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11/29/2006 12:00:00 AM

20% Limitation on Part-Time Clinic Thresholds

Subject: 20% Limitation on PT Clinic thresholds

DOH has begun to send out the attached correspondence warning clinics that they are exceeding the 20% limitation on PT thresholds. Rochester has already received this and is preparing a response indicating that their own review does not result in PT Thresholds in excess of the 20% and requests the detail of the visits that serve as a basis for the DOH determination.

The DOH letter speaks to exceeding 20% of Medicaid visits not total visits and it ignores the fact that the regulation speaks to exceeding 20% of total visits an “annual” basis. The letter is based on a projection from the first 3 months of 2006 and cites that compliance was required as of 2005. There is no attachment to the letter containing detail of the identified visits. Also the letter threatens potential recoupment etc. The regulation does not address potential consequences for non-compliance.

Please let me know if you have received this letter and please review your PT clinic thresholds for 2006 to determine if you are exceeding the 20%.

CP of NYS will be contacting DOH to discuss the matter.

[Attachment can be obtained by contacting the Affiliate Services Office at (518) 436-0178.]

Please note new e-mail address for replacement in your address book:  [email protected].  Thank you.

Joanne Genovese

Vice President, Regulatory Affairs

    & Policy Development

Cerebral Palsy Assns. of NYS

90 State Street, Suite 929

Albany, New York   12207

(518) 436-0178

Fax:  (518) 436-8619

[email protected]

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