Defines "mental health clubhouse"; provides that the department of health, in consultation with the office of mental health, shall authorize Medicaid reimbursement for services provided by mental health clubhouses.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9050
SPONSOR: Tapia TITLE OF BILL:
An act to amend the social services law, in relation to authorizing
Medicaid reimbursement for mental health clubhouses
PURPOSE OR GENERAL IDEA OF BILL:
To authorize Medicaid reimbursement for services provided by accredited
mental health clubhouses, formally recognizing them as part of New
York's behavioral health continuum and ensuring financial sustainability
for these vital community-based programs.
SUMMARY OF PROVISIONS:
Section 1: Amends the social services law by adding a new section 368-g
to define and authorize Medicaid reimbursement for services provided by
mental health clubhouses.
Defines a mental health clubhouse as a facility accredited, or seeking
accreditation, by a body approved by the Office of Mental Health that
provides a non-clinical, community-based environment focused on thera-
peutic engagement, work-based recovery, and peer support for individuals
with serious mental illness.
Requires that reimbursable services adhere to the standards set by Club-
house International and include psychosocial rehabilitation, vocational
and educational support, crisis assistance, housing services, case
management, peer support, social inclusion, and health promotion.
Directs the Department of Social Services, in consultation with the
Office of Mental Health, to authorize Medicaid reimbursement for eligi-
ble clubhouse services and to establish a reimbursement mechanism,
including a per diem rate and use of the H2031 billing code.
Authorizes the Office of Mental Health, in coordination with the depart-
ment and accredited clubhouses, to adopt necessary rules and regu-
lations, including certification and service delivery criteria.
Section 2: Sets the effective date as immediate upon enactment.
JUSTIFICATION:
Mental health clubhouses are an essential, evidence-based model of
community recovery that offer psychosocial support, job training, educa-
tional services, and housing assistance to individuals living with seri-
ous mental illness. Unlike clinical facilities, clubhouses operate as
peer-driven, non-clinical spaces where members and staff work side-by-
side to run daily operations, build confidence, and foster long-term
stability.
Despite their proven track record and accreditation by Clubhouse Inter-
national, these programs currently operate without a designated Medicaid
reimbursement pathway in New York. This leaves clubhouses underfunded
and restricts their ability to expand services to meet rising mental
health needs:
This bill fills that gap by enabling Medicaid to reimburse clubhouse
services in accordance with the federal definition of psychosocial reha-
bilitation. It aligns with the state's ongoing efforts to deinstitution-
alize mental health care and invest in community-based recovery models.
Recognizing clubhouses as Medicaid-reimbursable providers will create
financial stability for these programs, allowing them to reach more New
Yorkers and reduce reliance on emergency rooms, hospitals, and crisis
intervention services. Clubhouses also support social determinants of
health by addressing housing, employment, social isolation, and communi-
ty reintegration, all key priorities for both mental health outcomes and
health equity.
PRIOR LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
TBD
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
9050
2025-2026 Regular Sessions
IN ASSEMBLY
September 5, 2025
___________
Introduced by M. of A. TAPIA -- read once and referred to the Committee
on Health
AN ACT to amend the social services law, in relation to authorizing
Medicaid reimbursement for mental health clubhouses
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The social services law is amended by adding a new section
2 368-g to read as follows:
3 § 368-g. Reimbursement for mental health clubhouses. 1. For the
4 purposes of this section, the term "mental health clubhouse" or "club-
5 house" means a facility that:
6 (a) is accredited, or is in the process of becoming accredited, by a
7 recognized body or bodies approved by the office of mental health;
8 (b) addresses psychosocial deficits and social determinants of health;
9 (c) uses a therapeutic approach that emphasizes purposeful engagement,
10 relationship development, and mutual support for people with serious
11 mental illness;
12 (d) has members and program staff work side by side to build and
13 manage a non-clinical therapeutic community;
14 (e) offers members a community-based rehabilitative environment that
15 both addresses psychosocial needs of people living with serious mental
16 illness and provides structures that offer support in natural, community
17 environments;
18 (f) offers support services for employment, education, health care,
19 housing, and other services to broadly address health-related social
20 care needs;
21 (g) is an essential part of the continuum of care and works in tandem
22 with other medical and behavioral health services;
23 (h) relies on the restorative power of work and work-mediated
24 relationships to build a firm foundation for growth and individual
25 achievement for members;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13616-01-5
A. 9050 2
1 (i) emphasizes strengths-based teamwork and opportunities to contrib-
2 ute to operations through a work-ordered day; and
3 (j) offers social and community-based recreational opportunities to
4 contribute to a member's path and success in recovery.
5 2. The department, in consultation with the office of mental health,
6 shall authorize Medicaid reimbursement for services provided by mental
7 health clubhouses as defined in subdivision one of this section.
8 3. In alignment with the clubhouse model's holistic therapeutic envi-
9 ronment, services eligible for reimbursement shall adhere to the stand-
10 ards set forth by Clubhouse International and shall include, but shall
11 not be limited to:
12 (a) psychosocial rehabilitation;
13 (b) vocational and educational support;
14 (c) crisis support;
15 (d) housing assistance;
16 (e) mitigating loneliness and social isolation;
17 (f) peer support;
18 (g) case management; and
19 (h) health promotion.
20 4. The department shall establish a reimbursement mechanism for mental
21 health clubhouses that recognizes the holistic nature of the clubhouse
22 model, such as use of the H2031 billing code, and implement a standard-
23 ized per diem rate for services provided under this designation. Such
24 reimbursement shall be made available under the state Medicaid plan
25 subject to approval by the United States department of health and human
26 services.
27 5. The office of mental health, in consultation with the department
28 and accredited clubhouses, shall adopt any rules and regulations neces-
29 sary to implement this section, including the development of provider
30 certification standards, service delivery criteria, and reimbursement
31 methodologies.
32 § 2. This act shall take effect immediately.
