Included in CFR Manual Only - New York State Office of Mental Health

New York State
Consolidated
Budget and Claiming
Manual
Subject: Appendix M – OASAS Rules for
Counting Visits and Days
For the Periods:
January 1, 2010 to December 31, 2010
July 1, 2010 to June 30, 2011
Section/Page: 37.1
Issued: February 15, 2010
This Appendix is not applicable for Office of Mental Health (OMH), Office for People with
Developmental Disabilities (OPWDD) and State Education Department (SED). OMH providers
should refer to Part 587 and 588 of New York State Codes, Rules and Regulations.
The following rules have been established to reduce variation in service volumes due to interfacility
differences in organizational structure, operational interpretation of definitions, counting
procedures and criteria for admitting family members. Relevant definitions follow this section.
The rules below apply to statistical reporting. Rules for billing Medicaid and most other thirdparty
payors are more restrictive.
The following rules for counting visits apply to each program/site of the service provider.
Rule 1.
Rule 2.
Rule 3.
Rule 4.
Rule 5.
A person (participant, client, collateral or significant other) can have no more than
one full visit to a given program in a day (midnight to midnight).
A person can have a community residence day and, in addition, a visit to a nonresidential
program in the same day.
No combination of visits may add up to more than one full day visit. For example,
a participant may have up to two half day visits to a program, but not a full day
visit and another kind of visit.
When a participant attends a given program, then leaves and returns for a
second attendance in the same day, the time of the two (or more) attendances
must be cumulated and the visit reported as a single visit to that program.
If a client/participant and collateral or significant other are seen the same day,
separate visits may be counted provided:
1. The collateral or significant other participates actively in the program
and does not merely accompany or wait for the patient.
2. The collateral or significant other's participation is adequately
documented in facility/unit records.
Rule 6.
Rule 7.
Only one visit to a program may be reported even when the participant receives
more than one procedure or service or is served by more than one staff member
or discipline during a visit.
Except for pre-admission screening, a participant and collateral or significant
other visit may not be counted unless the patient is on the facility/unit rolls.