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.
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.
