14 CRR-NY 596.7NY-CRR
14 CRR-NY 596.7
14 CRR-NY 596.7
596.7 Reimbursement for telemental health services.
(a) The licensed or designated provider where the recipient is admitted is authorized to bill Medicaid for telemental health services.
(b) Under the Medicaid program, telemental health services are covered when medically necessary and under the following circumstances:
(1) the person receiving services is located at the originating/spoke site and the telemental health practitioner is located at the distant/hub site;
(2) the person receiving services is present during the encounter;
(3) the request for telemental health services and the rationale for the request are documented in the individual's clinical record;
(4) the clinical record includes documentation that the encounter occurred; and
(5) the telemental health practitioner at the distant/hub site is:
(i) authorized in New York State;
(ii) practicing within his/her scope of specialty practice;
(iii) affiliated with the originating/spoke site facility; and
(iv) if the originating/spoke site is a hospital, credentialed and privileged at the originating/spoke site facility.
(c) If the person receiving services is not present during the provision of the telemental health service, the service is not eligible for Medicaid reimbursement.
(d) The following interactions do not constitute reimbursable telemental health services:
(1) telephone conversations;
(2) e-mail messages; or
(3) text messages.
(e) The originating/spoke site may bill for administrative expenses only when a telemental health service connection is being provided and a qualified mental health professional is not present at the originating/spoke site with the recipient at the time of the encounter.
(f) Reimbursement for services provided via telemental health must be in accordance with the rates and fees established by the office and approved by the Director of the Budget.
(g) If a telemental health service is undeliverable due to a failure of transmission or other technical difficulty, reimbursement shall not be provided.
14 CRR-NY 596.7
Current through August 15, 2021
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