Current through Register Vol. 46, No. 52, December 24, 2024
(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.
