New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIII - Office of Mental Health
Part 508 - Medical Assistance Rates Of Payment For Assertive Community Treatment Services
Section 508.7 - Inpatient settings
Universal Citation: 14 NY Comp Codes Rules and Regs ยง 508.7
Current through Register Vol. 46, No. 39, September 25, 2024
(a) In order for an individual to be considered an active client of an ACT program in an inpatient setting, he or she must be:
(1)
admitted to a psychiatric unit of a hospital licensed under article 28 of the
Public Health Law, or admitted to a residential treatment facility for children
and youth;
(2) 21 years of age or
less, or 65 years of age or older, who is receiving services at a
State-operated psychiatric hospital or freestanding psychiatric hospital
licensed solely pursuant to article 31 of the Mental Hygiene Law; or
(3) admitted to a hospital or other
residential medical facility licensed pursuant to article 28 of the Public
Health Law.
(b) For the purpose of discharge planning, reimbursement is permitted for up to five calendar months of service during an inpatient episode without regard to the duration of the inpatient episode as follows:
(1) In the month of admission and/or month of
discharge full payment rate reimbursement is permitted for any month in which
four or more community-based contacts combined with inpatient face-to-face
contacts equals six or more total contacts in the month.
(2) In the month of admission and/or month of
discharge stepdown/partial payment rate reimbursement is permitted when a
minimum of two community-based contacts are provided in a month, or when a
minimum of one community contact, combined with a minimum of one inpatient
contact, is provided.
(3) Inpatient
payment rate reimbursement is permitted when a minimum of two inpatient
face-to-face contacts are provided in a month, regardless of the number of
community contacts. Reimbursement for more than one contact per day during
inpatient status is not permitted.
(c) Any episode of inpatient care is considered a continuous hospital or other medical facility stay if the client's discharge is followed by a readmission to a hospital on or before the tenth day following the date of discharge.
(d) For inpatient stays beyond the initial five months:
(1) the patient may be placed on
inactive ACT status. The ACT Team should notify the local SPOA of the inactive
status; and
(2) upon discharge from
the inpatient setting, the patient may return to active status on the same ACT
team for continuing community-based service. The ACT team must notify the local
SPOA of the reactivated status.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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