Title: Section 505.27 - Chemical Dependence Outpatient Services

505.27 - Chemical Dependence Outpatient Services

(a) Definitions. (1) Chemical Dependence outpatient services means services provided under the supervision and direction of a licensed physician, and includes the medical supervision of persons meeting the admission criteria for chemical dependence outpatient services in section 19.07 of the Mental Hygiene Law, as implemented in Title 14 of the Codes, Rules and Regulations of New York State (14 NYCRR), Part 822 or Part 823, as applicable.

(2) An occasion of service shall mean a chemical dependence service which meets the provisions of 14 NYCRR Part 822 or Part 823, as applicable.

(3) All definitions as specified in 14 NYCRR Part 822 or Part 823, as applicable, shall apply to this section except, if definitions specifically contained in this section are inconsistent with those contained in Parts 822 and 823, this section shall apply.

(4) OASAS shall mean the Office of Alcoholism and Substance Abuse Services.

(b) Services covered under the Medical Assistance Program.

(1) Reimbursement shall be limited to one visit per day, per patient.

(2) A visit means one or more distinct and separate occasions of service provided on-site by an OASAS licensed provider to a patient.

(3) For purposes of this section, a patient shall mean an individual who is admitted either to a chemical dependence outpatient service or an individual being diagnosed or assessed to determine that individual’s need for such services.

(4) There shall be reimbursement only for visits that meet the following requirements:

(i) An occasion of service must be a face-to-face contact between a patient and treatment staff, which takes place at a site certified by OASAS.

(ii) An occasion of service must be a chemical dependence outpatient service provided pursuant to 14 NYCRR Part 822 or Part 823, as applicable.

(5) All occasions of service provided during a visit must be documented in the patient’s treatment record.

(6) Services must be approved by the Medical Director or another physician employed by the program, recorded in the treatment plan of the patient, and may be subject to utilization review procedures.

(7) Reimbursement shall be limited to no more than two diagnosis and assessment visits per patient for each admission to a chemical dependence outpatient service.

(c) The Medical Assistance Program does not cover the following:

(1) Visits to the premises of a chemical dependence outpatient service for the sole purpose of attending meetings of a self-help group that does not meet the definition of a group covered under 14 NYCRR Part 822 or Part 823, as applicable;

(2) Any visits which include only companionship, recreation and/or social activity; and

(3) Services provided in a facility which is not enrolled in the Medical Assistance Program pursuant to Title 11 of Article 5 of the Social Services Law and Title 18 NYCRR.

(d) Reimbursement.

(1) Payment for chemical dependence outpatient services shall be at fees established by the Department of Health and approved by the Director of the Division of the Budget as contained in the fee schedule for chemical dependence outpatient services.

(2) The fee schedule for chemical dependence outpatient services is available from the department and is also contained in the department’s MMIS Provider Manual (Clinic). Copies of the manual may be obtained by writing Computer Sciences Corporation, Health and Administrative Services Division, 800 North Pearl St., Albany, New York 12243. Copies may also be obtained from the Department of Health, The Governor Nelson A. Rockefeller Empire State Plaza, Albany, New York 12237. The manuals are provided free of charge to every provider of chemical dependence outpatient services at the time of enrollment in the Medical Assistance program.

(3) Payment will be made under this subdivision only for services provided by a facility certified solely under Article 32 of the Mental Hygiene Law.

(e) Payment to chemical dependence outpatient programs certified under Article 28 of the Public Health Law for care to Medicaid recipients shall be at rates determined by the Department of Health for that particular facility.