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Office of Mental Health

New York State Consolidated Budget and Claiming Manual Subject: Appendix M OASAS Rules for Counting Visits and Days Section: 37
For the Periods:
January 1, 2009 to December 31, 2009
July 1, 2009 to June 30, 2010
Issued: September 9, 2009

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This Appendix is not applicable for OMH, OMRDD and 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 inter-facility 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 third-party payors are more restrictive.

The following rules for counting visits apply to each program/site of the service provider.

Rule 1. 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).

Rule 2. A person can have a community residence day and, in addition, a visit to a non-residential program in the same day.

Rule 3. 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.

Rule 4. 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.

Rule 5. 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. 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.

Rule 7. 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.

Rule 8. A visit is a face-to-face contact between a participant and a clinician whether singularly or in a group. For a group session, therefore, each individual should be counted as having a visit.

Comments or questions about the information on this page can be directed to the Community Budget & Financial Management (CBFM) Group.