N.Y. Comp. Codes R. & Regs. tit. 18 § 505.15

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

Section 505.15 - Psychiatric care

(a) Provision of psychiatric care by psychiatrists in private practice.

(1) Psychiatric care may be provided to a recipient of medical assistance by a qualified psychiatrist in the psychiatrist's office; in the recipient's home; in a clinic, a general or chronic disease hospital or approved medical institution or facility operated in compliance with applicable provisions of law; with respect to a child receiving psychiatric care pursuant to an individualized education program, such care may be provided in a school or an approved pre-school; or, for persons aged 65 and over and for those under 21 years of age, such care may be provided in a hospital caring exclusively or primarily for persons with mental disease. In the case of a recipient who during the course of hospitalization attains the age of 21, such services may continue until he or she reaches the age of 22.

(2) In the delivery of psychiatric care, a qualified psychiatrist in private practice may employ up to four certified social workers to provide care under his continuing direct supervision as part of a course of treatment. Services rendered by a social worker shall conform with the provisions of section 85.32 of the regulations of the New York State Department of Health. For purposes of this section, a certified social worker rendering services under the Medical Assistance Program shall mean a social worker certified pursuant to the New York State Education Law, and evidence of current registration under such law shall be provided upon request of the Department of Social Services.

(3) Psychiatric care furnished to a child which is part of the development of, or pursuant to, an individualized education program may be provided by a psychiatrist, certified social worker or certified school social worker employed by, or under contract to, a school district, an approved pre-school, or a county in the State or the city of New York. For purposes of this section, a certified school social worker means a school social worker currently registered and certified in accordance with the New York State Education Law and the rules of the Commissioner of Education.

(b) Reimbursement and payment for psychiatric care provided by psychiatrists in private practice and by certified social workers under their employ.

(1) Reimbursement and payment under the Medical Assistance Program for services described in paragraph (a)(2) of this section shall not be available for the provision of individual service to a recipient in the Medical Assistance Program whose care and maintenance is now provided pursuant to sections 41-i and/or 398-a of the Social Services Law.

(2) Reimbursement and payment under the Medical Assistance Program for services provided by a certified social worker employed by a qualified psychiatrist in private practice shall be available only when provided in the psychiatrist's office or the patient's home. For the purposes of this paragraph, patient's home shall not include facilities licensed pursuant to article 28 of the Public Health Law.

(3) Reimbursement and payment for care provided to recipients by psychiatrists or by certified social workers under their supervision shall be based on fees established by the State Department of Health and approved by the State Director of the Budget. Payment for services provided by a certified social worker shall be made to the supervising psychiatrist.

(4) A supervising psychiatrist shall provide the Department of Social Services with the name, and certification or license number issued by the New York State Education Department, of any certified social worker in his employ for whose service he may bill. Claims submitted by a supervising psychiatrist for services rendered by a certified social worker in his employ must include the name of the certified social worker who provided such services.

(5) Services provided by certified social workers under this subdivision shall be eligible for payment and State reimbursement effective January 30, 1980.

(6) Payment for drugs administered or dispensed by a psychiatrist in the course of treatment shall be in accordance with the policies set forth in this Subchapter.

(7) State reimbursement shall be available for expenditures made in accordance with provisions of this section.

(c) Reimbursement and payment for psychiatric care provided to children with disabilities. Payment is available for psychiatric care which is part of the development of, or furnished pursuant to, an individualized education program and which are provided by a psychiatrist, certified social worker or certified school social worker employed by, or under contract to, a school district, an approved pre-school, a county in the State or the city of New York. Reimbursement for such services must be made in accordance with the provider agreement.

(d) Standard of conformity. The provision of outpatient psychiatric care by a psychiatrist in private practice to a recipient in the Medical Assistance Program shall be in conformity with the provisions of sections 85.28 through 85.30 of the Department of Health regulations (10 NYCRR) in order to be a reimbursable service.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 505.15