Current through Register Vol. 46, No. 39, September 25, 2024
(a) Providers of
mental health services must receive prior approval by written designation of
the Office to provide any or all of the following EPSDT services:
(1) Crisis Intervention services are
available to a child or a member of his/her family who is experiencing a
behavioral health crisis event, and are designed to:
(i) interrupt and/or ameliorate the crisis
event;
(ii) include an assessment
that is culturally and linguistically competent;
(iii) result in immediate crisis resolution
and de-escalation; and
(iv) result
in the development of a crisis plan.
(2) Community Psychiatric Support and
Treatment services, which include interventions intended to achieve identified
goals or objectives as set forth in a treatment/recovery plan.
(3) Family Peer Support services, which
include formal and informal services to families of a child experiencing
social, emotional, developmental, medical, substance use, and/or behavioral
challenges in their home, school, placement, and/or community.
(4) Other Licensed Practitioner services,
which include services provided by the following professionals, operating
within a licensed children's mental health agency, if currently licensed by
State of New York to prescribe, diagnose, and/or treat individuals with a
physical, mental illness, substance use disorder, or functional limitations at
issue, provided such professionals are operating within their respective scope
of practice and in a setting permitted under New York State law, including
community settings:
(i) Licensed
Psychoanalyst;
(ii) Licensed
Clinical Social Worker;
(iii)
Licensed Marriage & Family Therapist;
(iv) Licensed Mental Health Counselor;
or
(v) Licensed Master Social
Worker under the supervision or direction of a Licensed Clinical Social Worker,
a Licensed Psychologist, or a Psychiatrist.
(5) Psychosocial Rehabilitation services,
which are task-oriented services designed to restore, compensate for, or
eliminate functional deficits and interpersonal and/or behavioral health
barriers associated with behavioral health needs.
(6) Youth Peer Support and Training services
are formal and informal services and supports to ensure engagement and active
participation of youth in the treatment planning and implementation
process.
(b) Requests
for designation to provide EPSDT services shall be made in a form and format
established by the Office.
(c) To
be eligible for designation, the applicant must:
(1) be enrolled in the Medicaid program prior
to commencing service delivery;
(2)
have a demonstrated history of compliance with applicable federal and state
laws and regulations governing the provision of mental health services;
and
(3) satisfy requisite criteria
identified in the New York State Plan Amendment Designation Application and the
standards of care identified in the Children's Health and Behavioral Health
Services Transformation Medicaid State Plan Provider Manual.
(d) The Office shall provide its
designation in writing, which shall identify the services such designation
authorizes the provider to deliver. The provider of services must retain a copy
of the approval document and shall make it available for inspection upon
request of the Office.
(e) Failure
to adhere to the requirements set forth in this Part, or any other applicable
laws or regulations relevant to the provision of health or behavioral health
services, may be grounds for revocation of designation. In the event that the
Office determines that designation must be revoked, it will notify the provider
of its decision in writing. The provider may request an informal administrative
review of such decision.
(1) The provider must
request such review in writing within 14 days of the date it receives notice of
revocation of designation to provide EPSDT services to the Commissioner or
designee. The request shall state specific reasons why the provider considers
the revocation of approval incorrect and shall be accompanied by any supporting
evidence or arguments.
(2) The
Commissioner or designee shall notify the provider, in writing, of the results
of the informal administrative review within 14 days of receipt of the request
for review. Failure of the Commissioner or designee to respond within that time
shall be considered confirmation of the revocation.
(3) The Commissioner's determination after
informal administrative review shall be final and not subject to further
administrative review.
(4) A
provider whose designation has been revoked pursuant to this Section may be
considered again for designation at the discretion of the Office, in
consultation with the State Agencies.
