New York Consolidated Laws, Public Health Law - PBH § 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.