New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-4 - Early Intervention Program › Section 69-4.30 - Computation of rates for early intervention services provided to infants and children ages birth to three years old and their families or caregivers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 commissioner shall annually determine the rates for approved early intervention
					 services and evaluations provided to eligible children, subject to the approval
					 of the Director of the Budget. For payments made pursuant to this section for
					 early intervention services to Medicaid patients, reimbursement shall be based
					 upon a uniform payment schedule with discrete prices as set forth in
					 subdivision (d) of this section. To be eligible to receive reimbursement
					 pursuant to this section, providers must be approved to provide early
					 intervention services pursuant to article 25 of the Public Health
					 Law.
(b) For purposes of this
					 section,
a billable visit
shall mean a face-to-face contact
					 for the provision of authorized early intervention services between a provider
					 of early intervention services and the individual(s) receiving such services,
					 except for service coordination as described in paragraph (c)(3) of this
					 section.
Duration
shall mean the time spent by a provider of
					 early intervention services providing direct care or client contact. Activities
					 such as case recording, training and conferences, supervisory conferences, team
					 meetings and administrative work are not separately billable
					 activities.
(c) Reimbursement shall
					 be available at prices established pursuant to this section for the following
					 early intervention program services:
(1)
Screening
as defined in section
					 69-4.1(an)  of
					 this Subpart and performed in accordance with section
					 69-4.8  of this Subpart. A provider
					 shall submit one claim for a screening regardless of the number of visits
					 required to perform and complete a screening. The Early Intervention Official
					 shall approve any screenings provided to a child beyond the initial screening
					 conducted in accordance with section
					 69-4.8  of this Subpart.
					 Reimbursement shall not be provided for screenings performed after a child has
					 been found eligible for early intervention services.
(2)
Multidisciplinary
					 evaluation
as defined in section
					 69-4.1 (o)  of
					 this Subpart and performed in accordance with section
					 69-4.8  of this Subpart.
					 Reimbursable evaluations shall include multidisciplinary evaluations and
					 supplemental evaluations. A provider shall submit one claim for an evaluation
					 (multidisciplinary or supplemental) regardless of the number of visits
					 required to perform and complete the evaluation.
(i) A
multidisciplinary
					 evaluation
shall include a developmental assessment, a review of
					 pertinent records and a parent interview as specified in section
					 69-4.8 (e)(3)(ii) 
					 of this Subpart, and may include a family -directed assessment.
(a) A
developmental
					 assessment
shall mean procedures conducted by qualified personnel with
					 sufficient expertise in early childhood development who are trained in the use
					 of professionally acceptable methods and procedures to evaluate each of the
					 developmental domains: physical development, cognitive development,
					 communication development, social or emotional development and adaptive
					 development.
(b) A
family-directed assessment
shall mean a voluntary,
					 family-directed assessment conducted by qualified personnel who are trained in
					 the use of professionally acceptable methods and procedures to assist the
					 family in identifying their concerns, priorities and resources related to the
					 development of the child.
(ii)
Supplemental
					 evaluations
shall include supplemental physician or non-physician
					 evaluations and shall be provided upon the recommendation of the IFSP based on
					 input from the team conducting the multidisciplinary evaluation and agreement
					 of the child's parent. Supplemental evaluations provided must be required by
					 and performed in accordance with the child's IFSP as specified in section
					 69-4.8 (l)  of
					 this Subpart.
(a)
Supplemental
					 physician evaluation
shall mean an evaluation by a physician licensed
					 pursuant to article 131 of the Education Law for the purpose of providing
					 specific medical information regarding physical or mental conditions that may
					 impact on the growth and development of the child and completing the required
					 evaluation of the child's physical development as specified in section
					 69-4.8 (f)(3)(i) 
					 of this Subpart, or assessing specific needs in one or more of the
					 developmental domains in accordance with section
					 69-4.8 (f)  of
					 this Subpart.
(b)
Supplemental non-physician evaluation
shall mean an additional
					 evaluation for assessing the child's specific needs in one or more of the
					 developmental domains in accordance with section
					 69-4.8  of this Subpart.
					 Information obtained from this evaluation shall provide direction as to the
					 specific early intervention services that may be required for the child for the
					 IFSP team to determine whether the current team can address the concerns with
					 the addition of another functional outcome or if additional services or
					 specific interventions are required to meet the needs of the child.
					 Supplemental non-physician evaluations may be conducted only by qualified
					 personnel as defined in section
					 69-4.1(al)  of
					 this Subpart.
(c) A non-physician
					 supplemental audiological evaluation may be performed for infants who have
					 failed newborn hearing screening.
(iii)
(a)
					 One multidisciplinary evaluation may be reimbursed within a 12 - month period
					 without prior approval of the Early Intervention Official to develop and
					 implement the initial IFSP. The Early Intervention Official shall assess the
					 need for and, if appropriate, approve and notify the department of any
					 additional multidisciplinary or supplemental evaluations provided to a child
					 within a twelve - month period. If additional multidisciplinary or supplemental
					 evaluations are necessary, such notice shall be provided on a monthly basis in
					 a format provided by the department. Additional multidisciplinary or
					 supplemental evaluations provided subsequent to the child's initial IFSP must
					 be required by and performed in accordance with the IFSP as specified in
					 section 69-4.8 (l)  of
					 this Subpart.
(b) Certain
					 evaluation and assessment procedures may be repeated if deemed necessary and
					 appropriate by the Early Intervention Official in conjunction with the required
					 annual evaluation of the child's IFSP or more frequently in accordance with
					 section 69-4.8 (k)  of
					 this Subpart. If additional evaluation or assessment procedures are necessary,
					 the Early Intervention Official shall approve up to one more multidisciplinary
					 evaluation and two supplemental evaluations prior to the next annual IFSP. Such
					 additional evaluations must be required by and performed in accordance with the
					 child's IFSP as specified in section
					 69-4.8 (l)  of
					 this Subpart. Any additional evaluations within that period shall be based on
					 the indicators specified in section
					 69-4.8 (k)  and
					 shall first be approved by the Early Intervention Official and the Commissioner
					 of Health of the New York State Department of Health; in assessing the need for
					 such additional evaluations, the Early Intervention Official and the
					 Commissioner of Health shall ensure that such additional evaluations are
					 required by and performed in accordance with the child's
					 IFSP.
(3)
Service coordination
as defined in section
					 69-4.1(m)(2)(xii) 
					 of this Subpart. Service coordination shall be provided by appropriate
					 qualified personnel, delivered in accordance with the child's IFSP, and billed
					 in 15 minute units that reflect the time spent providing services in accordance
					 with sections
					 69-4.6 and
					 69-4.7  of this Subpart, or billed
					 under a capitation or other rate methodology as may be established by the
					 Commissioner subject to the approval of the Director of the Budget and as
					 specified in prior written notice provided by the Commissioner to Early
					 Intervention Officials. Such written notice shall specify that any newly
					 established rate methodology shall apply only to initial IFSPs and IFSP
					 amendments made on or after the effective date of such written notice by the
					 Commissioner. The rate methodology may be established on a per month, per week,
					 and/or service component basis for providing service coordination services.
					 When units of time are billed, the first unit shall reflect the initial five to
					 fifteen minutes of service provided and each unit thereafter shall reflect up
					 to an additional fifteen minutes of service provided. Except for child/family
					 interviews to make assessments and plans, contacts for service coordination
					 need not be face-to-face encounters; they may include contacts with service
					 providers or a child's parent, caregiver, daycare worker or other similar
					 collateral contacts, in fulfillment of the child's IFSP.
(4)
Assistive technology
as
					 defined in section
					 69-4.1(m)(2)(ii) 
					 of this Subpart.
(5) Home and
					 community-based individual/collateral visit. This shall mean the provision by
					 appropriate qualified personnel of early intervention services to an eligible
					 child and/or collateral services that are provided in the context of the
					 parent/caregiver-child dyad to help the child reach their outcomes, as
					 articulated in the child's IFSP. Home and community-based visits take place at
					 the child's home or other natural setting in which children under three years
					 of age are typically found (including day care centers, other than those
					 located at the same premises as the early intervention provider, and family day
					 care homes). Reimbursable home and community-based individual/collateral visits
					 shall include basic and extended visits.
(i) A
					 basic visit is a minimum of 30 minutes and less than one hour in duration. Up
					 to three (3) such visits provided by appropriate qualified personnel within
					 different disciplines per day may be billed for each eligible child as
					 specified in an approved IFSP without prior approval of the Early Intervention
					 Official.
(ii) An extended visit is
					 one hour or more in duration. Up to three such visits provided by appropriate
					 qualified personnel within different disciplines per day may be billed for each
					 eligible child as specified in an approved IFSP without prior approval of the
					 early intervention official.
(iii)
					 Notwithstanding subparagraphs (i) and (ii) of this paragraph, no more than
					 three basic and extended visits combined per day may be billed for each
					 eligible child as specified in an approved IFSP without prior approval of the
					 early intervention official.
(iv) A
					 provider shall not bill for a basic and extended visit provided on the same day
					 by appropriate qualified personnel within the same discipline without prior
					 approval of the early intervention official.
(6) Office/facility-based
					 individual/collateral visit. This shall mean the provision by appropriate
					 qualified personnel of early intervention services to an eligible child and/or
					 collateral services that are provided in the context of the
					 parent/caregiver-child dyad to help the child reach his or her outcomes, as
					 articulated in the child's IFSP. Office/facility-based visits take place at an
					 approved early intervention provider's site (including day care centers located
					 at the same premises as the early intervention provider). A basic
					 office/facility-based visit is a minimum of 30 minutes and less than one hour
					 in duration. Up to one (1) visit per discipline and no more than three (3)
					 office/facility-based visits per day may be billed for each eligible child as
					 specified in an approved IFSP without prior approval of the Early Intervention
					 Official.
(7) Parent-child group
					 visit. This shall mean the provision of early intervention services in a group
					 composed of parent(s) or other designated caregivers and eligible children, and
					 a minimum of one appropriate professional qualified to provide early
					 intervention services at an early intervention provider's site or a
					 community-based site (e.g., day care center or family day care). Up to one (1)
					 visit per day may be billed for each eligible child as specified in an approved
					 IFSP without prior approval of the Early Intervention Official.
(8) Group early intervention service visit.
					 This shall mean the provision of physical therapy, occupational therapy,
					 speech-language therapy, applied behavior analysis, or special instruction
					 early intervention services by appropriate qualified personnel to eligible
					 children in a group at an approved early intervention provider's site or at a
					 day care facility duly licensed in New York State.
(i) Up to 120 minutes of group early
					 intervention services per day may be billed for each eligible child as
					 specified in an approved IFSP without prior approval of the Early Intervention
					 Official. Any additional group sessions in the same day shall be approved by
					 the Early Intervention Official.
(ii) A group early intervention service
					 session shall be a minimum of 60 minutes and a maximum of 120 minutes in length
					 and in accordance with the child's IFSP.
(iii) Groups shall consist of two to ten
					 eligible children. Use of a one-to-one aide should be based on clinical
					 appropriateness.
(iv) Groups shall
					 be provided by, at a minimum, one approved and appropriately qualified early
					 intervention provider and one assistant.
(v) Groups shall consist of children with
					 similar IFSP outcomes and include appropriate therapeutic approaches.
(vi) Children participating in a group early
					 intervention service shall not also receive individual services (including
					 push-in/pull-out services) while the group is in session.
(vii) Session notes shall be provided for
					 each child as an individual, not for the group as a whole, and shall include,
					 at a minimum:
(a) eligible child's
					 name;
(b) specific type of service
					 provided;
(c) individual or group
					 service;
(d) group size if
					 applicable;
(e) setting in which
					 the group service was rendered;
(f)
					 date and time the service was rendered, including start and end
					 times;
(g) brief description of the
					 student's progress made by receiving the service during the session;
(h) name, title, signature, and credentials
					 of the person furnishing the service; and
(i) signature and credentials of supervising
					 clinician as appropriate, dated within 45 days of the date of
					 service.
(9)
					 Family/caregiver support group visit. This shall mean the provision of early
					 intervention services by appropriate qualified personnel to a group of parents
					 or other designated caregivers (such as foster parents, day care staff) and/or
					 siblings of eligible children for the purposes of:
(i) enhancing their capacity to care for
					 and/or enhance the development of the eligible child; and/or
(ii) provide support, education, and guidance
					 to such individuals relative to the child's unique developmental needs. Up to
					 two (2) visits per day may be billed for each eligible child as specified in an
					 approved IFSP without prior approval of the Early Intervention Official (for
					 example, one (1) for parents or other designated caregivers and one (1) for
					 sibling(s) in a given day).
(10) ABA services. ABA services shall be
					 billed as either basic or extended visits, as described in subdivision (c)
					 paragraph (5) of this section, up to and in accordance with the hours of
					 service as specified the child's IFSP.
(11) The Early Intervention Official shall
					 approve and notify the department of any visits provided in addition to those
					 described in paragraphs (5) through (11) of this subdivision as may be required
					 by and provided in accordance with the child's IFSP. If such additional visits
					 are necessary, such notice shall be provided on a monthly basis on forms
					 provided by the Department.