14 CRR-NY 690.3NY-CRR
14 CRR-NY 690.3
14 CRR-NY 690.3
(a) Principles of compliance.
(1) The day treatment facility is required to provide or ensure provision of a planned combination of diagnostic, treatment and habilitation services in accordance with the comprehensive functional assessment (see glossary) of each person's needs. Allowable services (see glossary), delivered by qualified professionals (see glossary) or appropriately supervised paraprofessional or direct care staff (see glossary), include:
(i) independent living services (see paragraph [a] of this subdivision);
(ii) medical oversight services (see section 690.5[b] of this Part);
(iii) nursing services;
(iv) nutrition services;
(v) occupational therapy services;
(vi) physical therapy services;
(vii) psychology services;
(viii) self-care services;
(ix) social work services;
(x) speech pathology services; and
(xi) therapeutic recreational services.
(2) Where clinically appropriate, and incorporated into the person's individual program plan (see glossary), a day treatment facility may elect to provide, as part of the allowable services in the area of independent living or other category, active treatment-based activities of a therapeutic prevocational nature. Included here, for example, might be training in the performance of an assembly task to improve manipulation skills, training in the performance of a sorting task to improve cognitive discrimination skills, etc. However, this excludes those activities/interventions which have a purely vocational (i.e., work-for-pay) purpose. Therapeutic prevocational activities are eligible for reimbursement through the Medical Assistance Program as part of a day treatment facility's allowable services if:
(i) The activities/interventions are documented in a written individual program plan and conform to the requirements for the provision of active treatment (see glossary).
(ii) The activities in which persons are engaged are primarily therapeutic and individualized in nature (i.e., the treatment goal is the amelioration of a developmental skill deficit, or developmental skill enhancement, rather than the production of a product), and the activities are chosen, approved or developed by the interdisciplinary treatment team (see glossary) on the basis of clinical judgement related to the person's needs.
(iii) The activities engaged in are not performed as part of contract work (see glossary) for which the day treatment facility in particular, has made any commitments for itself, its staff, or the participants.
(iv) The activities engaged in by persons at the facility do not generate any outside income which accrues to the day treatment facility.
(v) In accordance with the Department of Labor regulations, if the therapeutic activity/intervention results in a saleable product or an economic benefit to any party, the person(s) must be recompensed in accordance with New York State's Wage and Hour Law requirements.
(3) As part of the day treatment facility's reimbursement, allowable services shall be provided as needed on a regular basis (though not necessarily on a daily basis), to person(s)/people attending the day treatment facility in accordance with an individual program plan and, in the case of occupational and physical therapy, by specific written medical prescription.
(i) The frequency and intensity of service delivery shall be based on the needs indicated in each person's comprehensive functional assessment.
(ii) Medical oversight, nursing, psychology, social work, speech pathology, occupational therapy and physical therapy services as specified in the program plans of the facility's participants, may be provided directly or through contract or letter of agreement, but the costs for such services are to be considered as part of the day treatment facility's reimbursement.
(iii) Transportation to and from the facility is a separately reimbursable service until June 30, 1996. Effective July 1, 1996, such transportation shall be the responsibility of the day treatment provider.
(iv) The level of all services provided shall be based on a person's assessed needs and in accordance with the treatment plans (see glossary) contained in the individual program plan.
(v) The facility shall encourage and facilitate the coordination of service delivery among each person's major day and residential providers.
(4) Each of the allowable services set forth in this Part shall be provided either directly by the facility or through contract or agreement with other providers, and may be delivered through group or individual activities, as indicated in a person's individual program plan.
(i) Where required by law, all contractual service providers shall have a valid operating certificate or applicable licensure/certification issued by the appropriate State agency.
(ii) Services provided by the facility or to the facility by outside agencies or parties shall meet the applicable requirements of this Part. Contracts or agreements for these services shall state that these standards will be met.
(5) It is generally expected that most person(s)/people receiving full or half-day day treatment services are having their basic needs for day treatment services accommodated. However, it is realized that in individual cases, the person's need for clinical supports may extend beyond the day treatment facility's scope or duration of responsibility. In such cases, and in other appropriate circumstances, a person may receive a day treatment service and a Part 679 (of this Title) certified clinic treatment service on the same day. In such cases, it shall be the responsibility of both the day treatment and the clinic treatment provider to ensure adherence to these requirements.
(i) A person admitted to a day treatment facility and receiving full, half or collocated (a.k.a., partial - see section 690.1[d] of this Title) day treatment services five or fewer days per week, may, as needed, receive a Part 679 clinic treatment service on the same day as the day treatment visit in the clinical areas of audiology, special medical, routine medical, and dentistry without any restriction. This presumes that the person receives the full duration of day treatment visit being claimed, and the clinic treatment service(s) is/are provided outside of the time the person is at the day treatment setting. Nothing herein shall preclude such clinical services being delivered as part of a program plan-specified community integration opportunity which meets the requirements of paragraph (6) of this subdivision.
(ii) A person participating in fewer than five full days per week of day treatment, may receive a claimable Part 679 (of this Title) clinic treatment service on those days he/she does not attend day treatment. Such clinic service(s) may consist of any clinical discipline treatment area(s) deemed necessary and appropriate, other than a comprehensive interdisciplinary assessment (see section 679.5[c] of this Title). Said comprehensive assessment is required to be provided by the day treatment provider as part of its admission and initial and/or annual programming process.
(a) For second opinion purposes, and where the person's needs are particularly complex and/or intractable or resistive to conventional treatment interventions, a person in day treatment may receive a claimable clinic treatment in-depth discipline-specific assessment visit on a same day he/she is receiving a full or half day treatment visit.
(b) It is expected that the day treatment facility or other referral agent will provide, and that the clinic treatment facility will keep on file, the documentation substantiating the person's need (e.g., diagnostic clarification and/or new treatment recommendations) for the discipline specific assessment and the reasons why the day treatment facility's means for this type of assessment are inadequate.
Unavailability of day treatment qualified professionals due to recruitment problems, is not sufficient justification.
(iii) A day treatment facility may make arrangements with a clinic treatment facility to provide specific day treatment "allowable" services, but only the day treatment facility shall submit a claim for such services and then must pay the clinic treatment facility provider directly for the service that was provided.
(iv) A same day clinic visit for any authorized Part 679 (of this Title) clinical service is allowable if the person receiving a full or half day treatment visit also has clinical needs which are clearly separate from his/her participation in the day treatment facility (i.e., related primarily to the person's residence/home). The residential facility's plan of service for the person shall clearly articulate the use of a Part 679 (of this Title) clinic to deliver the residentially-needed clinical support service(s). In addition:
(a) For both ICF/DDs and community residences, the residential provider must clearly be able to demonstrate upon request or audit that the services for which the residential provider is being reimbursed through its residential rate/fee, are clearly separate from (i.e., not duplicative of the additional services received by the person through the Part 679 (of this Title) clinic;
(b) All facilities involved (day treatment, clinic treatment, and residence) shall be able to document their efforts at integration and coordination of the services with each other, to ensure that the persons are provided necessary services in the most economical and efficient fashion available.
(v) A person participating in collocated day treatment (a.k.a., partial day treatment - see section 690.1[d] of this Title), may receive a clinic treatment service (other than per subparagraph [i] of this paragraph) only on the days when he/she is not receiving the collocated service. In addition, the clinic service must be necessary to support the person's living situation.
(6) The provision of isolated, off-site day treatment services is not permitted. However, where clinically appropriate and incorporated into the person's individual program plan, a day treatment facility may provide, as part of the allowable services in the area of independent living or other category, an individualized, programmatically sound community integration opportunity which extends the facility's habilitation environment in accordance with the following requirements:
(i) The community integration opportunity shall be individually, and primarily designed to meet the developmental skill or behavioral needs and preferences of the person involved, and shall be documented in the person's individual program plan.
(ii) The community integration opportunity shall be planned and implemented so that the skill or behavior activities originate at the certified day treatment site (or satellite); that said activities that take place during the period of transportation to the community integration setting; that said activities take place at the setting and during the period of transportation from the setting; and that said activities end at the certified day treatment site (or satellite).
This does not presume or require that the same activities, interventions, or skills be conducted/addressed throughout the duration of the community integration opportunity or its segments, nor does it presume continuous interaction. It does presume that the community integration opportunity is only part of the person's daily day treatment experience.
(iii) Each particular community integration opportunity (i.e., the activity and its associated outcome) shall be time limited (as specified by the IT, but in any event, no longer than one year), and focused on the initiation or enhancement of a specific developmental skill(s) or behavior(s) appropriate for increasing the person's independent functioning in the community. Such experiences shall not be for the sole purposes of placing the person in another setting/alternative or for facilitating the person's adaptation to a new setting/alternative without an emphasis on objectives to facilitate specific developmental skill(s) or behavior(s).
(b) Standards of certification.
(1) OPWDD shall verify, where community integration opportunities have been utilized, that the appropriate treatment plans document the habilitation activities being carried out during the various phases of each opportunity.
(2) OPWDD shall verify that, where applicable, the day treatment program has coordinated the provision of allowable day treatment services with other significant services received by the person outside of the day treatment facility.
(3) OPWDD shall verify where the day treatment facility is utilizing pre-vocational skills training materials or activities, that said materials/activities are not part of a contract work arrangement that binds the day treatment facility, its staff or service recipients to any production obligations.
(4) OPWDD shall verify that the outcomes of individualization, inclusion, independence and productivity have been considered as part of the overall program planning process for the person and incorporated, as appropriate, into various treatment activities, interventions and/or therapies addressing skill and behavioral development.
(5) OPWDD shall verify that, where the IT has chosen to include pre-vocational services as part of the person's overall day treatment services, the plan for said services includes the clinical justification as to why such pre-vocational activities/interventions/therapies are appropriate to meeting the person's needs for the time in question.
14 CRR-NY 690.3
Current through June 30, 2021
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