PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:
Proposed Action:
Amendment of Part 599 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 7.09, 31.04, 43.01 and 43.02
Subject:
Clinic Treatment Programs.
Purpose:
Amend reimbursement structure for delivery of psychotherapy services; eliminate utilization threshold for court-mandated services.
Text of proposed rule:
1. Subdivision (e) of Section 599.13 of Title 14 NYCRR is amended to read as follows:
(e) Payments for procedures will be determined by multiplying the assigned weight for the appropriate procedure code set forth at 10 NYCRR Part 86 by the base fee, and adjusting such fee for modifiers and discounts, as appropriate. When a modifier or discount is expressed as a percentage, it will adjust the payment by its percentage of the procedure weight. When more than one procedure applies to a visit, the highest value procedure shall be paid at its full fee value.
(1) Payments for additional procedures related to the visit will be discounted by 10 percent.
(2) Payments will be reduced by 25 percent for any visit in excess of 30, excluding crisis visits, off-site visits, complex care management, and any services that are counted as health services, provided during a state fiscal year to any individual who is 21 years of age or older on the first day of such fiscal year, and 50 percent for any visit in excess of 50, excluding crisis visits, off-site visits, complex care management, and any services counted as health services, provided during such fiscal year to any recipient, for fiscal years commencing on or after April 1, 2011, except that effective January 1, 2015, this reduction in payment will not apply to court-mandated services.
2. Subparagraph (i) of paragraph (6) of subdivision (d) of Section 599.14 of Title 14 NYCRR is amended to read as follows:
(6) Psychotherapy services. Psychotherapy services consist of the following levels of billable service.
(i) Psychotherapy services - individual shall be reimbursed as follows:
(a) brief individual psychotherapy service: [requires face-to-face service with the recipient of a minimum duration of 30 minutes; or]
(1) service provided face to face with the recipient with a documented duration of 30 minutes shall receive full reimbursement; or
(2) effective January 1, 2015, service provided face to face with the recipient with a documented duration of 20 minutes shall receive a 30 percent reduction in reimbursement.
(b) extended individual psychotherapy service: [requires documented face-to-face service with the recipient of a minimum duration of 45 minutes.]
(1) service provided face to face with the recipient requires a documented duration of 45 minutes; or
(2) effective January 1, 2015, service provided face to face with the recipient requires a documented duration of 30 minutes (with or without a collateral), with the remaining 15 minutes spent with the collateral (with or without the recipient);
(3) For school-based services, the duration of such services may be that of the school period provided the school period is of a duration of at least 40 minutes.
(c) Brief or Extended Psychotherapy Services provided on or after October 1, 2010, to a child off-site shall be reimbursable on a Federally-non-participating basis and only for children up to age 19.
Text of proposed rule and any required statements and analyses may be obtained from:
Sue Watson, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, (518) 474-1331, email: Sue.Watson@omh.ny.gov
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
45 days after publication of this notice.
Regulatory Impact Statement
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/her jurisdiction, and 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 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.
Section 43.02(b) of the Mental Hygiene Law authorizes the Commissioner to request from operators of facilities licensed by the Office of Mental Health such financial, statistical and program information as the Commissioner may determine to be necessary.
2. Legislative Objectives: Articles 7 and 31 of the Mental Hygiene Law reflect the Commissioner’s authority to establish regulations regarding mental health programs. The proposed rule furthers the legislative policy of providing high quality outpatient mental health services to individuals with mental illness in a cost-effective manner. Part 599 of Title 14 NYCRR sets forth standards for the certification, operation and reimbursement of clinic treatment programs serving adults and children. In the four years since the Office of Mental Health (OMH) adopted Part 599 to establish a new, redesigned clinic structure, provider feedback has provided valuable insight into suggested changes to the regulation. As a result, OMH has amended its clinic regulations on several occasions; these technical changes are a continuation of this process.
3. Needs and Benefits: Under existing regulations, reimbursement is discounted for certain services provided in excess of established thresholds. Currently, payments are reduced by 25 percent for any visit in excess of 30 (excluding crisis visits, off-site visits, complex care management and services counted as health services) provided during a state fiscal year to any individual who is 21 years of age or older on the first day of such fiscal year, and 50 percent for any visit in excess of 50 (excluding crisis visits, off-site visits, complex care management, and any services counted as health services) provided during such fiscal year to any recipient. To provide regulatory relief and ensure that providers are not penalized by a reduction in reimbursement when visits have been required by the court, the Office is proposing to eliminate these utilization thresholds for court-mandated services. Therefore, effective January 1, 2015, the reduction in payment for visits in excess of the stated amounts will not apply to court-mandated services.
In addition, the proposal amends the reimbursement structure for “brief individual psychotherapy services” and “extended individual psychotherapy services.” Under existing regulations, brief individual psychotherapy services must be provided face to face with the recipient for a minimum duration of 30 minutes. Under this proposal, clinics would have the option of providing brief individual psychotherapy services for a duration of 20 minutes. Clinics would then receive a 30 percent reduction in reimbursement for these services provided for 20 minutes. Extended individual psychotherapy services currently require documented face-to-face services with the recipient for a minimum duration of 45 minutes. Under this proposal, clinics would have the option of providing extended individual psychotherapy services to the recipient for a documented duration of 30 minutes (with or without a collateral), with the remaining 15 minutes being spent with the collateral (with or without the recipient). These adjustments serve to provide flexibility and regulatory relief and, based on provider feedback, more accurately reflect the needs of recipients of service and standards of good clinical care. These amendments would be effective as of January 1, 2015.
4. Costs:
(a) cost to State government: The costs to State government as a result of these regulatory amendments are estimated to be $4.375 million. The funding source for these changes is part of the funding in the Behavioral Health Transformation Initiative made available to OMH to preserve critical access.
(b) cost to local government: There are no new costs to local government as a result of these regulatory amendments.
(c) cost to regulated parties: There are no new costs to regulated parties as a result of these regulatory amendments.
5. Local Government Mandates: These regulatory amendments will not result in any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.
6. Paperwork: No increased paperwork is anticipated as a result of these regulatory amendments. Under existing regulations, regulated parties are required to supply the necessary documentation with respect to services provided. Under the amendment, providers will be required to use a modifier or an additional rate code when billing for court-mandated services over the threshold limits and psychotherapy services provided for a 20-minute duration. OMH will provide billing guidance to assist in this process.
7. Duplication: These regulatory amendments do not duplicate existing State or federal requirements.
8. Alternatives: OMH is proposing these amendments based on provider feedback. The only alternative to the regulatory amendment would be inaction, which would be contrary to the recommendations of providers to allow flexibility in the delivery of services to more accurately reflect the needs of recipients and standards of good clinical care.
9. Federal Standards: The regulatory amendments do not exceed any minimum standards of the federal government for the same or similar subject areas.
10. Compliance Schedule: The regulatory amendments will be effective immediately upon adoption.
Regulatory Flexibility Analysis
The amendments to 14 NYCRR Part 599 are intended to provide regulatory relief to mental health clinic providers and allow flexibility in the delivery of services to more accurately reflect the needs of recipients and standards of good clinical care. 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.
Rural Area Flexibility Analysis
The amendments to 14 NYCRR Part 599 are intended to provide regulatory relief to mental health clinic providers and allow flexibility in the delivery of services to more accurately reflect the needs of recipients and standards of good clinical care. 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.
Job Impact Statement
The amendments to 14 NYCRR Part 599 are intended to provide regulatory relief to clinic providers and allow flexibility in the delivery of mental health services to more accurately reflect the needs of recipients and standards of good clinical care. 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.
