Current through Register Vol. 46, No. 39, September 25, 2024
(a) Provision of
psychiatric care by psychiatrists in private practice.
(1) Psychiatric care may be provided to a
recipient of medical assistance by a qualified psychiatrist in the
psychiatrist's office; in the recipient's home; in a clinic, a general or
chronic disease hospital or approved medical institution or facility operated
in compliance with applicable provisions of law; with respect to a child
receiving psychiatric care pursuant to an individualized education program,
such care may be provided in a school or an approved pre-school; or, for
persons aged 65 and over and for those under 21 years of age, such care may be
provided in a hospital caring exclusively or primarily for persons with mental
disease. In the case of a recipient who during the course of hospitalization
attains the age of 21, such services may continue until he or she reaches the
age of 22.
(2) In the delivery of
psychiatric care, a qualified psychiatrist in private practice may employ up to
four certified social workers to provide care under his continuing direct
supervision as part of a course of treatment. Services rendered by a social
worker shall conform with the provisions of section 85.32 of the regulations of
the New York State Department of Health. For purposes of this section, a
certified social worker rendering services under the Medical Assistance Program
shall mean a social worker certified pursuant to the New York State Education
Law, and evidence of current registration under such law shall be provided upon
request of the Department of Social Services.
(3) Psychiatric care furnished to a child
which is part of the development of, or pursuant to, an individualized
education program may be provided by a psychiatrist, certified social worker or
certified school social worker employed by, or under contract to, a school
district, an approved pre-school, or a county in the State or the city of New
York. For purposes of this section, a certified school social worker means a
school social worker currently registered and certified in accordance with the
New York State Education Law and the rules of the Commissioner of
Education.
(b)
Reimbursement and payment for psychiatric care provided by psychiatrists in
private practice and by certified social workers under their employ.
(1) Reimbursement and payment under the
Medical Assistance Program for services described in paragraph (a)(2) of this
section shall not be available for the provision of individual service to a
recipient in the Medical Assistance Program whose care and maintenance is now
provided pursuant to sections 41-i and/or 398-a of the Social Services
Law.
(2) Reimbursement and payment
under the Medical Assistance Program for services provided by a certified
social worker employed by a qualified psychiatrist in private practice shall be
available only when provided in the psychiatrist's office or the patient's
home. For the purposes of this paragraph, patient's home shall not include
facilities licensed pursuant to article 28 of the Public Health Law.
(3) Reimbursement and payment for care
provided to recipients by psychiatrists or by certified social workers under
their supervision shall be based on fees established by the State Department of
Health and approved by the State Director of the Budget. Payment for services
provided by a certified social worker shall be made to the supervising
psychiatrist.
(4) A supervising
psychiatrist shall provide the Department of Social Services with the name, and
certification or license number issued by the New York State Education
Department, of any certified social worker in his employ for whose service he
may bill. Claims submitted by a supervising psychiatrist for services rendered
by a certified social worker in his employ must include the name of the
certified social worker who provided such services.
(5) Services provided by certified social
workers under this subdivision shall be eligible for payment and State
reimbursement effective January 30, 1980.
(6) Payment for drugs administered or
dispensed by a psychiatrist in the course of treatment shall be in accordance
with the policies set forth in this Subchapter.
(7) State reimbursement shall be available
for expenditures made in accordance with provisions of this section.
(c) Reimbursement and payment for
psychiatric care provided to children with disabilities. Payment is available
for psychiatric care which is part of the development of, or furnished pursuant
to, an individualized education program and which are provided by a
psychiatrist, certified social worker or certified school social worker
employed by, or under contract to, a school district, an approved pre-school, a
county in the State or the city of New York. Reimbursement for such services
must be made in accordance with the provider agreement.
(d) Standard of conformity. The provision of
outpatient psychiatric care by a psychiatrist in private practice to a
recipient in the Medical Assistance Program shall be in conformity with the
provisions of sections 85.28 through 85.30 of the Department of Health
regulations (10 NYCRR) in order to be a reimbursable service.
