N.Y. Comp. Codes R. & Regs. tit. 14 § 508.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 508.7 - Inpatient settings

(a) In order for an individual to be considered an active client of an ACT program in an inpatient setting, he or she must be:

(1) admitted to a psychiatric unit of a hospital licensed under article 28 of the Public Health Law, or admitted to a residential treatment facility for children and youth;

(2) 21 years of age or less, or 65 years of age or older, who is receiving services at a State-operated psychiatric hospital or freestanding psychiatric hospital licensed solely pursuant to article 31 of the Mental Hygiene Law; or

(3) admitted to a hospital or other residential medical facility licensed pursuant to article 28 of the Public Health Law.

(b) For the purpose of discharge planning, reimbursement is permitted for up to five calendar months of service during an inpatient episode without regard to the duration of the inpatient episode as follows:

(1) In the month of admission and/or month of discharge full payment rate reimbursement is permitted for any month in which four or more community-based contacts combined with inpatient face-to-face contacts equals six or more total contacts in the month.

(2) In the month of admission and/or month of discharge stepdown/partial payment rate reimbursement is permitted when a minimum of two community-based contacts are provided in a month, or when a minimum of one community contact, combined with a minimum of one inpatient contact, is provided.

(3) Inpatient payment rate reimbursement is permitted when a minimum of two inpatient face-to-face contacts are provided in a month, regardless of the number of community contacts. Reimbursement for more than one contact per day during inpatient status is not permitted.

(c) Any episode of inpatient care is considered a continuous hospital or other medical facility stay if the client's discharge is followed by a readmission to a hospital on or before the tenth day following the date of discharge.

(d) For inpatient stays beyond the initial five months:

(1) the patient may be placed on inactive ACT status. The ACT Team should notify the local SPOA of the inactive status; and

(2) upon discharge from the inpatient setting, the patient may return to active status on the same ACT team for continuing community-based service. The ACT team must notify the local SPOA of the reactivated status.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 508.7