Current through Register Vol. 46, No. 39, September 25, 2024
(a) Purpose: This section promotes the
expansion of health and behavioral health services for children/youth under 21
years of age. The New York State Department of Health (DOH), the New York State
Office of Mental Health (OMH), the New York State Office of Alcoholism and
Substance Abuse Services (OASAS), and the New York State Office of Children and
Family Services (OCFS) (the "State Agencies") shall designate licensed,
certified or approved providers to deliver specifically defined services under
the Medicaid program.
(b) Services:
The following services shall be available to children and youth who are
eligible for Medicaid, when provided in accordance with the provisions of this
section.
(1) Crisis Intervention (CI) CI
services are provided to a child/ youth under age 21, and his/her
family/caregiver, who is experiencing a psychiatric or substance use
(behavioral health) crisis, and are designed to:
(i) Interrupt and/or ameliorate the crisis
experience
(ii) Include an
assessment that is culturally and linguistically sensitive
(iii) Result in immediate crisis resolution
and de-escalation
(iv) Develop a
crisis plan
(2) Other
Licensed Practitioner:
(i) A non-physician
licensed behavioral health practitioner (NPLBHP) is an individual who is
licensed and acting within his or her lawful scope of practice under Title VIII
of the Education Law and in any setting permissible under State law.
(ii) Individual Staff Qualifications:
(a) NP-LBHPs include the following
practitioners; each is permitted to practice independently within his or her
scope of practice:
(1) licensed
psychoanalysts;
(2) licensed
clinical social workers (LCSWs);
(3) licensed marriage and family therapists;
and
(4) licensed mental health
counselors.
(b) NP-LBHPs
also include licensed master social workers (LMSWs) under the supervision of
licensed clinical social workers (LCSWs), licensed psychologists, or
psychiatrists.
(3) Community Psychiatric Support and
Treatment (CPST): CP ST services are goal-directed supports and
solution-focused interventions intended to achieve identified goals or
objectives as set forth in the child's/ youth's individualized treatment plan.
CPST is designed to provide community-based services to children or youth and
their families or caregivers who may have difficulty engaging in formal office
settings, but can benefit from community based rehabilitative services. CPST
allows for delivery of services within a variety of permissible settings
including community locations where the child/youth lives, works, attends
school, engages in services (e.g. provider office sites), and/or socializes.
This includes the implementation of Evidence Based Practices with approval by
the State Agencies.
(4)
Psychosocial Rehabilitation (PSR): PSR services are provided to children or
youth and their families or caregivers to implement interventions outlined in
the individualized treatment plan to compensate for or eliminate functional
deficits and interpersonal and/or environmental barriers associated with a
child/youth's behavioral health needs. The intent of PSR is to restore,
rehabilitate, and support a child/youth's functional level as much as possible
and as necessary for the integration of the child/youth as an active and
productive member of their community and family with minimal ongoing
professional interventions. Activities included must be task oriented and
intended to achieve the identified goals or objectives as set forth in the
child/youth's individualized treatment plan.
(5) Family Peer Support (FPS): FPS services
are an array of formal and informal services and supports provided to families
caring for/raising a child/youth who is experiencing social, emotional,
developmental, medical, substance use, and/or behavioral challenges in their
home, school, placement, and/or community. FPS services provide a structured,
strengthbased relationship between a credentialed Family Peer with relevant
lived experience as determined appropriate by the State Agencies as defined in
subdivision (a) of this section and the parent/family member/caregiver for the
benefit of the child/youth. Activities must be task oriented and intended to
achieve the identified goals or objectives as set forth in the child/youth's
individualized treatment plan.
(6)
Youth Peer Support and Training (YPST): YPST services are youth formal and
informal services and supports provided to youth who are experiencing social,
emotional, medical, developmental, substance use, and/or behavioral challenges
in their home, school, placement, and/or community centered services. These
services provide the training and support necessary by a credentialed youth
peer with relevant lived experience as determined appropriate by the State
Agencies as defined in subdivision (a) of this section to ensure engagement and
active participation of the youth in the treatment planning process and with
the ongoing implementation and reinforcement of skills learned throughout the
treatment processes. YPST activities must be intended to develop and achieve
the identified goals and/or objectives as set forth in the youth's
individualized treatment plan. YPST services delivered are based on the
individualized treatment plan developed by the licensed practitioner working
with the youth.
(c)
Provider Qualifications:
(1) Any child
serving agency or agency with children's behavioral health and health
experience must have the necessary licensure, certification, designation, or
approval from DOH, OMH, OASAS, or OCFS to provide the services authorized by
this section.
(2) Any licensed
practitioner providing behavioral health or health services authorized under
this section must work in a child serving agency or agency with children's
behavioral health and health experience, as described in paragraph (1) of this
subdivision.
(3) Crisis
Intervention practitioners must work in a child serving agency, or agency with
children's behavioral health and health experience, that obtains or possesses a
current license or authorization to provide crisis and/or crisis treatment
services, consistent with the requirements of paragraph (1) of this
subdivision.
(4) Any organization
seeking to provide any service authorized by this regulation and to serve the
general population needing mental health services must be licensed or
authorized to do so by OMH in addition to obtaining the licensure,
certification, designation, or approval described in paragraph (1) of this
subdivision.
(5) Any organization
seeking to provide any service authorized by this regulation and to serve the
general population needing substance use disorder services must be certified,
designated or authorized to do so by OASAS in addition to obtaining the
licensure, certification, designation, or approval described in paragraph (1)
of this subdivision.
(d)
Designation of Providers:
(1) As a
prerequisite to providing any of the services authorized by this section, a
provider must receive a designation from DOH, OMH, OASAS, or OCFS. Being
designated to provide services authorized by this section is not a substitute
for possessing any required State licensure, certification, authorization or
credential, and any such designation may be conditioned upon obtaining or
modifying a required licensure, certification, authorization or
credential.
(2) To be eligible for
designation, a provider must submit an application on a form required by the
State agencies and must:
(i) Be enrolled in
the Medicaid program prior to commencing service delivery;
(ii) Be a qualified provider as described in
subdivision (c) o f this section and maintain its license, certification or
approval with that state agency;
(iii) Be in good standing according to the
standards of each agency by which it is licensed, certified or approved;
(iv) Be a fiscally viable agency;
(v) Meet developed criteria as
outlined in the Provider Designation Application guidance and form, including
adequate explanation of how the provider meets such criteria; and
(vi) Adhere to the Standards of Care
described in the Children's Health and Behavioral Health Services
Transformation Medicaid State Plan Provider Manual for Children's BH Early and
Periodic Screening and Diagnostic Testing (EPSDT) Services which have been
incorporated by reference in this Part and have been filed in the Office of the
Secretary of State of the State of New York, the publication so filed being the
document entitled: Children's Health and Behavioral Health Services
Transformation Medicaid State Plan Provider Manual for Children's B H Early and
Periodic Screening and Diagnostic Testing (EPSDT) Services, published in
December, 2016, and any subsequent updates. This document incorporated by
reference may be examined at the Office of the Department of State, 99
Washington Ave, Albany, NY 12231 or obtained from the Department of Health, 99
Washington Ave, Albany, NY 12231.
(3) A provider designated to provide services
authorized by this section will be assigned a lead State agency (DOH, OASAS,
OCFS or OMH), based on the primary population served, location, and indicated
line of business on the provider application, which will be responsible, in
collaboration with the other State agencies, for monitoring and oversight of
the provider.
(4) If a provider is
designated to provide Community Support and Treatment services, it may seek
approval of the lead State agency and DOH to utilize, in the provision of
services, specified evidence-based techniques drawn from cognitive-behavioral
therapy and/or other evidence based psychotherapeutic interventions.
(5) Nothing contained herein shall authorize
a provider to provide medical services, except as otherwise authorized by law.
(e) Rescinding a
designation.
(1) A provider who fails to
comply with laws, regulations and policies may have its designation rescinded
by the lead State agency, which will consult with the other State agencies
before taking such action. The provider has 14 business days to appeal the
action to the lead State agency. The lead State agency shall respond with a
final decision with in 14 business days of appeal.
(2) A provider whose designation was
rescinded may apply for redesignation pursuant to subdivision (d) of this
section. The provider must show that it corrected the problems that led to the
rescission. An onsite and/or desk evaluation may be conducted by the lead Stat
e agency prior to approving the redesignation request.
(f) Reimbursement: Reimbursement for
children's behavioral health and health services must be in accordance with the
rates established by the Department and approved by the Director of the
Division of Budget.