Statutes, codes, and regulations
New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENEChapter XIII - Office of Mental Health
Part 588 - Medical Assistance Payment For Outpatient Programs
Section 588.5 - Standards applicable to all outpatient programs

N.Y. Comp. Codes R. & Regs. tit. 14 § 588.5

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Current through Register Vol. 46, No. 45, November 2, 2024
Section 588.5 - Standards applicable to all outpatient programs
(a) The program shall have a valid operating certificate issued by the Office of Mental Health.
(b) Reimbursement shall be made only for services provided to recipients who meet the eligibility criteria of an outpatient program as specified in Part 587 of this Title. In order to be eligible for reimbursement, all claims for reimbursement from the medical assistance program for persons admitted to an outpatient program shall include the designated mental illness diagnosis.
(c) Reimbursement shall only be made for services identified and provided in accordance with an individual treatment plan or psychiatric rehabilitation service plan as defined in section 587.4(c) of this Title.
(d) Reimbursement shall be made for one outpatient visit and one collateral visit per recipient per day irrespective of the number of collaterals involved in the visit.
(e) Upon admission to a specific outpatient program, reimbursement shall be made for participation in that program only, except as provided in paragraphs (1) through (4) of this subdivision. In no event shall a recipient be concurrently admitted to a clinic treatment program, a continuing day treatment program and an intensive psychiatric rehabilitation treatment program.
(1) Reimbursement shall be made for three concurrent visits when a recipient is in transition from one outpatient program to another outpatient program. Recipients in transition shall be considered in preadmission status in the new program in accordance with subdivision (k) of this section.
(2) Reimbursement shall be made for no more than five clinic visits per month for a recipient concurrently admitted to an intensive psychiatric rehabilitation treatment program and a clinic treatment program.
(3) Reimbursement shall be made for recipients currently admitted to a continuing day treatment program in accordance with this Part or a day treatment program in accordance with Part 585 or Part 587 of this Title when such recipient shall also be admitted to a clinic treatment program solely for the purpose of clozapine medication therapy. Reimbursement shall be made for no more than five clinic visits per month per recipient.
(4) Reimbursement shall be made for no more than five continuing day treatment program visits per month for a recipient concurrently admitted to an intensive psychiatric rehabilitation treatment program and a continuing day treatment program.
(f) Reimbursement for crisis intervention services or emergency mental health services to a recipient pursuant to either Part 587 or 590 of this Title is not subject to the limitations of subdivisions (d) and (e) of this section.
(g) Nothing in this Part shall be interpreted to limit recipient access to, or eligibility for services provided by an intensive case management program as defined in Part 506 of this Title. Reimbursement for case management services in an outpatient program shall be in accordance with the limitations in Part 506 of this Title.
(h) Service hours shall be determined by rounding to the nearest full hour once the minimum billable period has occurred, except for preadmission visits and crisis visits to a partial hospitalization program which shall be a minimum of one hour, and all continuing day treatment visits, for which no rounding shall be permitted.
(i) Reimbursement for outpatient services provided to recipients who are in a residential health care facility shall be made to the provider of the mental health services by the residential health care facility.
(j) Educational services or recipient education programs are not reimbursable, except that such services may be utilized to meet the duration of visit requirements specified in section 588.8(a) of this Part.
(k) Reimbursement for preadmission visits shall be as follows:
(1) a minimum of 30 minutes for a clinic treatment program;
(2) a minimum of one hour for a continuing day treatment program, partial hospitalization program and intensive psychiatric rehabilitation treatment program;
(3) a minimum of three hours for a day treatment program serving children; and
(4) limited to a maximum of three visits which shall occur over a period of time not to exceed the remaining days of the month in which the first preadmission visit occurred plus one full calendar month.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 588.5