Sub - Section Two: Reimbursement for SUD and Addiction Services: This section: Provides information regarding the associated Medicaid fee schedule/ reimbursement for the specific services; coding; and, what modality / OASAS certified program delivers such services. Identifies SUD and addiction service limitations Coding and Medicaid Fee-for- Service Table Sub - Section Three: Listing of OASAS Certified Programs Listing of OASAS certified programs that deliver the authorized SPA / 1115 demonstration services; the applicable authorizing New York State program regulation; and, where appropriate a cross walk to ASAM levels of care. Section One - Part A: General Overview SPA /1115 service and associated OASAS Certified program / setting: New York State SUD services include an array of participant-centered crisis, inpatient, residential and outpatient services consistent with the treatment needs, with a individual’s assessed rehabilitation and recovery focus designed to promote skills for managing substance use disorder symptoms, and behaviors. SUD services are provided by programs that are OASAS certified pursuant to applicable program specific sections of Title 14 NYCRR (Part 822; Part 818, Part 820 and Part 816). Additionally, programs are subject to shared title 14 NYCRR Part 800 regulatory staffing definitions for: Clinical staff; medical director; medical staff; and, Qualified Health Professionals Appendix B. This subsection offers a brief overview on the primary SUD service settings: Outpatient(including: clinic; opioid; outpatient rehabilitation); SUD Services in a Residential Setting; and, Inpatient (including: detoxification and inpatient rehabilitation); Outpatient services Setting: OASAS Certified Title 14 NYCRR Part 822 Outpatient Clinic; Opioid and; Rehabilitation Programs. The setting will be determined by the goal which is identified to be achieved in the written treatment plan and may include OASAS outpatient settings Certified by individual’s Title 14 NYCRR Part 822 (clinic, opioid; and, outpatient rehabilitation). The 1115 give OASAS demonstration authority to provide any clinic service outside of the clinic. For
Sub - Section Two: Reimbursement for SUD and Addiction Services: This section: Provides information regarding the associated Medicaid fee schedule/ reimbursement for the specific services; coding; and, what modality / OASAS certified program delivers such services. Identifies SUD and addiction service limitations Coding and Medicaid Fee-for- Service Table Sub - Section Three: Listing of OASAS Certified Programs Listing of OASAS certified programs that deliver the authorized SPA / 1115 demonstration services; the applicable authorizing New York State program regulation; and, where appropriate a cross walk to ASAM levels of care. Section One - Part A: General Overview SPA /1115 service and associated OASAS Certified program / setting: New York State SUD services include an array of participant-centered crisis, inpatient, residential and outpatient services consistent with the individual’s assessed treatment needs, with a rehabilitation and recovery focus designed to promote skills for managing substance use disorder symptoms, and behaviors. SUD services are provided by programs that are OASAS certified pursuant to applicable program specific sections of Title 14 NYCRR (Part 822; Part 818, Part 820 and Part 816). Additionally, programs are subject to shared title 14 NYCRR Part 800 regulatory staffing definitions for: Clinical staff; medical director; medical staff; and, Qualified Health Professionals Appendix B. This subsection offers a brief overview on the primary SUD service settings: Outpatient(including: clinic; opioid; outpatient rehabilitation); SUD Services in a Residential Setting; and, Inpatient (including: detoxification and inpatient rehabilitation); Outpatient services Setting: OASAS Certified Title 14 NYCRR Part 822 Outpatient Clinic; Opioid and; Rehabilitation Programs. The setting will be determined by the goal which is identified to be achieved in the individual’s written treatment plan and may include OASAS outpatient settings Certified by Title 14 NYCRR Part 822 (clinic, opioid; and, outpatient rehabilitation). The 1115 give OASAS demonstration authority to provide any clinic service outside of the clinic. For
harp-mainstream-billing-manual-9-1-15.docx