N.Y. Comp. Codes R. & Regs. tit. 14 § 100.2

Current through Register Vol. 46, No. 51, December 18, 2024

Section 100.2 - Conditions and extent of reimbursement

(a) Establishment of a community mental health, retardation, and alcoholism services board and appointment of its members must precede any application for State aid. Section 11.11 of article 11 of the Mental Hygiene Law describes the composition of the board and its methods of appointment and terms of office of its members.

(b) No provider of services shall be eligible for reimbursement of operating costs unless it is in possession of a current valid operating certificate authorizing the operation of the programs, the costs of which are to be reimbursed.

(c) Costs incurred subject to reimbursement shall include:

(1) salaries and expenses of qualified and necessary personnel, including the director of community mental health services and other staff of the local governmental unit;

(2) approved facilities and services provided through contract or other arrangement;

(3) operation, maintenance, and service costs;

(4) actual and necessary expenses of members of the board incurred in the performance of official duties;

(5) such other expenditures as may be approved by the Commissioner of Mental Hygiene pursuant to the provisions of article 11.

(d) Claims for State reimbursement shall be made quarterly on forms which shall be provided by the Commissioner of Mental Hygiene. When certified by the Commissioner of Mental Hygiene, State reimbursement shall be paid quarterly from the State treasury upon the audit and warrant of the Comptroller out of funds made available therefor.

(e) For purposes of State aid, revenue of the local government shall be deducted from operating costs to form net operating costs in accordance with the following schedule:

(1) revenues for operating costs received from other State agencies or another local government pursuant to an agreement to purchase community services;

(2) other income realized in the operation of specific program;

(3) federal aid received for operating costs;

(4) fees received from patients or on their behalf from private and public health insurance and medical aid programs.

(f) Where reimbursement is sought for services rendered or facilities operated (with the approval of the governing body or, in the case of the City of New York, of the board of estimate) by agencies of the city or county other than the local governmental unit, the budgets of proposed expenditures for such services or facilities must be part of the budget of the local governmental unit and the services or facilities must be under the general supervision of the said unit.

(g) Contributions and gifts from private sources to the political subdivision which are disbursed or expended by the appropriate local fiscal officer on the direction of the local governmental unit shall be considered to be the same as tax funds in computing State aid.

(h) Mental health clinics or other services made available to or provided for children attending public schools for which State aid is sought shall be made available to or provided for children who attend schools other than public, upon request by the authorities of such schools.

(i) Fees shall be charged for direct patient services for which reimbursement is sought, provided that services shall not be refused to any person because of his inability to pay therefor.

(j) Fee schedules and rules for determining ability to pay may be established by the local governmental unit or the unit may approve schedules and rules established by the clinical services or facilities. In either case, these may be approved by the Commissioner of Mental Hygiene.

(k) Fees for services in outpatient psychiatric clinics shall be all-inclusive. Fee charges for inpatient psychiatric services in general hospitals and in nonprofit licensed private institutions shall be consistent with prevailing hospital practice, including a per diem rate which, preferably, should be all-inclusive.

(l) Services for which reimbursement is sought must not be refused to any person because of his race, color, creed, or country of origin and the said services must comply with the New York State laws and policies against discrimination in employment.

(m) Fees for visits to psychiatric clinics shall be fixed in accordance with the following pattern:

(1) For a visit to a psychiatric clinic operated by a general hospital, the fee shall be fixed as determined by the New York State Department of Health for the particular clinic.

(2) For the following defined services rendered in psychiatric clinics which are not operated by a general hospital, the fees indicated shall apply

Service provided	Fee per unit of service
(i)	Intake session -a clinical interview, under supervision of a psychiatrist, between one or more personnel and a patient, the primary purpose of which is the determination of the most appropriate mode of treatment for the patient's condition. The interview may include counseling of the patient incidental to placement.	$28.00
(ii)	Clinic visit -a period of direct, individual patient treatment or counselling or planned social, recreational, occupational or vocational activity by personnel under supervision of a psychiatrist and for a period not exceeding three hours.	28.00
(ii)	Clinic visit with psychiatrist -a clinic visit as defined in (ii) above, conducted by a psychiatrist	28.00
(iv)	Group therapy session -a period of treatment of more than one patient and/or collateral with one or more staff members at one time not exceeding three hours, under the supervision of a psychiatrist.	9.00
(v)	Day care -a program offering treatment including a planned program of recreational, social and vocational activities in a therapeutic environment. Treatment services may be provided by a staff which may include psychiatrists, psychologists, social workers, nurses, educators, occupational and recreational therapists, psychiatric aides and volunteers. Treatment may include individual or group therapy, patient-staff meetings, drug therapy, occupational therapy, recreational therapy and other activity. A unit of day care regardless of its components must be at least five hours in duration for an individual patient	28.00
(vi)	Half-day of care -a period of care more than three but less than five hours in a day care program, as described above.	14.00
(vii)	Evening care -a program of care in the evening hours similar to day care, described above.	28.00
(viii)	Night care -a program of care in the evening hours similar to day care, described above, and would also include a bed at the facility during the night	28.00
(ix)	Medication -the dispensing to the patient of a prescribed dosage of drugs.	None
(x)	Clinical home visit -visits to patients in their homes are appropriate as a component of a 24-hour emergency or follow-up service program, and as the preferred method of providing treatment services to selected patients who cannot attend clinics. The latter would include persons who have a physical handicap or concurrent physical illness, many older patients who with the support of an occasional home visit can be maintained at home, persons responsible for the care of small children in the home when there is no way to arrange for their care and patients for whom transportation is neither available nor otherwise feasibly arranged. Home visits should be a component of an individual patient's therapeutic program, planned under the supervision of a physician and subject to periodic review and evaluation.	28.00
(xi)	Pre-admission clinical diagnostic evaluation -a clinical examination by a physician alone or accompanied by other members of a team of a person referred for admission to a mental hospital in order to determine the applicant's care needs.	28.00

N.Y. Comp. Codes R. & Regs. Tit. 14 § 100.2