N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-12.2

Current through Register Vol. 46, No. 53, December 31, 2024

Section 86-12.2 - Utilization limits on OMH licensed clinics

(a) Effective for services provided on and after April 1, 2011 Medicaid payments for outpatient mental health services provided in outpatient facilities licensed by the Office of Mental Health ("OMH") pursuant to article 31 of the Mental Hygiene Law shall reflect applicable provisions of regulations promulgated by OHM and shall be adjusted relative to 2009 service utilization and payment levels in accordance with the following:

(1) For persons 21 years of age or older, the thirty-first through fiftieth visit in a state fiscal year shall be subject to a 25% reduction in the otherwise applicable payment amount as computed in accordance with applicable provisions of article 31 of the Mental Hygiene Law or regulations promulgated thereunder.

(2) For persons 21 years of age or older, visits in excess of fifty visits in a state fiscal year shall be subject to a 50% reduction in the otherwise applicable payment amount as computed in accordance with applicable provisions of article 31 of the Mental Hygiene Law or regulations promulgated thereunder.

(3) For persons less than 21 years of age at the start of the state fiscal year, visits in excess of fifty visits in that state fiscal year shall be subject to a 50% reduction in the otherwise applicable payment amount as computed in accordance with applicable provisions of article 31 of the Mental Hygiene Law or regulations promulgated thereunder.

(4) Off-site visits, medical visits and crises visits, when billed under their applicable rate codes, shall be disregarded in computing the number of visits pursuant to paragraphs (1), (2) and (3) of this subdivision.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-12.2

Adopted New York State Register August 12, 2015/Volume XXXVII, Issue 32, eff. 8/12/2015