N.Y. Comp. Codes R. & Regs. tit. 14 § 588.9

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

Section 588.9 - Standards pertaining to reimbursement for partial hospitalization programs

(a) Partial hospitalization visits shall be reimbursed on the basis of duration of hours provided as follows:

(1) Reimbursement shall be provided for visits of at least four hours in duration and not more than seven hours per recipient per day.

(2) Reimbursement for partial hospitalization shall be limited to no more than 180 hours per course of treatment per recipient within a partial hospitalization program. A course of treatment shall not exceed six calendar weeks, unless, during the course of treatment, the recipient is admitted to an inpatient psychiatric facility. Such course of treatment may be extended to include the number of days of inpatient treatment, up to a maximum of 30 days. Each course of treatment is a new admission.

(3) Reimbursement shall be limited to 360 hours per calendar year per recipient.

(4) Collateral visit: shall be reimbursed for clinical support services of at least 30 minutes in duration but not more than two hours of face-to-face interaction between one or more collaterals and one therapist with or without a recipient.

(5) Group collateral visit: shall be reimbursed for clinical support services, in accordance with section 587.4(c) of this Part, of at least 60 minutes in duration but not more than two hours and shall represent services to more than one recipient and/or his or her collaterals. Such visits need not include recipients but shall not include more than 12 collaterals and/or recipients in a face-to face interaction with a therapist.

(b) The utilization review authority designated pursuant to section 587.6 of this Title shall conduct the following reviews regarding, at a minimum, a random 25 percent sample of recipients:

(1) a review of the appropriateness of admission to a partial hospitalization program by the fourth visit after admission;

(2) a review of the need for continued treatment in a partial hospitalization program every two weeks.

(c) The determination of need for admission to or continued treatment in a partial hospitalization program shall be reviewable by the Office of Mental Health or its designated agent, and shall take the following criteria into account:

(1) the recipient's history, diagnosis, prognosis, progress or lack thereof; and

(2) whether the recipient requires services at that level of care, or would be more appropriately discharged or referred to another program.

(d) The treatment plan required pursuant to section 587.16 of this Title shall be completed prior to the fourth visit after admission. Review of the treatment plan shall be every two weeks.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 588.9