For Providers
The NYC 9/11 Benefit Program reimburses out-of-pocket costs for outpatient mental health and substance use services for NYC residents affected by 9/11.
Important Dates
January 2, 2007 Coverage begins (retroactively)
July 7, 2010 Enrollment ends
January 7, 2011 Coverage ends
March 31, 2011 Last day to submit claims
Eligibility Groups
Two groups of NYC residents are eligible to receive reimbursement from the NYC 9/11 Benefit Program:
NYC residents and their financially dependent immediate and extended family members or immediate and extended family members living in the same household.
NYC residents who are not in
Group A PDF Document (Reader Required; Click to Download) , but have psychological symptoms that are likely related to the attacks. Individuals in this category will be screened, and their treating providers will be asked to submit a letter affirming that their conditions are likely related to 9/11.
Covered Services
The NYC 9/11 Benefit Program reserves the right to modify covered services at any time. Covered services include:
- Outpatient mental health and substance use services: The benefit program covers out-of-pocket costs associated with outpatient treatment. There is no dollar cap on reimbursement for members of Group A PDF Document (Reader Required; Click to Download) . For members of Group B PDF Document (Reader Required; Click to Download) reimbursement is limited to $3,000 over the lifetime of the benefit.
- Medication and laboratory work related to mental health and substance-use treatment: Additionally, the benefit program covers reimbursement for medication and/or laboratory work up to $1,500 for the lifetime of the benefit.
- Psychological evaluations and testing: the benefit covers up to eight hours of evaluation and testing for children age 21 and under.
The NYC 9/11 Benefit Program does not cover the following services:
- Inpatient services
- Emergency room (ER) visits and related services
- Acupuncture
- Art therapy and other expressive therapies
- Missed appointment fees
- Medication not related to mental health or substance use
Billing Information
If your patient has insurance that covers mental health and substance use treatment, you or your patient must first bill the patient's insurance and then submit expenses not covered by their insurance to the NYC 9/11 Benefit Program.
Enclosed is a list of covered services and the maximum fee schedule for each service. The
fee schedule PDF Document (Reader Required; Click to Download) is the maximum amount covered for each service (including payments received by your patient's insurance). If your usual and customary fee is different from the rate listed on the fee schedule, you should bill at the lesser rate.
There is no actual or implied contract between treatment providers and the NYC 9/11 Benefit Program. Reconciliation of payment is between you and your patient.
By accepting payment from the NYC 9/11 Benefit Program, you are indicating that the mental health/substance use condition for which you are treating your patient is likely related to 9/11.
License Requirements
The NYC 9/11 Benefit Program provides assistance with the cost of services delivered by providers who are:
- Licensed or certified for independent clinical practice in New York, or
- Work under the direct supervision of a colleague in the same field of practice.
The following licensed or certified professions are covered under the NYC 9/11 Benefit Program:
- Physicians
- Psychologists
- Social workers
- Nurse practitioners
- Certified alcoholism and substance use counselors
- Mental health counselors
- Marriage and family counselors
- Licensed psychoanalysts (must be NYS licensed; national certification not sufficient)
Proof of license, such as a copy of your active license, is required before payment can be made.
