This rule will amend 14 NYCRR Part 594, Operation of Licensed Housing Programs for Children and Adolescents with Serious Emotional Disturbances, by establishing a new sub-class of community residence for children and adolescents who have been diagnosed as having an eating disorder such as anorexia nervosa, bulimia, binge eating disorder, or other eating disorder identified as such in generally accepted medical or mental health diagnostic references.

Overview

The new category of community residences will be known as Community Residences for Eating Disorder Integrated Treatment (CREDIT), and will address the needs of individuals who have reached at least the 12th birthday but not the 19th, who have been referred by a provider who is a participant in a Comprehensive Care Center for Eating Disorders (CCCED) designated by the State Department of Health or by the individual's primary care physician or mental health provider, and whose individual treatment issues preclude being served in a family setting or other less restrictive residential alternative.

Requirements

CREDIT programs will be required to have written affiliation agreements with CCCED providers, which must include referral and admission procedures, as well as procedures for crisis clinical back-up. The agreements will be subject to approval by the Office of Mental Health, and will be required to assure continuity and integration of care with the CCCED. The agreements will provide, at a minimum, for the following:

• The performance of a psychiatric assessment;

• The development of an integrated service plan;

• The performance of a medical examination;

• The supervision of meal, bathroom and exercise time;

• Family participation, as appropriate;

• Coordination of residents' educational needs with residents' school districts.

CREDIT programs will be required to have sufficient staff to meet the special needs of children and adolescents residing in a community residence who have been diagnosed with an eating disorder. Services will be required to be provided pursuant to an initial service plan developed by program staff with the resident and family and/or any collateral identified for participation within three days of admission, and a more extensive plan to be developed within four weeks of admission. The service plan will be required to be reviewed weekly. The CREDIT program will be required to complete progress notes weekly.

Revisions Regarding Children's Residences other than CREDIT Program

Part 594 is also being amended to include several technical amendments concerning the operation of licensed housing programs for children and adolescents. Included in these amendments is utilization of "person first" language and an emphasis on family-centered community-based treatment, resilience and recovery. In addition, each licensed housing program will be required to submit a staffing plan which includes at least one full-time employee who is a registered nurse for each eight-bed community residence and for each 12-bed teaching family home.

1. Statutory Authority: Subdivision (b) of Section 7.09 of the Mental Hygiene Law grants the Commissioner of the Office of Mental Health the authority and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.

Subdivision (a) of Section 31.04 of the Mental Hygiene Law grants the Commissioner of the Office of Mental Health the power to adopt regulations setting standards of quality and adequacy of facilities and establishing procedures for the issuance, amendment and renewal of operating certificates.

Chapter 676 of the Laws of 2007, as amended by Chapter 24 of the Laws of 2008, creates Section 31.25 of the Mental Hygiene Law, which requires the Commissioner of the Office of Mental Health to establish, pursuant to regulation, licensed residential providers of treatment and/or supportive services to individuals with eating disorders.

2. Legislative Objectives: Articles 7 and 31 of the Mental Hygiene Law reflect the Commissioner's authority to establish regulations regarding mental health programs. Section 2799-e of the Public Health Law establishes Comprehensive Care Centers for Eating Disorders, and requires that they include within their scope of services a licensed residential component.

3. Needs and Benefits: These amendments establish the CREDIT program (Community Residences for Eating Disorder Integrated Treatment). The development of licensed residential services for persons with eating disorders by the Office of Mental Health was required by Chapter 676 of the Laws of 2007, as amended by Chapter 24 of the Laws of 2008, and codified in Section 31.25 of the Mental Hygiene Law. The CREDIT program will serve the needs of those individuals who have attained at least the 12th birthday but not the 19th, who have been referred by a provider who is a participant in a Comprehensive Care Center for Eating Disorders (CCCED) designated by the State Department of Health or by the individual's primary care physician, and whose individual treatment issues preclude being served in a family setting or other less restrictive residential alternative.

4. Costs:

(a) Cost to regulated persons: There will be no costs to providers as a result of this regulatory amendment.

(b) Cost to State and local government: None expected. It is anticipated that the costs of operating each licensed program will be paid for by private insurance.

5. Paperwork: The paperwork that would be required as a result of this rulemaking would be consistent with the required paperwork of any new community residence.

6. Local Government Mandates: This regulatory amendment will not result in any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.

7. Duplication: There are no duplicate, overlapping or conflicting mandates which may affect this rule.

8. Alternative Approaches: The only alternative to this regulatory amendment would be inaction. The development of these providers is mandated by Section 31.25 of the Mental Hygiene Law. A failure to promulgate these regulations would be contrary to the legislation. Therefore, that alternative was necessarily rejected. It should be noted that in the development of these regulations, OMH staff met with providers of eating disorder treatment and representatives of the insurance industry, and their input was instrumental in crafting the regulatory amendments.

9. Federal Standards: The regulatory amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.

10. Compliance Schedule: The regulatory amendment would be effective immediately upon adoption.

The proposed rule will serve to develop Community Residences for Eating Disorder Integrated Treatment (CREDIT). Because it is evident from the nature of the proposed rule that there will be no adverse economic impact on small businesses or local governments, a regulatory flexibility analysis is not submitted with this notice.

A Rural Area Flexibility Analysis is not submitted with this notice because the proposed rule will not impose any adverse economic impact on rural areas. Recipients of mental health services in rural and non-rural programs may benefit from the Community Residences for Eating Disorder Integrated Treatment (CREDIT) program.

A Job Impact Statement is not submitted with this notice because the proposed rule, which serves to establish the CREDIT program (Community Residences for Eating Disorder Integrated Treatment) will not have any adverse impact on jobs and employment opportunities. In fact, the creation of this new type of community residence should have a positive influence on employment opportunities.