N.Y. Public Health Law § 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.