N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-13.4

Current through Register Vol. 46, No. 45, November 2, 2024

Section 635-13.4 - General provisions on service delivery

(a) Independent practitioner services for individuals with developmental disabilities (IPSIDD) may be delivered in the following locations:

(1) individualized residential alternatives (IRAs), community residences (CRs) or family care homes certified by OPWDD, or private residences;

(2) certified day habilitation, pre-vocational, and day training facilities;

(3) community settings as deemed appropriate by the clinician, including community settings where OPWDD services may occur; or

(4) clinicians' private offices.

(b) IPSIDD services are prohibited from being delivered in the following locations:

(1) educational settings serving students in any grade from preschool through grade 12;

(2) private schools certified by OPWDD;

(3) ICFs/IID;

(4) day treatment facilities;

(5) clinic treatment facilities certified by OPWDD, DOH, OMH and OASAS;

(6) hospitals (including an OPWDD certified specialty hospitals); or

(7) other licensed or certified residential or day healthcare settings that include the clinical services identified in section 635-13.1(c) of this Subpart as part of their service models and reimbursement rates (e.g., skilled nursing facilities, rehabilitation centers, adult day healthcare facilities, PACE centers).

(c) IPSIDD services are prohibited from being delivered via telehealth.

(d) IPSIDD services cannot be provided to individuals receiving or eligible to receive similar clinical services from the early intervention program. IPSIDD services must not duplicate or replace preschool supportive health services or school supportive health services authorized through an approved individualized educational plan (IEP); however, IPSIDD services may address service needs of preschool and school aged children that are not addressed in the IEP and are not school-related as determined by the child's committee on special education.

(e) IPSIDD services must not duplicate or replace services available through the ICF/IID program, or OPWDD operated or certified residential or day programs. IPSIDD services must not duplicate OPWDD funded home and community based services (HCBS), including intensive behavioral services, or services provided in clinic treatment facilities and hospital outpatient departments or services provided by certified home health agencies. However, services described by the same clinical procedure code may be provided to address different clinical needs.

(f) Time spent receiving another Medicaid service shall not be counted toward IPSIDD billable service time in instances when the Medicaid service is received simultaneously with IPSIDD.

(g) See 10 NYCRR Part 86 for reimbursement methodology.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-13.4

Adopted New York State Register March 30, 2016/Volume XXXVIII, Issue 13, eff. 4/1/2016

Adopted New York State Register April 20, 2016/Volume XXXVIII, Issue 16, eff. 4/20/2016

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016

Amended New York State Register December 12, 2018/Volume XL, Issue 50, eff. 12/12/2018