Health Department Announces Certificate of Need (CON) Reform For Ambulatory Care Services

Albany, N.Y. (March 4, 2008) – The Department of Health today announced revisions to the certification process for ambulatory care that includes behavioral and chemical abuse services. These changes are part of an overall restructuring of New York's health care system to strengthen primary and preventive care, and were developed in collaboration with the Office of Mental Health, the Office of Mental Retardation and Developmental Disabilities, and the Office of Alcohol and Substance Abuse Services.

The State's initiative to reform Medicaid reimbursement for outpatient services will not be successful without certification reform. Administrative responsibility for licensure, certification and Medicaid payment currently rests with several different agencies and is a complex and sometimes confusing process for providers. Reforming the certification process for clinic services is an imperative step in shifting service delivery away from expensive inpatient services to more efficient and effective primary care as well as rationalizing Medicaid reimbursement.

The Department of Health will continue to certify hospital outpatient departments and community clinics primarily engaged in the provision of medical services. Certification by the Office of Mental Health, the Office of Mental Retardation and Developmental Disabilities and/or the Office of Alcoholism and Substance Abuse Services will also be required when the provider offers significant behavioral health services as well.

This reform is intended to ensure that the appropriate agency has the lead authority for surveillance; that applicable rules are clear to providers; and, that certification rules facilitate the integration of behavioral health services into the primary care delivery system and advance coordinated care for patients with multiple co-morbidities. The new certification rules will go into effect on April 1, and will be applied prospectively. Reviews of existing clinics will also begin on April 1, and it is expected that any necessary certification adjustments would be completed by April 1, 2009.

The new certification guidelines are attached.