N.Y. Comp. Codes R. & Regs. tit. 14, § 588.13
(a) Reimbursement under the medical assistance program for outpatient programs licensed solely pursuant to article 31 of the Mental Hygiene Law and Part 587 of this Title which serve adults with a diagnosis of mental illness and children with a diagnosis of emotional disturbance shall be in accordance with the following fee schedule.
(1) Reimbursement under the medical assistance program for clinic treatment programs shall be in accordance with the following fee schedule. Such reimbursement shall be adjusted pursuant to subdivisions (i), (j) and (k) of this section.
(i) For programs operated in Bronx, Kings, New York, Queens, Richmond, Nassau, Suffolk, Putnam, Rockland and Westchester Counties:
| Regular | at least 30 minutes | $71.94 |
| Brief | at least 15 minutes | 35.97 |
| Group | at least 60 minutes | 25.18 |
| Collateral | at least 30 minutes | 71.94 |
| Group Collateral | at least 60 minutes | 25.18 |
| Crisis | at least 30 minutes | 71.94 |
(ii) For programs operated in Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Wyoming and Yates Counties:
| Regular | at least 30 minutes | $64.75 |
| Brief | at least 15 minutes | 32.37 |
| Group | at least 60 minutes | 22.66 |
| Collateral | at least 30 minutes | 64.75 |
| Group Collateral | at least 60 minutes | 22.66 |
| Crisis | at least 30 minutes | 64.75 |
(iii) For programs operated in Broome, Cayuga, Chenango, Clinton, Cortland, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, Otsego, St. Lawrence, Albany, Columbia, Dutchess, Greene, Orange, Rensselaer, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren and Washington Counties:
| Regular | at least 30 minutes | $63.55 |
| Brief | at least 15 minutes | 31.77 |
| Group | at least 60 minutes | 22.25 |
| Collateral | at least 30 minutes | 63.55 |
| Group Collateral | at least 60 minutes | 22.25 |
| Crisis | at least 30 minutes | 63.55 |
(3) Reimbursement under the medical assistance program for non-State operated continuing day treatment programs licensed pursuant to article 31 of the Mental Hygiene Law and Part 587 of this Title for services provided on or after January 1, 2009, and prior to April 1, 2009, shall be in accordance with the following fee schedule.
(i) For programs operated in Bronx, Kings, New York, Queens, Richmond, Nassau, Suffolk, Putnam, Rockland and Westchester Counties: Regular, collateral, group collateral, and crisis visits shall be reimbursed on the basis of service hours. The reimbursement for any service hour shall be based upon the cumulative number of service hours provided in a calendar month to an individual recipient. When the service hours of any single visit include more than one rate, the provider of service shall be reimbursed at the rate that applies to the first hour of such visit. The rates of reimbursement are as follows:
| Service hour 1–50 | $12.54 per service hour |
| Service hour 51–80 | $8.97 per service hour |
| Service hour beyond 80 | $6.61 per service hour |
(ii) For programs operated in Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Tompkins, Wayne, Wyoming and Yates Counties: Regular, collateral, group collateral, and crisis visits shall be reimbursed on the basis of service hours. The reimbursement for any service hour shall be based upon the cumulative number of service hours provided in a calendar month to an individual recipient. When the service hours of any single visit include more than one rate, the provider of service shall be reimbursed at the rate that applies to the first hour of such visit. The rates of reimbursement are as follows:
| Service hour 1–50 | $11.29 per service hour |
| Service hour 51–80 | $8.97 per service hour |
| Service hour beyond 80 | $6.61 per service hour |
(iii) For programs operated in Broome, Cayuga, Chenango, Clinton, Cortland, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, Otsego, St. Lawrence, Tioga, Albany, Columbia, Dutchess, Greene, Orange, Rensselaer, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren and Washington Counties: Regular, collateral, group collateral, and crisis visits shall be reimbursed on the basis of service hours. The reimbursement for any service hour shall be based upon the cumulative number of service hours provided in a calendar month to an individual recipient. When the service hours for any single visit include more than one rate, the provider of service shall be reimbursed at the rate that applies to the first hour of such visit. The rates of reimbursement are as follows:
| Service hour 1–50 | $11.08 per service hour |
| Service hour 51–80 | $8.97 per service hour |
| Service hour beyond 80 | $6.61 per service hour |
(4) Reimbursement under the medical assistance program for non-state operated continuing day treatment programs licensed solely pursuant to article 31 of the Mental Hygiene Law, and Part 587 of this Title for services provided on or after April 1, 2015, shall be in accordance with the following fee schedule. The reimbursement for any regular visit shall be based upon the cumulative number of program hours provided in a calendar month to an individual recipient, excluding time spent in meals, adding two hours for each half-day visit and four hours for each full-day visit. Collateral, group collateral pre-admission and crisis visits will be reimbursed at the half-day rate for program hours 1-40 regardless of the cumulative total of hours for regular visits in that month. Collateral, group collateral, pre-admission and crisis visits shall not be included in the calculation of the cumulative total hours in the program for a recipient. When the program hours of any single visit include more than one rate, the provider of service shall be reimbursed at the rate that applies to the first hour of such visit. Regular visits shall be reimbursed on the basis of program attendance and service provision as set forth in section 588.7 of this Part. The rates of reimbursement are as follows:
(i) For programs operated in Bronx, Kings, New York, Queens, Richmond, Nassau, Suffolk, Putnam, Rockland and Westchester Counties:
| Program hours 1–40 | $62.07 full day (4 hours) |
| Program hours 1–40 | $31.04 half day (2 hours) |
| Program hours 41–64 | $46.56 full day (4 hours) |
| Program hours 41–64 | $23.28 half day (2 hours) |
| Program hours 65+ | $34.30 full day (4 hours) |
| Program hours 65+ | $17.16 half day (2 hours) |
| Collateral | $31.04 |
| Group collateral | $31.04 |
| Crisis | $31.04 |
| Pre-admission | $31.04 |
(ii) For programs operated in Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Tompkins, Wayne, Wyoming and Yates Counties:
| Program hours 1–40 | $55.92 full day (4 hours) |
| Program hours 1–40 | $27.96 half day (2 hours) |
| Program hours 41–64 | $46.60 full day (4 hours) |
| Program hours 41–64 | $23.60 half day (2 hours) |
| Program hours 65+ | $34.34 full day (4 hours) |
| Program hours 65+ | $17.17 half day (2 hours) |
| Collateral | $27.96 |
| Group collateral | $27.96 |
| Crisis | $27.96 |
| Pre-admission | $27.96 |
(iii) For programs operated in Broome, Cayuga, Chenango, Clinton, Cortland, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, Otsego, St. Lawrence, Tioga, Albany, Columbia, Dutchess, Greene, Orange, Rensselaer, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren and Washington Counties:
| Program hours 1–40 | $54.92 full day (4 hours) |
| Program hours 1–40 | $27.47 half day (2 hours) |
| Program hours 41–64 | $46.63 full day (4 hours) |
| Program hours 41–64 | $23.32 half day (2 hours) |
| Program hours 65+ | $34.36 full day (4 hours) |
| Program hours 65+ | $17.19 half day (2 hours) |
| Collateral | $27.47 |
| Group collateral | $27.47 |
| Crisis | $27.47 |
| Pre-admission | $27.47 |
(b) Reimbursement under the medical assistance program for non-State operated continuing day treatment programs licensed pursuant to article 31 of the Mental Hygiene Law and operated by agencies licensed pursuant to article 28 of the Public Health Law, and Part 587 of this Title shall be in accordance with the following fee schedule:
(1) For services provided on or after April 1, 2015, the reimbursement for any regular visit shall be based upon the cumulative number of program hours provided in a calendar month for an individual recipient, excluding time spent in meals, adding two hours for each half-day visit and four hours for each full-day visit. Collateral, group-collateral, pre-admission and crisis visits will be reimbursed at the half-day rate for program hours 1-40 regardless of the cumulative total of hours for regular visits in that month. Collateral, group-collateral, pre-admission and crisis visits shall not be included in the calculation of the cumulative total hours in the program for a recipient. When the program hours of any single visit include more than one rate, the provider of service shall be reimbursed at the rate that applies to the first hour of such visit. Regular visits shall be reimbursed on the basis of program attendance and program provision as set forth in section 588.7 of this Part. The rates of reimbursement are as follows:
| Program hours 1–40 | $62.16 full day (4 hours) |
| Program hours 1–40 | $41.65 half day (2 hours) |
| Program hours 41+ | $46.62 full day (4 hours) |
| Program hours 41+ | $31.23 half day (2 hours) |
| Collateral | $41.65 |
| Group collateral | $41.65 |
| Crisis | $41.65 |
| Pre-admission | $41.65 |
(2) For amounts paid under this subdivision:
(c) Effective April 1, 2015, reimbursement under the medical assistance program for day treatment programs serving children licensed solely pursuant to article 31 of the Mental Hygiene Law, and Part 587 of this Title shall be in accordance with the following fee schedule.
(1) For programs operated in Bronx, Kings, New York, Queens and Richmond Counties:
| Full day | at least 5 hours | $98.36 |
| Half day | at least 3 hours | 49.19 |
| Brief day | at least 1 hour | 32.79 |
| Collateral | at least 30 minutes | 32.79 |
| Home | at least 30 minutes | 98.36 |
| Crisis | at least 30 minutes | 98.36 |
| Preadmission - full day | at least 5 hours | 98.36 |
| Preadmission - half day | at least 3 hours | 49.19 |
(2) For programs operated in other than Bronx, Kings, New York, Queens and Richmond Counties:
| Full day | at least 5 hours | $95.08 |
| Half day | at least 3 hours | 47.54 |
| Brief day | at least 1 hour | 31.64 |
| Collateral | at least 30 minutes | 31.64 |
| Home | at least 30 minutes | 95.08 |
| Crisis | at least 30 minutes | 95.08 |
| Preadmission - full day | at least 5 hours | 95.08 |
| Preadmission - half day | at least 3 hours | 47.54 |
(e) Effective April 1, 2015, reimbursement under the medical assistance program for regular, collateral and crisis visits to all non-State operated partial hospitalization programs licensed pursuant to article 31 of the Mental Hygiene Law and Part 587 of this Title shall be in accordance with the following fee schedule:
(g) The commissioner will only consider requests for revisions of rates calculated under the provisions of this section due to errors made by the Office of Mental Health in the calculation of the rates.