Section 41.36. Community residential facilities

(a) As used in this section:
    1. "Community  residential  facility"  means  any  facility subject to
  licensure  by  the  office  of  mental  retardation  and   developmental
  disabilities  which  provides  a  supervised  residence  or  residential
  respite services for mentally  disabled  persons.  Such  term  does  not
  include family care homes.
    2. "Reimbursable  services"  means  services,  other than intermediate
  care services, comprehensive medicaid case management and personal  care
  services  for  which funding is available under Title XIX of the federal
  social security  act,  provided  at  a  community  residential  facility
  described  by  regulations of the commissioner of mental retardation and
  developmental disabilities for which fees or rates  may  be  paid  to  a
  provider of services pursuant to this section.
    3. "Income"   means  revenues  received  by  a  provider  of  services
  incidental to the operation of  a  community  residential  facility  and
  includes:
    (i)  revenues  received  from  other  units of state, local or federal
  government in consideration for the provision  of  care  to  a  mentally
  disabled  person,  excluding  that  portion of such revenue specifically
  intended to offset capital  costs  and  that  portion  of  such  revenue
  received  pursuant  to  Title  XIX of the federal social security act as
  payment for  personal  care  services  or  comprehensive  medicaid  case
  management services;
    (ii)  charges  received  from  residents or on their behalf from third
  party insurers or medical assistance programs; and
    (iii)  other  funds  received  in  the  operation  of  the   community
  residential facility.
    4. "Provider  of  services" means a local government, voluntary agency
  or other entity or person  that  provides  reimbursable  services  at  a
  community residential facility.
    5. "Commissioner"  means  the  commissioner  of mental retardation and
  developmental disabilities.
    (b)  The  commissioner  shall  establish,  by  rules  or  regulations,
  descriptive  listings  of reimbursable services at community residential
  facilities for which payments may be made pursuant to this section. Such
  services shall include direct care and support staff services,  housing,
  administrative services and other than personal services.
    (c)  The  commissioner  shall  establish standards for programs funded
  under this section and shall by  rule  or  regulation,  subject  to  the
  approval of the director of the budget, establish fees or rates at least
  annually  for  each  reimbursable  service  to  be  paid to providers of
  services. Fees or rates may be varied for geographic or other reasons.
    (d) Each local governmental unit shall include in its annual local  or
  unified  services  plan  a  review  of  existing  community  residential
  facilities providing  reimbursable  services  and  a  recommendation  of
  anticipated  needs  for  the  development of such facilities, consistent
  with the needs of the mentally  retarded  and  developmentally  disabled
  within the jurisdiction of the local governmental unit.
    (e)  Notwithstanding  any  inconsistent provision of this chapter, the
  commissioner may, from monies appropriated by the legislature for  state
  aid  for services provided pursuant to this article, grant state aid for
  the operation of a community residential facility through the payment of
  fees or rates for reimbursable services provided at such facility.
    (f) Providers of services may apply to the  commissioner  pursuant  to
  this  section  to  receive payment of fees or rates for the provision of
  reimbursable services at community residential facilities.

    (g) The commissioner may, after consideration of the service needs  of
  the  area  in  which a community residential facility is to operate, the
  capacity of the facility  to  meet  those  needs,  the  availability  of
  services  in  the  area,  the  annual  comprehensive  plan  of the local
  governmental  unit,  the  recommendations of the local governmental unit
  and the availability  or  resources  therefor,  grant  state  aid  to  a
  provider  of  services for the payment of fees or rates for reimbursable
  services, subject to the provisions of subdivision (h) of this section.
    (h) Payments for reimbursable services  shall  be  made  monthly.  The
  commissioner  shall each month advance to providers of services an equal
  monthly proration of fees or rates which may be  paid  for  reimbursable
  services  estimated  to  be provided during the fee or rate period, from
  which shall be deducted income received during the preceding months  and
  rent  charged  clients.  At  the  end  of  each  fee  or rate period, an
  adjustment shall  be  made  so  that  payments  of  fees  or  rates  for
  reimbursable services provided during the fee or rate period shall equal
  fees  or rates for reimbursable services provided during the fee or rate
  period less income received and the rent charged clients as required  in
  this subdivision.
    (i)  No  client  shall be denied services because of inability to pay.
  Voluntary agencies and local governments  may  charge  clients  for  the
  provision  of  reimbursable services and shall charge rent in accordance
  with the client's ability to pay and the availability to the  client  of
  health insurance or other third party reimbursement for the provision of
  such  services.  Charge  and  rental schedules shall be developed by the
  commissioner and approved by the director of the budget. Providers shall
  bill third party insurers and other state or local agencies directly  if
  payments  are available from such parties and report to the commissioner
  claims made against them and any  billings  of  clients  for  whom  such
  reimbursement  is not available. Providers shall make reasonable efforts
  to collect such billings.  In  the  event  payment  of  charges  is  not
  received  after such efforts, the provider shall assign the commissioner
  the right to enforce the claim and receive payment. Every  effort  shall
  be made to assure that the process of collection of charges from clients
  does not interfere with the therapeutic program.
    (j)  Providers  of  service  shall  be reimbursed for capital costs in
  accordance with the provisions of this section.
    (k) Payments pursuant to this section shall be made in lieu  of  state
  aid  for operating costs payable pursuant to any other provision of this
  article.
    (l) The operator of a community residential facility may appeal to the
  commissioner  or  his  designee  for  reconsideration  of  his  decision
  regarding authorization of payments to the facility and establishment of
  fees  or  rates  for reimbursable services provided at the facility. The
  commissioner,  after  hearing  such  appeal  or  consideration  of   the
  recommendations of his designee, may amend such decision, subject to the
  approval of the director of the budget.
    (m) The commissioner shall issue regulations as necessary to implement
  the  provisions  of this section. Public hearings shall be held prior to
  final issuance of such regulations.
    (n) The commissioner shall  establish  a  procedure,  subject  to  the
  approval  of  the state comptroller, whereby payments in addition to the
  client's personal allowance may be made to providers of services for one
  or more of the following needs of clients residing in  such  facilities,
  limited  to  two  hundred  fifty  dollars  per  client per year and paid
  semi-annually in the manner specified by such procedures:
    1. Replacement of necessary clothing;
    2. Personal requirements and incidental needs of clients;

    3. Recreational and cultural activities of clients. Such payments  may
  be  made  from  monies appropriated to the office for this purpose. Such
  payments shall be audited by  the  office  pursuant  to  an  audit  plan
  approved by the comptroller.
    (o)  Notwithstanding  any  inconsistent provision of this article, the
  commissioner may reimburse voluntary agencies for the reasonable cost of
  rental of a community residential facility less any income received from
  a state or federal agency or third party insurer which  is  specifically
  intended  to  offset  the  cost  of  rental of the facility or housing a
  client at the facility, subject to the  availability  of  appropriations
  therefor  and  the commissioner's certification of the reasonableness of
  the rental cost, with the approval of the director of the budget.