The main goals of the additional services as identified in New York State’s Medicaid Plan is to:

- Identify needs early on in a child’s life;

- Maintain the child at home with support and services;

- Maintain the child in the community in the least restrictive settings possible;

- Prevent the need for long-term and/or more expensive services; and

- To increase the delivery of services following trauma-informed care principles.

To accomplish these goals, the following services will be implemented:

- Other Licensed Practitioner;

- Crisis Intervention;

- Community Psychiatric Support and Treatment;

- Psychosocial Rehabilitation;

- Family Peer Support; and

- Youth Peer Advocacy and Training.

To facilitate the delivery of these services, DOH, OMH, OASAS, and OCFS will designate licensed, certified, or approved providers under their respective jurisdictions to offer these services under the Medicaid program. OMH is proposing a new Part 511 to Title 14 NYCRR to establish the process under which providers of mental health services that are operated, licensed, or funded may obtain designation to offer any or all of these six services.

A provider of mental health services is eligible to apply for designation if it is enrolled in the Medicaid program prior to commencing service delivery; have a history of compliance with federal and state laws and regulations governing the provision of mental health services; and satisfy requisite criteria identified in the New York State Plan Amendment Designation Application and standards of care identified in the Children’s Health and Behavioral Health Services Transformation Medicaid State Plan Provider Manual. Requests for designation must be in writing, in a form and format identified by OMH. The proposed regulations also include a process for revocation of a designation, establish a requirement for OMH to publish guidelines for service provision on its public website, and indicate that the aforementioned standards of care are incorporated by reference.

1. Statutory authority: Sections 7.09 and 31.04 of the Mental Hygiene Law grant the Commissioner of Mental Health the authority and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.

2. Legislative objectives: Articles 7 and 31 of the Mental Hygiene Law reflect the Commissioner’s authority to establish regulations regarding mental health programs.

3. Needs and benefits: Federal law requires state Medicaid programs to offer Early and Periodic Screening, Diagnosis and Treatment (EPSDT) to all Medicaid-eligible children under age 21. Within the scope of EPSDT benefits, states are required to cover any service that is medically necessary to “correct or ameliorate a defect, physical or mental illness, or a condition identified by screening” and which are recommended by a licensed practitioner of the healing arts. New York State has obtained an amendment to its Medicaid State Plan that authorizes the provision of six new children’s behavioral and health services under the EPSDT program. When recommended by a practitioner of the healing arts, these six services will be made available to any child eligible for Medicaid who meets relevant medical necessity criteria, and include: Crisis Intervention Services; Family Peer Support Services; Youth Peer Advocacy and Training; Psychosocial Rehabilitation Services; Community Psychiatric Support and Treatment; and Other Licensed Practitioner. This Part establishes a process to obtain designation from the Office of Mental Health to offer EPSDT behavioral health services.

4. Costs: Costs to implement these EPSDT behavioral health services in general, are significantly offset by the cost savings that can result from its use. These services will be provided in the home or community settings with the goal of identifying needs early, maintaining the child at home with support and services, and preventing longer term need for costly higher-end services. All services are intended to be delivered in a culturally competent manner and to be trauma-informed. Service planning will consider the child and his or her family’s strengths, assets, needs and any history of adverse experiences.

(a) Cost to State government: There are no new costs to State government as a result of these amendments.

(b) Cost to local government: There are no new costs to local government as a result of these amendments.

(c) Cost to regulated parties: For providers that obtain designation and offer these services, there are no new costs to providers as a result of these amendments.

5. Local government mandates: The provision of this service is not required. These regulatory amendments will not involve or result in any additional imposition of duties or responsibilities upon county, city, town, village, school, or fire districts.

6. Paperwork: For providers that wish to be designated to provide this service, written plans must be submitted for approval by the Office.

7. Duplication: These regulatory amendments do not duplicate existing State or federal requirements.

8. Alternatives: Although regulations are not required to establish the standards and process for designation, the regulation ensures the requirements and process for designation, as well as the due process requirements for removing designation, are clearly established.

9. Federal standards: There are currently no federal standards specific to the provision of these EPSDT behavioral health services. However, the regulatory amendments are consistent with the definition of EPSDT services issued by the Centers for Medicare and Medicaid Services. (42 U.S.C. §§ 1396d(r)(5).

10. Compliance schedule: The amendments would be effective upon adoption.

The amendments to 14 NYCRR Part 511 are intended to establish a designation process to obtain Office authorization to deliver children’s behavioral services under the EPSDT program by providers that are operated, licensed, or funded by the Office. Participation in the program by such providers is not mandatory. As there will be no adverse economic impact on small businesses or local governments as a result of these amendments, a regulatory flexibility analysis is not submitted with this notice.

The amendments to 14 NYCRR Part 511 are intended to establish a designation process to obtain Office authorization to deliver EPSDT children’s behavioral services by providers that are operated, licensed, or funded by the Office. Participation in this program by such providers is not mandatory. The proposed rule will not impose any adverse economic impact on rural areas; therefore, a Rural Area Flexibility Analysis is not submitted with this notice.

The amendments to 14 NYCRR Part 511 are intended to establish a designation process to obtain Office authorization to deliver EPSDT children’s behavioral services by providers that are operated, licensed, or funded by the Office. Participation in this program by such providers is not mandatory. Because it is evident from the subject matter that there will be no adverse impact on jobs and employment opportunities as a result of these amendments, a Job Impact Statement is not submitted with this notice.