N.Y. Comp. Codes R. & Regs. tit. 14 § 506.7

Current through Register Vol. 46, No. 43, October 23, 2024

Section 506.7 - Standards pertaining to reimbursement for blended icm/scm services

(a) The blended ICM/SCM program allows case managers to deliver services through a team approach and shared caseloads. The blended options for ICM/SCM are as follows:

(1) one ICM case manager and one SCM case manager;

(2) one ICM case manager and two SCM case managers;

(3) two ICM case managers and one SCM case manager; and

(4) any multiple of the options presented in paragraph (1), (2) or (3) of this subdivision.

(b) In order to receive reimbursement for the provision of services, a provider of a blended ICM/SCM program shall provide services to persons who meet the criteria set forth in sections 506.5(a) and 506.6(a) of this Part.

(c) A minimum of two face-to-face contacts within a month between a member of a team of a blended ICM/SCM case management program and an active client shall be considered a billable service; provided, however, that the number of aggregate monthly contacts for the blended ICM/SCM program must be consistent with the requirements set forth in sections 506.5(b)(2) and 506.6(b) of this Part.

(d) A face-to-face contact between a member of a blended ICM/SCM case management team and an active client shall be counted as a separate contact for purposes of reimbursement per patient day regardless of the number of face-to-face contacts provided or other outpatient programs in which the active client participates in a single day.

(e) Collaterals. Collateral contacts shall be counted as a billable service pursuant to the criteria established in sections 506.5(c) and 506.6(f) of this Part.

(f) While awaiting discharge from the blended ICM/SCM case management program, a client shall be considered on transitional status and may receive one visit per month for a period of two months following discharge. The one visit per month during this time period is a billable service.

(g) Each blended ICM/SCM provider of services shall furnish any and all information and records concerning the provision of blended ICM/SCM case management services which may be requested by the Office of Mental Health. Such information and records shall be provided as the Office of Mental Health may prescribe including but not limited to, the program of services, individual client specific services and statistical, administrative and fiscal operations carried out under the agreement.

(h) If a provider does not achieve the required aggregate number of contacts, billings associated with the difference between the required number of contacts and achieved number of contacts shall be withheld pursuant to a schedule to be furnished to the provider by the Office of Mental Health.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 506.7