a) the amount of federal funds, if any, properly received or to be
received on account of such expenditures;

(b) the full amount expended on behalf of the department for medical
assistance furnished under this title to eligible patients in state
institutions for the mentally disabled, in facilities or parts thereof
for the care and treatment of drug dependent persons operated pursuant
to the mental hygiene law and in other hospitals while such patients are
on release from an institution in the state department of mental hygiene
or from a drug abuse treatment facility or part thereof operated in
compliance with applicable provisions of law and supervised by the state
division of substance abuse services, to eligible veterans and their
dependents in that part of the New York state home for veterans and
their dependents at Oxford that has been approved pursuant to law as a
nursing home and in a hospital while on release from that home for the
purpose of receiving care in such hospital, in that part of a public
institution operated for the care of the mentally disabled that has been
approved pursuant to law as an intermediate care facility, to eligible
veterans and their dependents in that part of the New York state home
for veterans and their dependents at Oxford that has been approved
pursuant to law as an intermediate care facility and in a hospital while
on release from such intermediate care facilities for the purpose of
receiving care in such hospital, and for the administration thereof,
after first deducting therefrom any federal funds properly received or
to be received on account thereof;

(c) the full amount expended for medical assistance furnished under
this title to eligible Indians and members of their families residing on
any Indian reservation in this state, and for the administration
thereof, after first deducting therefrom any federal funds properly
received or to be received on account thereof;

(d) fifty per centum of the amount expended for medical assistance
furnished under this title to other eligible persons, and for the
administration thereof, after first deducting therefrom any federal
funds properly received or to be received on account thereof.

(e) one hundred percentum of the amount expended for the development
of medical assistance data systems, after first deducting therefrom any
federal funds properly received or to be received on account thereof.
Such reimbursement shall be available only to the extent that such
projects have received federal approval and to the extent that claims
for ninety percent federal aid have been approved.

(f) The full amount expended on behalf of the department for medical
assistance furnished to persons described in subdivision five of section
three hundred sixty-five of this article, including the administration
thereof, after first deducting therefrom any federal funds properly
received or to be received on account of such expenditures.

(g) Notwithstanding any other provision of law, reimbursement for the
following services: care, treatment, maintenance and nursing services in
nursing homes and health related care and services in intermediate care
facilities provided in accordance with paragraph (b) of subdivision two
of section three hundred sixty-five-a of this title; home health
services provided in accordance with paragraph (d) of subdivision two of
section three hundred sixty-five-a of this title; personal care services
provided in accordance with paragraph (e) of subdivision two of section
three hundred sixty-five-a of this title; long term home health care
programs services provided in accordance with section three hundred
sixty-seven-c of this title; and nursing home transition and diversion
services provided in accordance with subdivision six-a of section three
hundred sixty-six of this title shall be made as follows:

(i) for services provided on or after January first, nineteen hundred
eighty-four through December thirty-first, nineteen hundred eighty-four,
seventy-two per centum after first deducting therefrom any federal funds
properly received or to be received on account thereof;

(ii) for services provided on or after January first, nineteen hundred
eighty-five through December thirty-first, nineteen hundred eighty-five,
seventy-six per centum after first deducting therefrom any federal funds
properly received or to be received on account thereof; and

(iii) for services provided on or after January first, nineteen
hundred eighty-six through March thirty-first, nineteen hundred
ninety-four, eighty per centum after first deducting therefrom any
federal funds properly received or to be received on account thereof;

(iv) for services provided on or after April first, nineteen hundred
ninety-four eighty-one and two hundred thirty-five thousandths per
centum after first deducting therefrom any federal funds properly
received or to be received on account thereof.

(h) (i) Beginning January first, nineteen hundred eighty-four, one
hundred per centum of the amount expended for medical assistance for
those individuals who are eligible pursuant to section three hundred
sixty-six of this article as a result of a mental disability as
determined by the commissioner in consultation with the commissioner of
the office of mental health and the commissioner of the office for
people with developmental disabilities and with the approval of the
director of the budget after first deducting therefrom any federal funds
properly received or to be received on account thereof.

(ii) Notwithstanding any other provision of law to the contrary, on
and after the effective date of this subparagraph, the department of
health shall make no further recovery or recoupment of monies that were
advanced to local social services districts, during the period from
April first, nineteen hundred ninety-two to the effective date of this
subparagraph, to cover the medical assistance costs pursuant to this
paragraph for rehabilitative services for residents of community
residences licensed or operated by the office of mental health or for
the office for people with developmental disabilities home and community
based waiver services.

(i) The full amount expended on behalf of the department for medical
assistance furnished to persons described in subdivision eight of
section three hundred sixty-five of this article, including the
administration thereof, after first deducting therefrom any federal
funds properly received or to be received on account thereof.

(j) Notwithstanding any other provision of law, but in conjunction
with the provisions of paragraph (g) of subdivision one of this section,
reimbursement for the care and services provided to those persons
eligible pursuant to subparagraph seven of paragraph (a) of subdivision
one of section three hundred sixty-six of this title shall be
seventy-five per centum after first deducting therefrom any federal
funds properly received or to be received on account thereof.

(k) Notwithstanding any other provision of law, reimbursement by the
state for payments made, whether by the department on behalf of a social
services district pursuant to section three hundred sixty-seven-b of
this article or by a social services district directly, for a
supplementary bad debt and charity care adjustment component of rates of
payment determined in accordance with subdivision fourteen-a of section
twenty-eight hundred seven-c of the public health law for general
hospital inpatient hospital services provided in accordance with
paragraph (b) of subdivision two of section three hundred sixty-five-a
of this article shall be limited to the amount of federal funds properly
received or to be received on account of such expenditures; provided,
however, that reimbursement shall be made by the state for the full
amount expended for a supplementary bad debt and charity care adjustment
for a general hospital operated by the state of New York or by the state
university of New York, after first deducting therefrom any federal
funds properly received or to be received on account of such
expenditure.

(l) Effective January first, nineteen hundred ninety, one hundred per
centum of the amount expended for medical assistance for those
individuals who are eligible pursuant to paragraphs (n) and (o) of
subdivision four of section three hundred sixty-six of this article
after first deducting therefrom any federal funds properly received or
to be received on account thereof.

(m) Notwithstanding any other provision of law, reimbursement by the
state for payments made, whether by the department on behalf of a social
services district pursuant to section three hundred sixty-seven-b of
this article or by a social services district directly, for a
supplementary low income patient adjustment component of rates of
payment for a public general hospital determined in accordance with
subdivision fourteen-d of section twenty-eight hundred seven-c of the
public health law for general hospital inpatient hospital services
provided in accordance with paragraph (b) of subdivision two of section
three hundred sixty-five-a of this article shall be limited to the
amount of federal funds properly received or to be received on account
of such expenditures; provided, however, that reimbursement shall be
made by the state for the full amount expended for a supplementary low
income patient adjustment for a general hospital operated by the state
of New York or by the state university of New York, after first
deducting therefrom any federal funds properly received or to be
received on account of such expenditure.

(n) Notwithstanding any inconsistent provision of law, reimbursement
for the amount expended for medical assistance furnished under this
title to eligible persons pursuant to a statewide managed care plan or
managed care demonstration program, or to eligible persons enrolled in
any health maintenance organization or other entity authorized by law to
furnish comprehensive health services pursuant to a plan, shall be
reimbursed, after first deducting therefrom any federal funds properly
received or to be received on account thereof, in accordance with the
following schedule: (i) for services provided for the period April
first, nineteen hundred ninety-four to March thirty-first, nineteen
hundred ninety-nine, fifty-three and eight hundred seventy-five
ten-thousandths percent thereof; and (ii) for services provided for the
period April first, nineteen hundred ninety-nine to March thirty-first,
two thousand three, fifty percent thereof.

(o) Notwithstanding any other provision of law, reimbursement by the
state for payments made, whether by the department on behalf of a social
services district pursuant to section three hundred sixty-seven-b of
this article or by a social services district directly, for the
component of rates of payment for a general hospital determined in
accordance with paragraph (s) of subdivision eleven of section
twenty-eight hundred seven-c of the public health law for general
hospital inpatient hospital services provided in accordance with
paragraph (b) of subdivision two of section three hundred sixty-five-a
of this article shall be one hundred per centum of the amount expended
for medical assistance, after first deducting therefrom any federal
funds properly received or to be received on account of such
expenditure.

(p) Notwithstanding any other provision of law, reimbursement by the
state for payments made, whether by the department on behalf of a social
services district pursuant to section three hundred sixty-seven-b of
this article or by a social services district directly, for a public
general hospital indigent care adjustment payment for a public general
hospital determined in accordance with subdivision fourteen-f of section
twenty-eight hundred seven-c of the public health law for general
hospital inpatient hospital services provided in accordance with
paragraph (b) of subdivision two of section three hundred sixty-five-a
of this article shall be limited to the amount of federal funds properly
received or to be received on account of such expenditures; provided,
however, that reimbursement shall be made by the state for the full
amount expended for a public general hospital indigent care adjustment
for a general hospital operated by the state of New York or by the state
university of New York, after first deducting therefrom any federal
funds properly received or to be received on account of such
expenditure.

* (q) Notwithstanding any inconsistent provision of this chapter or
any other provision of law to the contrary, reimbursement for the amount
expended for medical assistance furnished under this title to eligible
persons for services provided by a managed long term care plan, shall be
based upon a uniform average of expenditures reflecting a mix of
primary, acute and long term care services. Such uniform average, or
averages, will be determined by the commissioner of health and shall
reflect the mix of services as applied to the amounts calculated
pursuant to applicable paragraphs (g) and (n) of this subdivision, after
first deducting therefrom any federal funds properly received or to be
received on account of such expenditure.

* NB Repealed December 31, 2024

* (r) Notwithstanding any other provision of law, reimbursement by the
state for payments made, whether by the department of health on behalf
of a social services district pursuant to section three hundred
sixty-seven-b of this title or by a social services district directly,
for medical assistance furnished pursuant to the provisions of
subparagraph one of paragraph (q) of subdivision four of section three
hundred sixty-six of this title to children born on or before September
thirtieth, nineteen hundred eighty-three, shall be made for the full
amount expended for such children, after first deducting therefrom any
federal funds properly received or to be received on account of such
expenditure.

* NB Expired April 1, 2005

* (s) Notwithstanding any other provision of law, reimbursement by the
state for payments made, whether by the department of health on behalf
of a social services district pursuant to section three hundred
sixty-seven-b of this title or by a social services district directly,
for medical assistance furnished pursuant to the provisions of
subparagraph one of paragraph (t) of subdivision four of section three
hundred sixty-six of this title to children, shall be made for the full
amount expended for such children, after first deducting therefrom any
federal funds properly received or to be received on account of such
expenditure.

* NB Expired April 1, 2005

(t) (i) for services provided on or after January first, two thousand
three through December thirty-first, two thousand four, fifty percent of
the amount expended for health care services under section three hundred
sixty-nine-ee of this article, after first deducting therefrom any
federal funds properly received or to be received on account thereof;

(ii) for services provided on or after January first, two thousand
five, through September thirtieth, two thousand five, seventy-five
percent of the amount expended for health care services under section
three hundred sixty-nine-ee of this article, after first deducting
therefrom any federal funds properly received or to be received on
account thereof;

(iii) for services provided on or after October first, two thousand
five, through December thirty-first, two thousand five, seventy-five
percent of the amount expended by the social services district
consisting of the city of New York, and one hundred percent of the
amount expended by all other social services districts, for health care
services under section three hundred sixty-nine-ee of this article,
after first deducting therefrom any federal funds properly received or
to be received on account thereof; and

(iv) for services provided on or after January first, two thousand six
through December thirty-first, two thousand six, and thereafter, one
hundred percent of the amount expended for health care services under
section three hundred sixty-nine-ee of this article, after first
deducting therefrom any federal funds properly received or to be
received on account thereof.

(u) Notwithstanding any other provision of law, the full amount
expended for family planning services provided to eligible persons
pursuant to subparagraph eleven of paragraph (a) of subdivision one of
section three hundred sixty-six of this title, after first deducting
therefrom federal funds properly received or to be received on account
of such expenditures.

(v) One hundred per centum of the amount expended for the
administration of medical assistance furnished pursuant to subparagraphs
twelve and thirteen of paragraph (a) of subdivision one of section three
hundred sixty-six of this title, after first deducting any federal funds
properly received or to be received on account of such expenditures.

(w) One hundred per centum of the amount expended for the
administration of medical assistance furnished pursuant to paragraph (v)
of subdivision four of section three hundred sixty-six of this title,
after first deducting any federal funds properly received or to be
received on account of such expenditures.

(x) One hundred percent of the amount expended for health care
services as determined in accordance with paragraph (c) of subdivision
ten of section twenty-eight hundred seven-d of the public health law,
after first deducting therefrom any federal funds properly received or
to be received on account thereof.

(y) One hundred percent of the amount expended for health care
services as determined in accordance with paragraph (v-1) of subdivision
four of section three hundred sixty-six of this title, after first
deducting therefrom any federal funds properly received or to be
received on account thereof.

(z) One hundred percent of the amount expended for health care
services described in sections three hundred sixty-eight-d and three
hundred sixty-eight-e of this title, after first deducting therefrom any
federal funds properly received or to be received on account thereof.

2. (a) For the purpose of state reimbursement under this title,
expenditures for administration of medical assistance for needy persons
shall include expenditures for salaries of employees of local welfare
departments, except for those excluded under paragraph (b) of this
subdivision; operation, maintenance and service costs; and such other
expenditures, such as equipment costs, depreciation charges, and rental
values, as may be approved by the department. It shall not include
expenditures for capital additions or improvements.

(b) State reimbursement shall not be made for any part of the salary
of a social services official, or a chief executive officer of a social
services department, whose qualifications do not conform to those fixed
by the department, or a city or town service officer; nor shall such
reimbursement be made on the salary of a deputy commissioner, or deputy
director or an employee, unless his employment is necessary for the
administration of medical assistance and his qualifications conform to
those fixed by the department.

(c) State reimbursement shall not be made for any part of the salary
of a local medical director appointed after the effective date of this
act whose qualifications do not conform to those established pursuant to
section three hundred sixty-four of this title.

(d) State reimbursement shall not be made for any part of the cost of
those items of care, services, supplies and equipment, and drugs which
represent co-payment amounts for which a provider of medical assistance
is authorized to charge a recipient in accordance with subdivision six
of section three hundred sixty-seven-a of this article.

* 3. For the purpose of state reimbursement for personal care
services, such reimbursement to a social services district shall be
limited to expenditures for such district's allocation of the statewide
need for personal care services, pursuant to section three hundred
sixty-seven-d of this chapter.

* NB Expired March 31, 1985

3. (a) Claims for state reimbursement shall be made in such form and
manner and at such times and for such periods as the department shall
determine.

(b) When certified by the department, state reimbursement shall be
paid from the state treasury upon the audit and warrant of the
comptroller out of funds made available therefor.

(c) When the moneys allotted to the state by the federal department of
health, education and welfare or other authorized federal agency for any
quarter shall have been received by the department of taxation and
finance, the department shall, as soon as possible, certify to the
comptroller the amount to which each public welfare district is entitled
for such quarter and such amount shall be paid out of the state treasury
after audit by the comptroller to the respective public welfare
districts.

(d) The department is authorized in its discretion to make advances to
public welfare districts in anticipation of the state reimbursement
provided for in this section.

4. Payment of state reimbursement and advances shall be made to the
fiscal officer of the public welfare district entitled thereto pursuant
to the provisions of this chapter.