New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XXI - OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES
Part 841 - Medical Assistance for Chemical Dependence Services
Section 841.13 - Utilization Review
Universal Citation: 14 NY Comp Codes Rules and Regs ยง 841.13
Current through Register Vol. 46, No. 12, March 20, 2024
(a) Except as otherwise specified, programs shall provide that:
(1) An Office approved tool was utilized to
identify the appropriate level of care for treatment delivered to the
patient.
(2) A practitioner must
certify for each Medicaid recipient that services of the type provided are or
were needed in accordance with the controlling Part under this Title.
(3) The utilization review plan of an
eligible provider shall ensure that each provider have policies and procedures
to address:
(i) Patients continue to require
services furnished in accordance with the applicable criteria of the
controlling Part of this Title and review of treatment planning and progress
notes;
(ii) Patients are receiving
care consistent with psychosocial needs and diagnosis for which they are
receiving treatment; and,
(iii)
patients have been referred for additional services consistent with their
health and physical.
(4)
Providers shall have policies and procedures for a utilization management team
charged with meeting at least twice annually. Such team shall review the
results of audits, utilization management process and other quality assurance
activities that are related to charting and to create a comprehensive
corrective action plan as needed to ensure compliance with state and federal
laws, regulations and guidance issued by the Office.
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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