Title: Section 505.38 - Children’s Behavioral Health and Health Services.
505.38 Children’s Behavioral Health and Health Services.
(a) Purpose: This section promotes the expansion of health and behavioral health services for children/youth under 21 years of age. The New York State Department of Health (DOH), the New York State Office of Mental Health (OMH), the New York State Office of Alcoholism and Substance Abuse Services (OASAS), and the New York State Office of Children and Family Services (OCFS) (the “State Agencies”) shall designate licensed, certified or approved providers to deliver specifically defined services under the Medicaid program.
(b) Services: The following services shall be available to children and youth who are eligible for Medicaid, when provided in accordance with the provisions of this section.
(1) Crisis Intervention (CI) - CI services are provided to a child/youth under age 21, and his/her family/caregiver, who is experiencing a psychiatric or substance use (behavioral health) crisis, and are designed to:
(i) Interrupt and/or ameliorate the crisis experience
(ii) Include an assessment that is culturally and linguistically sensitive
(iii) Result in immediate crisis resolution and de-escalation
(iv) Develop a crisis plan
(2) Other Licensed Practitioner:
(i) A non-physician licensed behavioral health practitioner (NP-LBHP) is an individual who is licensed and acting within his or her lawful scope of practice under Title VIII of the Education Law and in any setting permissible under State law.
(ii) Individual Staff Qualifications
(a) NP-LBHPs include the following practitioners; each is permitted to practice independently within his or her scope of practice:
(1) licensed psychoanalysts;
(2) licensed clinical social workers (LCSWs);
(3) licensed marriage and family therapists; and
(4) licensed mental health counselors.
(b) NP-LBHPs also include licensed master social workers (LMSWs) under the supervision of licensed clinical social workers (LCSWs), licensed psychologists, or psychiatrists.
(3) Community Psychiatric Support and Treatment (CPST): CPST services are goal-directed supports and solution-focused interventions intended to achieve identified goals or objectives as set forth in the child’s/youth’s individualized treatment plan. CPST is designed to provide community-based services to children or youth and their families or caregivers who may have difficulty engaging in formal office settings, but can benefit from community based rehabilitative services. CPST allows for delivery of services within a variety of permissible settings including community locations where the child/youth lives, works, attends school, engages in services (e.g. provider office sites), and/or socializes. This includes the implementation of Evidence Based Practices with approval by the State Agencies.
(4) Psychosocial Rehabilitation (PSR): PSR services are provided to children or youth and their families or caregivers to implement interventions outlined in the individualized treatment plan to compensate for or eliminate functional deficits and interpersonal and/or environmental barriers associated with a child/youth’s behavioral health needs. The intent of PSR is to restore, rehabilitate, and support a child/youth’s functional level as much as possible and as necessary for the integration of the child/youth as an active and productive member of their community and family with minimal ongoing professional interventions. Activities included must be task oriented and intended to achieve the identified goals or objectives as set forth in the child/youth’s individualized treatment plan.
(5) Family Peer Support (FPS): FPS services are an array of formal and informal services and supports provided to families caring for/raising a child/youth who is experiencing social, emotional, developmental, medical, substance use, and/or behavioral challenges in their home, school, placement, and/or community. FPS services provide a structured, strength-based relationship between a credentialed Family Peer with relevant lived experience as determined appropriate by the State Agencies as defined in subdivision (a) of this section and the parent/family member/caregiver for the benefit of the child/youth. Activities must be task oriented and intended to achieve the identified goals or objectives as set forth in the child/youth’s individualized treatment plan.
(6) Youth Peer Support and Training (YPST): YPST services are youth formal and informal services and supports provided to youth who are experiencing social, emotional, medical, developmental, substance use, and/or behavioral challenges in their home, school, placement, and/or community centered services. These services provide the training and support necessary by a credentialed youth peer with relevant lived experience as determined appropriate by the State Agencies as defined in subdivision (a) of this section to ensure engagement and active participation of the youth in the treatment planning process and with the ongoing implementation and reinforcement of skills learned throughout the treatment processes. YPST activities must be intended to develop and achieve the identified goals and/or objectives as set forth in the youth’s individualized treatment plan. YPST services delivered are based on the individualized treatment plan developed by the licensed practitioner working with the youth.
(c) Provider Qualifications:
(1) Any child serving agency or agency with children’s behavioral health and health experience must have the necessary licensure, certification, designation, or approval from DOH, OMH, OASAS, or OCFS to provide the services authorized by this section.
(2) Any licensed practitioner providing behavioral health or health services authorized under this section must work in a child serving agency or agency with children’s behavioral health and health experience, as described in paragraph (1) of this subdivision.
(3) Crisis Intervention practitioners must work in a child serving agency, or agency with children’s behavioral health and health experience, that obtains or possesses a current license or authorization to provide crisis and/or crisis treatment services, consistent with the requirements of paragraph (1) of this subdivision.
(4) Any organization seeking to provide any service authorized by this regulation and to serve the general population needing mental health services must be licensed or authorized to do so by OMH in addition to obtaining the licensure, certification, designation, or approval described in paragraph (1) of this subdivision.
(5) Any organization seeking to provide any service authorized by this regulation and to serve the general population needing substance use disorder services must be certified, designated or authorized to do so by OASAS in addition to obtaining the licensure, certification, designation, or approval described in paragraph (1) of this subdivision.
(d) Designation of Providers:
(1) As a prerequisite to providing any of the services authorized by this section, a provider must receive a designation from DOH, OMH, OASAS, or OCFS. Being designated to provide services authorized by this section is not a substitute for possessing any required State licensure, certification, authorization or credential, and any such designation may be conditioned upon obtaining or modifying a required licensure, certification, authorization or credential.
(2) To be eligible for designation, a provider must submit an application on a form required by the State agencies and must:
(i) Be enrolled in the Medicaid program prior to commencing service delivery;
(ii) Be a qualified provider as described in subdivision (c) of this section and maintain its license, certification or approval with that state agency;
(iii) Be in good standing according to the standards of each agency by which it is licensed, certified or approved;
(iv) Be a fiscally viable agency;
(v) Meet developed criteria as outlined in the Provider Designation Application guidance and form, including adequate explanation of how the provider meets such criteria; and
(vi) Adhere to the Standards of Care described in the Children’s Health and Behavioral Health Services Transformation Medicaid State Plan Provider Manual for Children’s BH Early and Periodic Screening and Diagnostic Testing (EPSDT) Services which have been incorporated by reference in this Part and have been filed in the Office of the Secretary of State of the State of New York, the publication so filed being the document entitled: Children’s Health and Behavioral Health Services Transformation Medicaid State Plan Provider Manual for Children’s BH Early and Periodic Screening and Diagnostic Testing (EPSDT) Services, published in December, 2016, and any subsequent updates. This document incorporated by reference may be examined at the Office of the Department of State, 99 Washington Ave, Albany, NY 12231 or obtained from the Department of Health, 99 Washington Ave, Albany, NY 12231.
(3) A provider designated to provide services authorized by this section will be assigned a lead State agency (DOH, OASAS, OCFS or OMH), based on the primary population served, location, and indicated line of business on the provider application, which will be responsible, in collaboration with the other State agencies, for monitoring and oversight of the provider.
(4) If a provider is designated to provide Community Support and Treatment services, it may seek approval of the lead State agency and DOH to utilize, in the provision of services, specified evidence-based techniques drawn from cognitive-behavioral therapy and/or other evidence based psychotherapeutic interventions.
(5) Nothing contained herein shall authorize a provider to provide medical services, except as otherwise authorized by law.
(e) Rescinding a designation.
(1) A provider who fails to comply with laws, regulations and policies may have its designation rescinded by the lead State agency, which will consult with the other State agencies before taking such action. The provider has 14 business days to appeal the action to the lead State agency. The lead State agency shall respond with a final decision within 14 business days of appeal.
(2) A provider whose designation was rescinded may apply for redesignation pursuant to subdivision (d) of this section. The provider must show that it corrected the problems that led to the rescission. An on-site and/or desk evaluation may be conducted by the lead State agency prior to approving the redesignation request.
(f) Reimbursement: Reimbursement for children’s behavioral health and health services must be in accordance with the rates established by the Department and approved by the Director of the Division of Budget.
VOLUME C (Title 18)