New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.35 - Computation of basic rates for clinic services provided to acquired immune deficiency syndrome (aids) and human immunodeficiency virus (hiv) sero-positive patients by freestanding ambulatory care facilities and hospital clinic outpatient services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
					 payments made pursuant to this section and pursuant to section 86- 1.11(h) of
					 this Part, for ambulatory services to AIDS patients, HIV positive patients, and
					 patients seeking verification of HIV infection, reimbursement shall be based
					 upon a single payment schedule with a discrete price for each of the five
					 clinic services set forth in subdivision (c) of this section.
(b) To be eligible to receive reimbursement
					 pursuant to this section, facilities must be licensed pursuant to article 28 of
					 the Public Health Law and certified to provide general medical services and
					 complete a written signed agreement with the commissioner to provide these
					 discrete services. Facilities interested in establishing such agreements must
					 submit in writing the required documentation in a manner acceptable to the
					 commissioner. Such agreement shall describe the Medicaid patients who will be
					 eligible for reimbursement under this section and shall establish the
					 documentation and services required for patient assignment to each of the five
					 clinic services.
(c) The five
					 clinic services for which reimbursement shall be available according to the
					 prices as established by this section are as follows:
(1) HIV counseling and testing visits. This
					 visit shall mean the provision of pre-test HIV counseling in a medical setting
					 as performed in compliance with article 27-f of the State Public Health Law.
					 This visit shall also include laboratory testing necessary to determine whether
					 a person has HIV disease. This visit shall also mean the provision of post-test
					 HIV counseling in a medical setting as performed in compliance with the
					 confidentiality provisions of article 27-f of the State Public Health Law for
					 those individuals whose test results are positive. This visit is available for
					 the purpose of informing these individuals of their test results and providing
					 supportive counseling for those HIV zero positive persons experiencing adverse
					 psychological responses to their serostatus.
(2) Post-test counseling visit. This visit
					 shall mean the provision of post-test HIV counseling in a medical setting as
					 performed in compliance with the confidentiality provisions of article 27-f of
					 the State Public Health Law for those persons whose test results are negative.
					 This visit is available for the purpose of informing these individuals of their
					 results and counseling them on preventive measures.
(3) Initial comprehensive HIV medical
					 evaluation visit. This visit shall mean a comprehensive medical history and
					 physical examination, and laboratory testing necessary for the evaluation of
					 HIV disease and related conditions. The evaluation shall be complete enough to:
					 establish the state of HIV illness, diagnose active opportunistic infections
					 and tumors, identify appropriate prophylactic therapies to prevent future
					 opportunistic infections, initiate indicated anti-HIV therapy, and identify
					 significant psycho-social problems to be addressed in the care plan.
(4) Drug and immunotherapy visits for HIV
					 infected patients. This visit shall mean to those HIV-related treatments that
					 require active health care supervision during the treatment visit and/or
					 extensive amount of provider monitoring following the treatment.
(5) Monitoring visit for asymptomatic HIV
					 disease. This visit shall mean the clinical and laboratory evaluation necessary
					 to monitor the status of HIV disease to indicate the appropriate stage to
					 initiate active drug treatment for HIV or prophylactic treatment for
					 opportunistic infections.