As of March 25, 2011, new Federal Rules and Regulations surrounding provider screening and enrollment have been in effect. Please refer to the Federal Register 42 CFR Parts 405, 424, 447 et al. for the complete set of rules and regulations. Changes include: additional screening may be required, all ordering and referring physicians or other professionals providing services under the State plan or under a waiver of the plan must be enrolled as participating providers, revalidation of enrollment of all providers at least every five (5) years, and an application fee may apply.
Effective January 1, 2011, Physicians wishing to enroll in the FFS Medicaid program must also participate in the CAQH® Universal Provider Datasource® (UPD®). For further information, please see the Physician section under Provider Enrollment.
All Medicaid Provider Enrollment forms have been updated to include information on the Provider Compliance Program requirements found in Title 18NYCRR, Part 521.
Medically-supervised day services for eligible individuals
Serves persons, medically eligible for nursing home placement, in a less medically intensive, lower-cost setting. Persons with Medicaid coverage must have their ALP services approved in advance by their Local Social Services District.
Provides services to children in foster care who have significant mental health, developmental disabilities or health care needs to help them to live in a home or community-based setting.
Provides medical assistance to families with children living at home who have severe disabilities or medical conditions.
Includes case management, health homes and early intervention service coordination
To be completed by CAEs employed by a Physician or Group Practice OR to be completed by the clinic or hospital who employs a CAE
To be completed by CDEs employed by a Physician or Group Practice OR to be completed by the clinic or hospital who employs a CDE
A clinic/outpatient program licensed by the Office of Alcohol and Substance Abuse Services (OASAS)
Child Care agencies care for, place or board children in approved settings.
Provides therapeutic and support services to children under age 3 (and their families) who have a confirmed disability or established developmental delay in one or more areas of development.
A Health Home is a care management service model whereby all of an individual's caregivers communicate with one another so that all of a patient's needs are addressed in a comprehensive manner.
Home care services provided by an agency licensed by the Department of Health. If you are a nurse seeking to provide home care services, please choose the Nurse (LPN/RN) link below.
A coordinated and supportive program for terminally ill persons and their families. Hospice providers are licensed by the Department of Health.
Hospitals located outside of New York State are reimbursed based on NYS rates.
For more information, click here
24-hour medical and behavioral care for those individuals whose disabilities prevent them from living independently.
Both freestanding and facility-based laboratories
Enrollment required when employed by a freestanding laboratory.
A coordinated plan of medical, nursing and rehabilitative care provided at home to eligible persons who are medically eligible for placement in a nursing home.
A NYS certified health insurance plan or system that coordinates the provision, quality and cost of care for its enrolled members.
A NYS Department of Health licensed home care agency which employs LPNs and RNs.
If your nursing home is located outside of NYS,
Home and Community Based program which provides supports and services to assist individuals with disabilities and seniors to return to, and remain in, the community.
Residential program designed to provide a therapeutic living environment for residents with mental illness.
Assertive Community Treatment (ACT) is a comprehensive and integrated set of psychiatric, psychosocial, rehabilitation, case management and support services.
Clinic services which provide an array of treatment services for assessment and/or symptom reduction or management.
Personalized Recovery Oriented Services
Residential Treatment Facilities (RTF) provide comprehensive mental health treatment for children and adolescents between the ages of 5-21 in a residential, inpatient setting.
Complete regardless of whether Optician is salaried or self employed
Complete regardless of whether Optometrist is salaried or self employed
A residential program that provides both supervised and supportive living environments. Individuals living in a Supervised CR have staff immediately available, on site 24/7.
Supports individuals with developmental disabilities in the community rather than in an Intermediate care facility.
Provides services such as housekeeping, meal preparation, bathing, toileting and grooming to eligible individuals
Vendors who provide equipment which connects the user to help/services in the event of an emergency.
Both freestanding and facility-based pharmacies
Services provided to specific beneficiaries residing in Residential Health Care Facilities (RHCF'S) or Intermediate Care Facilities for the Developmentally Disabled (ICF/DDs).
Reimbursement is only available for services rendered to Qualified Medicare
Provides Medicaid reimbursement to school districts for certain diagnostic and health support services for students with disabilities.
An entity which submits claims, and/or verifies patient eligibility for providers enrolled in the Medicaid Program.
Enrollment required when employed by a freestanding pharmacy.
Includes Occupational, Physical and Speech Therapy services
Includes ambulance, ambulette, taxi and livery
Provides services designed to assist individuals who have suffered a TBI to remain in their homes and communities.