New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIII - Office of Mental Health
Part 506 - Medical Assistance Rates Of Payment For Intensive Case Management Services (icm), Supportive Case Management (scm) And Blended Icm/scm Case Management Services
Section 506.5 - Standards pertaining to reimbursement for intensive case management services

Universal Citation: 14 NY Comp Codes Rules and Regs § 506.5

Current through Register Vol. 46, No. 39, September 25, 2024

(a) In order to receive reimbursement for the provision of services, a provider of an intensive case management program shall provide services to a person identified as a person with a serious mental illness and who is also enrolled as a client of the provider of case management services.

(b) A provider of service must indicate to the Office of Mental Health which one of the following billing methodologies will be adopted by the program:

(1) a minimum of four face-to-face contacts within a month between an intensive case manager and an active client shall be considered a billable service; or

(2) a minimum of two face-to-face contacts within a month between an intensive case manager and an active client shall be considered a billable service, if the intensive case manager's aggregate monthly contacts average four face-to-face contacts per active client.

(1) Collateral contacts shall not be counted as a billable service for adult active client.

(2) Collateral contacts may be counted as a billable service for an active child or adolescent client; however, no more than 25 percent of the aggregate contacts may be collateral contacts. Collateral contacts shall not count toward the minimum of two face-to-face contacts which may be considered a billable service pursuant to paragraph (b)(2) of this section.

(3) Contacts with a group composed of collaterals of more than one child or adolescent may be gathered together for the purposes of goal-oriented problem solving, assessment of treatment strategies and the developmental or practical skills for assisting the child or adolescent with the management of his or her illness; provided, however, that at least one collateral of the client for whom a billable service is being submitted must be a participant of the group.

(d) Only one contact per day shall be allowed as a billable service; provided, however, that two contacts per day shall be so allowable if one contact is a face-to-face contact with a child or adolescent client and the other contact is a face-to-face contact with a collateral of a child or adolescent client. The two contacts must occur separately and be consistent with a written service plan.

(e) For an intensive case management program that employs more than one intensive case manager, the program may deliver services through a team approach. Each enrolled client shall have a primary intensive case manager but team members must provide shared case management planning, specialty services and coverage during leaves, vacations and sick days and bill for such services pursuant to this Part.

(f) While awaiting discharge from the intensive care management program, a client shall be considered to be on transitional status and may receive one contact per month for a period of two months prior to discharge. The one contact per month during this time period is a billable service.

(g) Shared intensive case management staff shall be responsible to the Office of Mental Health for purposes of rate setting, billing and reimbursement for intensive case management services.

(h) Each provider of services shall furnish any and all information and records concerning the provision of intensive case management services which may be requested by the Office of Mental Health. Such information and records shall be provided as the Office of Mental Health may prescribe including but not limited to, the program of services, individual client specific services and statistical, administrative and fiscal operations carried out under the agreement.

(i) If a provider does not achieve the required aggregate number of contacts, billing associated with the difference between the required number of contacts and achieved number of contacts shall be withheld pursuant to a schedule to be furnished to the provider by the Office of Mental Health.

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