(a) Providers of mental health services must receive prior approval by written designation of the office to provide any or all of the following EPSDT services:

1. (1) crisis intervention services are available to a child or a member of his/her family who is experiencing a behavioral health crisis event, and are designed to:

   1. (i) interrupt and/or ameliorate the crisis event;
   2. (ii) include an assessment that is culturally and linguistically competent;
   3. (iii) result in immediate crisis resolution and de-escalation; and
   4. (iv) result in the development of a crisis plan;
2. (2) community psychiatric support and treatment services, which include interventions intended to achieve identified goals or objectives as set forth in a treatment/recovery plan;
3. (3) family peer support services, which include formal and informal services to families of a child experiencing social, emotional, developmental, medical, substance use, and/or behavioral challenges in their home, school, placement, and/or community;

4. (4) other licensed practitioner services, which include services provided by the following professionals, operating within a licensed children’s mental health agency, if currently licensed by State of New York to prescribe, diagnose, and/or treat individuals with a physical, mental illness, substance use disorder, or functional limitations at issue, provided such professionals are operating within their respective scope of practice and in a setting permitted under New York State Law, including community settings:

   1. (i) licensed psychoanalyst;
   2. (ii) licensed clinical social worker;
   3. (iii) licensed marriage and family therapist;
   4. (iv) licensed mental health counselor; or
   5. (v) licensed master social worker under the supervision or direction of a licensed clinical social worker, a licensed psychologist, or a psychiatrist;
5. (5) psychosocial rehabilitation services, which are task-oriented services designed to restore, compensate for, or eliminate functional deficits and interpersonal and/or behavioral health barriers associated with behavioral health needs;
6. (6) youth peer support and training services are formal and informal services and supports to ensure engagement and active participation of youth in the treatment planning and implementation process.

(c) To be eligible for designation, the applicant must:

1. (1) be enrolled in the Medicaid program prior to commencing service delivery;
2. (2) have a demonstrated history of compliance with applicable Federal and State laws and regulations governing the provision of mental health services; and
3. (3) satisfy requisite criteria identified in the New York State plan amendment designation application and the standards of care identified in the Children’s Health and Behavioral Health Services Transformation Medicaid State Plan Provider Manual.

(e) Failure to adhere to the requirements set forth in this Part, or any other applicable laws or regulations relevant to the provision of health or behavioral health services, may be grounds for revocation of designation. In the event that the office determines that designation must be revoked, it will notify the provider of its decision in writing. The provider may request an informal administrative review of such decision.

1. (1) The provider must request such review in writing within 14 days of the date it receives notice of revocation of designation to provide EPSDT services to the commissioner or designee. The request shall state specific reasons why the provider considers the revocation of approval incorrect and shall be accompanied by any supporting evidence or arguments.
2. (2) The commissioner or designee shall notify the provider, in writing, of the results of the informal administrative review within 14 days of receipt of the request for review. Failure of the commissioner or designee to respond within that time shall be considered confirmation of the revocation.
3. (3) The commissioner’s determination after informal administrative review shall be final and not subject to further administrative review.
4. (4) A provider whose designation has been revoked pursuant to this section may be considered again for designation at the discretion of the office, in consultation with the State agencies.