New York Laws
Article 36 - Home Care Services
3614-D - Universal Standards for Coding of Payment for Medical Assistance Claims for Long Term Care.

§ 3614-d. Universal standards for coding of payment for medical
assistance claims for long term care. Claims for payment submitted under
contracts or agreements with insurers under the medical assistance
program for home and community-based long-term care services provided
under this article, by fiscal intermediaries operating pursuant to
section three hundred sixty-five-f of the social services law, and by
residential health care facilities operating pursuant to article
twenty-eight of this chapter shall have standard billing codes. Such
insurers shall include but not be limited to Medicaid managed care plans
and managed long term care plans. Such payments shall be based on
universal billing codes approved by the department or a nationally
accredited organization as approved by the department; provided,
however, such coding shall be consistent with any codes developed as
part of the uniform assessment system for long term care established by
the department and shall include, for any entity operating pursuant to
section three hundred sixty-five-f of the social services law a code
that is specific to the hourly cost of services at an overtime rate;
provided, however, that this section shall not be construed to require
the department to develop an overtime rate.

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