New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 599 - Clinic Treatment Programs › Section 599.4 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For purposes of
				this Part:
(1)
After hours
means
				before 8 a.m., 6 p.m. or later, or during weekends.
(2)
Ambulatory Patient Groups
				(APGs)
means a defined group of outpatient procedures, encounters or
				ancillary services grouped for payment purposes. The groupings are based on the
				intensity of the services provided and the medical procedures
				performed.
(3)
Base
				rate
means the numeric value that shall be multiplied by the weight for
				a given service to determine the Medicaid fee for a service.
(4)
Clinical services contract
means a written agreement between the governing authority of an existing or
				proposed provider of services and another organization separate from the
				provider of services for the purpose of obtaining some of the clinical services
				or some of the clinical staff necessary to operate the program in compliance
				with requirements for an operating certificate.
(5)
Clinical staff
means staff
				members who provide services directly to individuals, including professional
				staff, non-licensed professional staff, paraprofessional staff, and student
				interns.
(6)
Clinician
means a person who is a member of the professional staff, or non-licensed
				professional staff.
(7)
Collateral
means a person who is a member of the individual's
				family or household, or other person who regularly interacts with the
				individual and is directly affected by or has the capability of affecting their
				condition, and is identified in the treatment plan as having a role in
				treatment and/or is necessary for participation in the evaluation and
				assessment of the individual prior to admission. A group composed of
				collaterals of more than one individual may be gathered together for purposes
				of goal-oriented problem solving, assessment of treatment strategies and
				provision of practical skills for assisting the individual in the management of
				their illness.
(8)
Commissioner
means the Commissioner of the New York State Office
				of Mental Health.
(9)
Community education
means activities designed to increase
				community awareness of the manifestations of mental illness and emotional
				disturbance and the benefits of early identification and treatment.
(10)
Counseling
means the
				provision of assistance and guidance in resolving personal, social, or
				psychological problems and difficulties
(11)
Current Procedural Terminology
				(CPT)
means codes used in a coding system for health care procedures as
				defined in the publication Current Procedural Terminology which is published by
				the American Medical Association (AMA).
(12)
Designated mental illness
means a disruption of cognitive, emotional, or behavioral functioning, which
				can be classified and diagnosed using the current edition of the Diagnostic and
				Statistical Manual of Mental Disorders (DSM), or the International
				Classification of Diseases (ICD), other than:
(i) substance use disorders in the absence of
				other mental health conditions defined in the DSM or ICD;
(ii) Neurodevelopmental disorders in the
				absence of other mental health conditions defined in the DSM or ICD except
				Attention-Deficit/Hyperactivity Disorder and Tic Disorders;
(iii) major neurocognitive disorder,
				traumatic brain injury, or mental disorders due to another medical condition;
				or
(iv) V-Codes . Other conditions
				that may be a focus of clinical attention (commonly described with Z codes),
				except Parent-Child Relational Problem (V61.20/Z62.820) for children.
(13)
Diagnostic and
				treatment center
, for the purposes of this Part, means an outpatient
				program licensed as a diagnostic and treatment center pursuant to article 28 of
				the Public Health Law which provides more than 10,000 mental health visits
				annually, or for which mental health visits comprise over 30 percent of the
				annual visits. A program providing fewer than 2,000 total visits annually shall
				not be required to be licensed by the Office.
(14)
Director of Community
				Services
shall mean the director of community services for the mentally
				disabled appointed pursuant to Mental Hygiene Law.
(15)
Evidence-based treatment
means an intervention for which there is consistent scientific evidence
				demonstrating improved outcomes.
(16)
Healthcare common procedure coding
				system (HCPCS codes
) means a comprehensive, standardized coding and
				classification system for health services and products.
(17)
Homebound individuals
means
				people who have been determined by a licensed clinician to have a physical
				and/or mental illness that prevents them from leaving their residence to access
				mental health services or for whom a physician determines that leaving the
				residence to access mental health services would be detrimental to their health
				or mental health.
(18)
Hospital-based Mental Health Outpatient Treatment and Rehabilitative
				Service Programs
means a mental health program which is operated by a
				psychiatric hospital or a general hospital and is licensed under Article 28 of
				the Public Health Law and Article 31 of the Mental Hygiene Law, or is licensed
				solely under Article 28 of the Public Health Law and provides more than 10,000
				mental health visits annually, or for which mental health visits comprise over
				30 percent of the annual visits. A Mental Health Outpatient Treatment and
				Rehabilitative Service program licensed solely under Article 28 which provides
				fewer than 2,000 total visits annually shall not be required to be licensed by
				the Office.
(19)
Injectable
				psychotropic medication administration with or without monitoring and
				education
means the process of preparing and administering the injection
				of intramuscular psychotropic medications. With monitoring and education it
				includes individual education related to the use of the medication, as
				necessary.
(20)
Linkage with
				primary care
means activities designed to promote coordination,
				continuity and efficiency of mental health services and primary care services
				received by the individual.
(21)
Local governmental unit (LGU)
means the unit of local government
				authorized in accordance with Article 41 of the Mental Hygiene Law to provide
				and plan for local or unified services.
(22)
Modifiers
means payment
				adjustments made to Medicaid fees for specific reasons such as billing for
				services in languages other than English and services delivered after
				hours.
(23)
Office
means the New York State Office of Mental Health.
(24)
Mental Health Outpatient Treatment
				and Rehabilitative Service Program
means a program licensed as a Mental
				Health Outpatient Treatment and Rehabilitative Service program under Article 31
				of the Mental Hygiene Law.
(25)
Off-site Location
means a location at which services are
				delivered. Locations including but not limited to the community, or the
				individual's place of residence. The location in which the service is provided
				is determined by the individual's needs and goals documented in the
				individual's record.
(26)
Peer group
is a billing term that means a grouping of providers
				sharing similar features such as geography or auspice.
(27)
Preadmission status
means
				the status of an individual who is being evaluated to determine whether they
				are appropriate for admission to the Mental Health Outpatient Treatment and
				Rehabilitative Service program.
(28)
Preadmission visit
means
				visits provided prior to admission to a Mental Health Outpatient Treatment and
				Rehabilitative Service program.
(29)
Primary clinician
is the
				clinician responsible for the development and implementation of the treatment
				plan.
(30)
Provider of
				service
means the entity which is responsible for the operation of a
				program. Such entity may be an individual, partnership, association or
				corporation. For purposes of this Part, unless otherwise noted, the term also
				applies to a psychiatric center or institute operated by the Office of Mental
				Health.
(31)
Quality
				improvement
means a systematic and ongoing process for measuring and
				assessing the performance of a Mental Health Outpatient Treatment and
				Rehabilitative Service program and for conducting initiatives and taking action
				to improve safety, effectiveness, timeliness, person centeredness or other
				aspects of services.
(32)
Satellite
means a physically separate site to a certified Mental
				Health Outpatient T reatment and Rehabilitative Service program, which provides
				either a full or partial array of outpatient services on a regularly and
				routinely scheduled basis (full or part time).
(33)
Serious emotional
				disturbance
means a child or adolescent has a designated mental illness
				diagnosis according to the most current Diagnostic and Statistical Manual of
				Mental Disorders (DSM) and has experienced functional limitations due to
				emotional disturbance over the past 12 months on a continuous or intermittent
				basis. The functional limitations must be moderate in at least two of the
				following areas or severe in at least one of the following areas:
(i) ability to care for self (e.g., personal
				hygiene; obtaining and eating food; dressing; avoiding injuries); or
(ii) family life (e.g., capacity to live in a
				family or family like environment; relationships with parents or substitute
				parents, siblings and other relatives; behavior in family setting);
				or
(iii) social relationships
				(e.g., establishing and maintaining friendships; interpersonal interactions
				with peers, neighbors and other adults; social skills; compliance with social
				norms; play and appropriate use of leisure time); or
(iv) self-direction/self-control (e.g.,
				ability to sustain focused attention for a long enough period of time to permit
				completion of age-appropriate tasks; behavioral self-control; appropriate
				judgment and value systems; decision-making ability); or
(v) ability to learn (e.g., school
				achievement and attendance; receptive and expressive language; relationships
				with teachers; behavior in school).
(34)
Specialty
Mental Health
				Outpatient Treatment and Rehabilitative Service means a program designated by
				the Commissioner as specializing in the provision of services to children who
				have a designated mental illness diagnosis and an impairment in functioning due
				to serious emotional disturbance.
(35)
Supplemental payment
means
				payments in addition to the service fee amount.
(36)
Visit
means an interaction
				consisting of one or more procedures occurring between a n individual and/or
				collateral and the clinic al staff on a given day.
(37)
Weight
means a numeric
				value that reflects the relative expected average resource utilization for each
				service as compared to the expected average resource utilization for all other
				services.