DAL 17-09 - Offsite Primary Care Services

May 11, 2017

DHDTC DAL 17-09 - Offsite Primary Care Services

Dear Chief Executive Officer:

The purpose of this letter is to inform you of legislation, effective March 28, 2017, which allows the Commissioner of Health to permit outpatient clinics of general hospitals and diagnostic and treatment centers (D&TCs), licensed pursuant to Article 28, if they choose to, to provide off-site primary care services to patients at their residences. This does not include home care services. A copy of the legislation is attached.

Public Health Law §2803(11) authorizes outpatient clinics of general hospitals and D&TCs to provide off-site primary care services in a patient's residence provided that:

  • These are primary care services ordinarily provided on-site at outpatient clinics of a hospital or a D&TC; and
  • The patient has a pre-existing clinical relationship with the outpatient clinic of the D&TC or the health care professional providing the service; and
  • These services are provided by a primary care practitioner; and
  • The patient is unable to leave his or her residence to receive services at the outpatient clinic or D&TC without unreasonable difficulty due to circumstances, which may include clinical impairment; and
  • These services are not home care services under Public Health Law Article 36.

This program is optional. Hospitals and D&TCs are not required to offer this off-site service to patients.

The New York State Department of Health is drafting regulations, which will be promulgated to implement the law. The regulations will provide programmatic requirements and the authority for Medicaid reimbursement. It is anticipated that a "primary care practitioner" will be defined as a physician, nurse practitioner, physician assistant or licensed midwife.

In addition to regulations, a State Plan Amendment (SPA) is being submitted to the Centers for Medicare & Medicaid Services (CMS). These services may be provided pending the enactment of the regulations and SPA approval. However, until the state administrative process to enact the regulations is completed and CMS approves New York's SPA, there will be no Medicaid reimbursement for service delivery.

If you have questions regarding the general requirements of the new law, please direct them to the Division of Hospitals and Diagnostic & Treatment Centers at 518-402-1004.

If you have questions concerning Medicaid reimbursement for these services, for hospitals, please direct your inquiry to the hospital rate setting unit at hospffsunit@health.ny.gov and for D&TCs, the D&TC rate setting unit at dtcffsunit@health.ny.gov.


Ruth Leslie
Division of Hospitals and Diagnostic & Treatment Centers
   Ronald Bass, Director
Bureau of Medical, Dental & Pharmacy Policy
Division of Program Development & Management
Office of Health Insurance Programs