(l) Complex care management means an ancillary service to psychotherapy, psychotropic medication treatment, or crisis intervention services. It is provided by a clinician in person or by telephone, with or without the client. It is a clinical level service which is required as a follow up to psychotherapy, psychotropic medication treatment, or crisis intervention service for the purpose of preventing a change in community status or as a response to complex conditions.

2. Subdivision (c) of section 599.14 of Title 14 NYCRR is amended to read as follows:

(c) Medicaid claims may be submitted for no more than three services per day for any individual, not including crisis intervention or complex care management services. For the purposes of this subdivision, psychotropic medication treatment, injectable psychotropic medication administration, [and] injectable psychotropic medication administration with monitoring and education, and complex care management services may be counted as either health services or psychiatric services. No more than one health physical may be claimed in one year. Medicaid claims may be submitted for no more than one off-site service per child, per day, excluding crisis intervention services.

3. Paragraph (9) of subdivision (d) of Section 599.14 of Title 14 NYCRR is amended to read as follows:

(9) [Complex] Effective October 1, 2014, complex care management must be provided within [five working] fourteen calendar days following a face-to-face psychotherapy, psychotropic medication treatment, or crisis intervention service. [Only one] A maximum of four units of at least five consecutive minutes of complex care [procedure shall] management may be billed following each face-to-face psychotherapy, psychotropic medication treatment, or crisis intervention service. [To bill medical assistance, this service requires at least 15 minutes of continuous time, not including standard reporting writing or brief follow-up calls.] Each full five-minute unit may be provided on separate days within the 14-calendar day limit, with a maximum of four full five-minute units associated with each eligible clinic visit. The time spent documenting the provision of complex care management or in other documentation activities shall not be included in the calculation of time for the purposes of billing of complex care management.

This proposal is filed as a Consensus rule on the grounds that it is non-controversial and makes minor technical corrections. No person is likely to object to this proposed rule since it merely adjusts the billing units associated with the reimbursement of a clinic service and allows flexibility in the delivery of complex care management.

14 NYCRR Part 599 sets forth standards for the certification, operation and reimbursement of clinic treatment programs serving adults and children. It has been four years since the Office of Mental Health (OMH) adopted 14 NYCRR Part 599 to establish a new, redesigned clinic structure. Since that time, based on provider feedback, OMH has amended the clinic regulations on several occasions. These technical changes are a continuation of this process.

Under existing regulations, complex care management is a clinical level service that must be provided for at least 15 continuous minutes and within five working days following a face-to-face psychotherapy or crisis service. OMH received feedback from providers stating that the five-day time frame for performance of complex care management is insufficient and that the requirement that this service be performed for 15 continuous minutes is untenable. Providers need flexibility to complete tasks (e.g., phone calls) that cannot necessarily be completed in 15 continuous minutes or within five days. To address these issues and provide regulatory relief, this proposal will allow for 14 calendar days for this service to be provided subsequent to a face-to-face psychotherapy, psychotropic medication treatment, or crisis intervention service. This amendment adds psychotropic medication management as a service that is eligible for complex care management. In addition, the APG billing weights have been adjusted to allow for a maximum of four units (five minutes each) instead of one 15-minute unit per day for performance of complex care management. Each full five-minute unit may be provided on separate days within the 14-day limit, with a maximum of four full five-minute units associated with each eligible clinic visit. These regulatory amendments will be retroactive to October 1, 2014.

Statutory Authority: Sections 7.09 and 31.04 of the Mental Hygiene Law grant the Commissioner of Mental Health the power and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction, to set standards of quality and adequacy of facilities, equipment, personnel, services, records and programs for the rendition of services for adults diagnosed with mental illness or children diagnosed with emotional disturbance, pursuant to an operating certificate. Section 364-j of the Social Services Law requires the establishment of managed care programs throughout the State and provides for the provision of special care services to enrollees in Medicaid managed care programs who require such services. Sections 364 and 364-a of the Social Services Law give the Office of Mental Health responsibility for establishing and maintaining standards for medical care and services in facilities under its jurisdiction, in accordance with cooperative arrangements with the Department of Health. Section 43.01 of the Mental Hygiene Law gives the Commissioner the authority to set rates for outpatient services at facilities operated by the Office of Mental Health. Section 43.02 of the Mental Hygiene Law provides that payments under the medical assistance program for outpatient services at facilities licensed by the Office of Mental Health shall be at rates certified by the Commissioner of Mental Health and approved by the Director of the Budget.

The amendments to 14 NYCRR Part 599 serve to adjust the billing units associated with the reimbursement of a clinic service and allow for flexibility in the delivery of complex care management. The amendments are intended to provide regulatory relief to clinic providers. As 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.