New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 599 - Clinic Treatment Programs › Section 599.13 - Medical assistance Mental Health Outpatient Treatment and Rehabilitative Service program reimbursement system

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reimbursement for Mental Health
				Outpatient Treatment and Rehabilitative Service programs procedures will be fee
				based.
(b) A weight for each Mental
				Health Outpatient Treatment and Rehabilitative Service program procedure shall
				be established by the Department of Health in conjunction with the Office which
				reflects the relative anticipated resource utilization for such procedure. For
				some procedures, fees shall be enhanced pursuant to section
				599.14  of this Part through the
				use of billing modifiers for such things as procedures delivered after hours,
				services provided in languages other than English, and services of a minimum
				duration of 15 continuous minutes delivered by a physician or nurse
				practitioner in psychiatry.
(c)
				Providers will be categorized into peer groups pursuant to this section. The
				Office will establish a base fee for reimbursement for each peer group. Such
				fee shall be reduced by 25 percent during the period in which any such provider
				retains an operating certificate with a duration of less than six months as a
				result of having been determined to be deficient in meeting applicable
				standards and requirements, pursuant to this Part.
(d) Peer group specific base fees may be
				adjusted as applicable by the Office. Provider specific fee adjustments may be
				made to reflect pay for performance enhancements, penalties resulting from the
				Office inspection and certification process, or for other reasons described in
				the regulations of the Office.
(e)
				Payments for procedures will be determined by multiplying the assigned weight
				for the appropriate procedure code set forth at 10 NYCRR Part 86 by the base
				fee, and adjusting such fee for modifiers and discounts, as appropriate. When a
				modifier or discount is expressed as a percentage, it will adjust the payment
				by its percentage of the procedure weight. When more than one procedure applies
				to a visit, the highest value procedure shall be paid at its full fee value.
(1) Payments for additional procedures
				related to the visit will be discounted by 10 percent, except for Mental
				Health Outpatient Treatment and Rehabilitative Service Programs approved by the
				Office to provide Intensive Outpatient Program (IOP) where there will be no
				discounted services for additional procedures.
(2) Payments will be reduced by 25 percent
				for any visit in excess of 30, excluding crisis intervention services, off-site visits, complex care management, peer/family support services, any
				services that are provided as part of IOP, and any services that are counted as
				health services, provided during a state fiscal year to any individual who is
				21 years of age or older on the first day of such fiscal year, and 50 percent
				for any visit in excess of 50, excluding crisis intervention services, off-site
				visits, complex care management, peer/family support services, any services
				that are provided as part of IOP, and any services counted as health services,
				provided during such fiscal year to any individual, for fiscal years
				commencing on or after April 1, 2011, except that effective January 1, 2015,
				this reduction in payment will not apply to court-mandated services.