14 CRR-NY 820.13NY-CRR
14 CRR-NY 820.13
14 CRR-NY 820.13
820.13 Standards pertaining to Medicaid reimbursement.
(a) Services must be delivered in accordance with signed treatment/recovery plan.
(1) Treatment/recovery plans should be signed by the responsible clinical staff member and the resident. Activities included in the service plan must be intended to achieve identified treatment/recovery plan goals or objectives and identify the following:
(i) medical or remedial services intended to reduce the condition;
(ii) anticipated outcomes for the resident;
(iii) frequency, amount and duration of the services.
(2) Treatment/recovery plans shall specify a timeline for plan reevaluation at least annually and be reevaluated at any time clinically necessary.
(b) Non-covered services.
(1) Components that are not provided to, or directed exclusively toward the treatment of the Medicaid beneficiary, are not eligible for Medicaid reimbursement.
(2) Services provided at a work site must not be job task oriented and must be directly related to treatment of a resident’s treatment needs.
(3) No more than one per diem rate may be billed a day for residential SUD programs, however bills may be submitted for allowable medical procedures in accordance with CPT approved coder set per the national correct coding initiative.
(c) Court ordered services.
(1) Assessments and testing for individuals who are Medicaid eligible, including any laboratory tests and urine tests.
(2) Drug court diversion treatment programs are eligible for Medicaid funding.
(3) Laboratory procedures which the practitioner refers to an outside laboratory must be billed by the laboratory.
(d) Service reimbursement.
Reimbursements for services are based upon a Medicaid fee schedule established by the State of New York. OASAS reimbursement rates and information may be found on the OASAS website and in Part 841 of this Title.
14 CRR-NY 820.13
Current through May 31, 2021
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