N.Y. Comp. Codes R. & Regs. tit. 14 § 576.5

Current through Register Vol. 46, No. 43, October 23, 2024

Section 576.5 - Standards pertaining to eligibility for payment

(a) A residential treatment facility is eligible for payment under the Medical Assistance Program under the following conditions:

(1) The residential treatment facility has a valid operating certificate issued by the Office of Mental Health, in accordance with Part 584 of this Title.

(2) The residential treatment facility complies with applicable requirements of title XIX of the Social Security Act and regulations promulgated thereunder.

(3) The residential treatment facility complies with applicable requirements of title 11 of article 5 of the Social Services Law and regulations promulgated thereunder.

(b) A residential treatment facility is eligible for payment for services provided to residents under the following conditions:

(1) The resident has been determined to be eligible for the Medical Assistance Program.

(2) The resident has been authorized for admission to the residential treatment facility in accordance with Part 584 of this Title.

(c) The residential treatment facility is eligible for payment for each patient day and for each reserved bed day.

(d) The residential treatment facility is eligible for payment at the per diem rate established pursuant to the provisions of Part 578 of this Title.

(e) The residential treatment facility is the only provider of services eligible for payment under the Medical Assistance Program for services provided to a resident of the residential treatment facility including a resident for whom a bed has been reserved except as follows:

(1) Hospitals other than residential treatment facilities are eligible for payment for inpatient services.

(2) Hospitals other than residential treatment facilities are eligible for payment for emergency services and for outpatient services provided as an alternative to hospitalization for medical care other than psychiatric care.

(3) Vendors who supply prosthetic or orthotic appliances and devices including hearing aids are eligible for payment for such appliances or devices in accordance with the established requirements of the Medical Assistance Program.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 576.5

Amended New York State Register August 18, 2021/Volume XLIII, Issue 33, eff. 8/4/2021