Operation of Crisis Residences in New York State
NY-ADR
6/26/19 N.Y. St. Reg. OMH-43-18-00001-A
NEW YORK STATE REGISTER
VOLUME XLI, ISSUE 26
June 26, 2019
RULE MAKING ACTIVITIES
OFFICE OF MENTAL HEALTH
NOTICE OF ADOPTION
I.D No. OMH-43-18-00001-A
Filing No. 571
Filing Date. Jun. 07, 2019
Effective Date. Jun. 26, 2019
Operation of Crisis Residences in New York State
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of Part 589 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 7.09 and 31.04
Subject:
Operation of Crisis Residences in New York State.
Purpose:
To revise and update the categories of Crisis Residences to match what is currently operating in New York.
Substance of final rule:
The New York State Office of Mental Health along with County leadership has developed a shared vision of a coordinated behavior health crisis management system available to all New Yorkers, regardless of ability to pay. This system will integrate existing crisis infrastructure with newly available resources in managed care, Delivery System Reform Incentive Payment (DSRIP) and Value Based Payments (VBP). To inform this vision, an interagency workgroup comprised of State and local governmental subject matter experts received input from relevant stakeholders, including people with mental illness, people in recovery from substance use disorders, family members, the advocacy community, behavioral health providers, hospital systems, managed care plans, the child welfare systems and meetings with other states.
The goals of the crisis management system are to maintain people safely in the community, reduce unnecessary emergency room visits and inpatient hospitalizations, reduce risk of future crises and coordinate information sharing among clinicians, recipients and involved family members and identified supports to reflect recipient’s preferences.
A continuum of crisis services available in a community allows for individuals to receive services at the right time and right place. An integral part of the crisis management system and continuum of crisis services are crisis residential programs.
At this time, the Office of Mental Health (OMH) is proposing amendments to 14 NYCRR Part 589 (regulations that guide the operations of crisis residences). OMH has revised Part 589 to update the language in the regulations and conform the regulations to more accurately reflect current practice related to the operation of crisis residences.
• The revision of the use of the phrases “mentally ill” to “persons experiencing mental illness” allows for the person to be defined separately from their illness in an effort to remove outdated language while conforming with the Mental Health Hygiene laws.
• The “background and intent” provision was updated to include a broader explanation of the purposes of crisis residences and to include the three types of crisis residences: Intensive Crisis Residence, Residential Crisis Support, and Children’s Crisis Residence. These types of residences reflect the current provision of residential crisis services.
• The “legal base” and “applicability” provisions contain no substantive changes, only minor technical changes to update the language.
• The “definitions” section was updated to include staffing and program components, with the intention of consolidating this information and including it in one section. The definition of residential programs was also revised to reflect the three types of crisis residences.
• The “certification” provision was similarly updated to reflect purpose of the crisis residences, as well as the population, and services that are included in each of the three types of residences.
• The “organization and administration” provision was revised to reflect the additional populations under discrimination and to include specific cultural and linguistic competency in staff training. It also includes policies and procedures for staff supervision, visiting, and identifying and mandatory reporting of child abuse and neglect for the children’s crisis residences.
• The “written plan for services and staff composition” provision now includes a plan for continuity and integration of care within the mental health system, and other systems of care under written plans for services and staff composition.
• There is also the inclusion of background checks and additional staffing requirements for children’s crisis residences that specifies minimum staffing and allows for an adequate volume of professional and nursing staff to ensure the continuous provision of treatment services—this is included in “staffing.” There are also case record requirements included under the individual services plan and included in the children’s crisis residence requirements.
• In the “quality assurances” provision, the language was updated to include monitoring of program performance and OMH monitoring of program quality. This monitoring process allow for oversight of the care of recipients and identify actions that can be taken if programs are in violation of its operating certificate, applicable statute, standard, rule or regulation.
• The language in the “utilization review” provision now includes review of admission and continued stay and over-utilization and under-utilization of services.
• The revised regulations add a “rights of recipients” provision that outlines the rights of recipients residing in a residential program and a grievance process which ensures the timely review and resolution of complaints.
• The “premises” provision includes changes to the safety requirement, which also removes space heaters as a prohibited fire hazard if pre-approved by OMH. The revised regulations also include carbon monoxide detectors to the safety requirements.
• Technical/logistical amendments were made to change the numbering of the “statistical records and reports” provision, and to eliminate subparts 589-1 and 589-2.
• Section 589.15 Determination of self-preservation section was added to the regulation.
The full text of the rule can be viewed online at: https://omh.ny.gov/omhweb/policy_and_regulations/
Final rule as compared with last published rule:
Nonsubstantive changes were made in sections 589.1, 589.2, 589.4, 589.5, 589.6, 589.7, 589.8, 589.9, 589.10, 589.12, 589.13, 589.14 and 589.15.
Revised rule making(s) were previously published in the State Register on
October 24, 2018.
Text of rule and any required statements and analyses may be obtained from:
Nancy Pepe, Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, (518) 474-1331, email: [email protected]
Revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement
A revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement are not required because the changes made to the last published rule do not necessitate revision to the previously published document. The changes to the text are not substantial, do not change the meaning of any provision and therefore do not change any statements in the document.
Initial Review of Rule
As a rule that requires a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2022, which is no later than the 3rd year after the year in which this rule is being adopted.
Assessment of Public Comment
The Office of Mental Health has received public comments from 5 stakeholder entities, including providers and provider organizations. All the comments were reviewed, assessed and taken into consideration. Below are the collective responses to each of the issues presented. The full Assessment of Public Comment can be viewed online at: https://omh.ny.gov/omhweb/policy_and_regulations/
Definitions
• Definitions such as ‘collateral’, ‘mental illness’, and ‘qualified mental health staff person’ were clarified to bring them into alignment with current regulations or more common usage.
Certification
• Service definitions will be defined in program guidance. Requests for additional services included under programs are at the discretion of the program. The regulation sets minimum standards for service delivery.
• Principles of service delivery will be included in program guidance.
• Medication therapy in Intensive Crisis Residences are intended as a part of a comprehensive treatment program and differentiates this from Residential Crisis Support.
Organization and Administration
• Programs may be in the same building, if they are programmatically and physically separate. Staff may not be shared between programs during a shift.
• HIPAA compliance, background checks and child and abuse neglect registry expectations were clarified.
Staffing
• Peer specialists as part of a staffing plan are included in the definitions and staffing sections.
• Program supervision may be on-site or on-call and must be addressed in the staffing plan. This is based on program’s ability to ensure health, safety and well-being of recipients and the efficacy of the program.
• Staffing ratios will be included in program guidance.
Individual Service Plan and Case Record
• Children’s crisis residential individual service plan review clarified that an intake assessment and preliminary service plan must be developed within 24 hours. Adult programs must also have an individual service plan completed within 24 hours.
• Reference to electronic health records has been included.
Quality Assurance
• All references to a ‘functional program’ were removed.
• Quality assurance practices that are not required in regulation, such as a committee comprised of current and former recipients will be addressed in program guidance and must be included in program policies and procedures.
Rights of Recipients
• The right of recipients to control their own schedules and activities has been added to this section.
Premises
• The requirement that 10% of the floor area of the bedroom be windows can be waived for cause.
A section on determination of self-preservation has been added to the regulation.
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