New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-1 › Section 511-1.1 - Background and Intent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Federal law
				  requires state Medicaid programs to offer Early and Periodic Screening,
				  Diagnostic and Treatment to all Medicaid-eligible children under age 21.
				  Commonly referred to as "EPSDT," these services are designed to support
				  childhood growth and development to ensure that children in low income families
				  receive the comprehensive and preventive health and behavioral health services
				  they need. EPSDT services include appropriate preventive, dental, health,
				  behavioral health, developmental and specialty services.
(b) Within the scope of EPSDT benefits under
				  the federal Medicaid law, states are required to cover any service that is
				  medically necessary "to correct or ameliorate a defect, physical or mental
				  illness, or a condition identified by screening" and which are recommended by a
				  Licensed Practitioner of the Healing Arts. Thus, EPSDT requires states not only
				  to screen and diagnose health and mental health illnesses or conditions in low
				  income children, but they must ensure children are provided treatment as
				  well.
(c) New York State has
				  obtained an amendment to its Medicaid State Plan that authorizes the provision
				  of six new children's behavioral health and health services under the EPSDT
				  benefit. When recommended by a Licensed Practitioner of the Healing Arts, these
				  six services will be made available to any child eligible for Medicaid who
				  meets relevant medical necessity criteria, and include:
(1) Crisis Intervention Services: services
				  designed to interrupt and/or ameliorate a behavioral health crisis through the
				  provision of support to an individual who may be experiencing a mental health
				  crisis, and subsequently connecting such individual to appropriate resources.
				  For purposes of this Part, provision of this services does not connote
				  examination, diagnosis, care, treatment, rehabilitation, or training of a
				  person with mental illness and thus does not constitute a nonresidential
				  service requiring licensure under Mental Hygiene Law Section
				  31.02;
(2) Community Psychiatric Supports &
				  Treatment: interventions intended to achieve identified goals or objectives as
				  set forth in a treatment/ recovery plan;
(3) Family Peer Support Services: formal and
				  informal services provided to families of a child experiencing social,
				  emotional, developmental, medical, substance use, and/or behavioral challenges
				  in their home, school, placement, and/or community;
(4) Youth Peer Support and Training: formal
				  and informal services and supports to ensure engagement and active
				  participation of youth in the treatment planning and implementation
				  process;
(5) Other Licensed
				  Practitioners: service provided by a non-physician behavioral health
				  practitioner operating within a licensed children's mental health agency, who
				  is licensed in New York and is operating within a scope of practice defined in
				  New York State law in any setting permissible under such law, including
				  community based settings; and
(6)
				  Psychosocial Rehabilitation Services: task-oriented services designed to
				  compensate for or eliminate functional deficits and interpersonal and/or
				  behavioral health barriers associated with behavioral health needs.