N.Y. Comp. Codes R. & Regs. tit. 14 § 679.7

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

Section 679.7 - Billing standards

(a) In order for the clinic treatment facility to be reimbursed for any service, the following conditions must be met:

(1) The clinic treatment facility shall have a valid Medicaid provider agreement with the New York State Department of Health at the time of service delivery.

(2) If the facility is authorized to provide any medical or dental care as a person's principal source of such care, the facility shall become a Medicare provider and submit for Medicare reimbursement as appropriate.

(3) Clinic services shall be delivered in accordance with the person's clinic treatment plan (see section 679.4[j] and [k] of this Part), except for a clinic intake and diagnostic and evaluation services.

(4) Initial clinic treatment plans shall reflect coordination with all of the person's other individualized written plans of services that are required by law or regulation. In addition, for persons who reside in an OPWDD-certified residence, such initial clinic treatment plans shall identify any clinic services to be delivered prior to April 1, 2016 in the OPWDD-certified residence and the justification for the delivery of the specific clinic services in the residence.

(5) Documentation of each clinic service shall specify the location of service delivery.

(6) Billing claims for services (except for a clinic intake) shall include the National Product Identifier (NPI) of the clinician delivering the clinic service or the clinician supervising the delivery of service, except for rehabilitation counselors and those employed by the State of New York who are not licensed but meet the civil service qualifications at the professional level appropriate to their discipline.

(7) Clinic treatment facilities shall assign ICD diagnostic codes and CPT/HCPCS procedure codes to all clinic services as appropriate and shall submit such information to DOH or to DOH's designee in accordance with written billing and reporting instructions issued by OPWDD and DOH.

(b) In order for the clinic treatment facility to be reimbursed for any clinic service delivered in an OPWDD-certified residence, as allowed prior to April 1, 2016, the clinic treatment facility shall retain a written description of the clinic services delivered in each residence, specifying the persons who received services, the specific services that were delivered to each person, and the justification for delivery of clinic services in the residence. The clinic treatment facility shall retain the consent of the executive director (or his/her designee) of the agency operating the residential facility or sponsoring agency for the delivery of such clinic services as described. Such consent was required on at least an annual basis. Consent was required before a new person began receiving clinic services at the residence and before any person began receiving a type of clinic service at the residence for which there was no current consent.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 679.7

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

Amended 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