N.Y. Comp. Codes R. & Regs. tit. 14 § 512.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 512.7 - Program operations

(a) Program purpose.

(1) The purpose of PROS programs is to partner with individuals in their recovery from mental illness through the delivery of integrated rehabilitation, treatment, and support services.

(i) PROS programs shall offer individuals who are recovering from mental illness an array of personalized and integrated recovery-oriented services, which are delivered within a site-based program setting as well as in off-site locations in the communities where such individuals live, learn, work and socialize.

(ii) PROS programs shall establish a therapeutic environment which fosters awareness, hopefulness and motivation for recovery, and incorporates a harm reduction philosophy.

(2) Depending upon program configuration and licensure category, PROS programs will include the following components: community rehabilitation and support (CRS); intensive rehabilitation (IR); ongoing rehabilitation and support (ORS); and clinical treatment.

(i) The CRS component shall be designed to engage and assist individuals in managing their illness and in restoring those skills and supports necessary to live in the community.

(ii) The IR component shall be designed to intensively assist individuals in attaining specific life roles such as those related to competitive employment, independent housing and school. The IR component may also be used to provide targeted interventions to reduce the risk of hospitalization or relapse, loss of housing or involvement with the criminal justice system, and to help individuals manage their symptoms.

(iii) The ORS component shall be designed to assist individuals in managing symptoms and overcoming functional impairments as they integrate into a competitive workplace. ORS interventions shall focus on supporting individuals in maintaining competitive integrated employment. Such services shall be provided off-site.

(iv) The clinical treatment component shall be designed to help stabilize, ameliorate and control an individual's symptoms of mental illness. Clinical treatment interventions must be highly integrated into the support and rehabilitation focus of the PROS program. The frequency and intensity of clinical treatment services shall be commensurate with the needs of the target population.

(3) A comprehensive PROS program shall offer, at a minimum, CRS, IR and ORS components. A comprehensive PROS program must be able to provide the following assessments:

(i) psychosocial assessment;

(ii) psychiatric rehabilitation assessment that addresses living, learning, working and social domains; and

(iii) screening for alcohol, substance abuse, and nicotine addiction.

(4) A comprehensive PROS program with clinical treatment shall offer, at minimum, CRS, IR, ORS, and clinical treatment components. In addition to the assessments required to be provided by all comprehensive PROS programs, a comprehensive PROS program with clinical treatment must be able to provide:

(i) psychiatric assessment; and

(ii) health assessment.

(5) A limited license PROS program shall offer IR and ORS components.

(6) All PROS providers shall establish mechanisms regarding the coordination of rehabilitation, treatment and support services for individuals, including linkage agreements with other providers as appropriate. These mechanisms shall address:

(i) coordination among any of the PROS components as specified in paragraph (2) of this subdivision that are delivered by the same PROS provider;

(ii) coordination among any of the PROS components as specified in paragraph (2) of this subdivision which are delivered by multiple PROS providers; and

(iii) coordination of PROS services with other service providers.

(b) Components and services.

(1) All PROS programs, regardless of certification category, shall offer the following services:

(i) individualized recovery planning services; and

(ii) pre-admission screening services.

(2) A CRS component shall include, at a minimum, the following services:

(i) assessment;

(ii) basic living skills training;

(iii) benefits and financial management;

(iv) community living exploration;

(v) crisis intervention;

(vi) engagement;

(vii) individualized recovery planning;

(viii) information and education regarding self help;

(ix) structured skill development and support; and

(x) wellness self-management.

(3) When CRS services are provided in a group format, such group size shall not, on a routine and regular basis, exceed 12 members. However, on an occasional basis, group sizes of between 13 and 24 members are permissible if the group is co-facilitated by at least two staff members, and there is documentation that the expanded group size is clinically appropriate for the service being provided. Pursuant to section 512.11(b)(13) of this Part, a PROS program may, within the specified limits, still use the service to satisfy the service frequency requirement of section 512.11(b)(11) of this Part for some group participants.

(4) An IR component, as part of a comprehensive PROS program, shall include, at a minimum, the following services:

(i) family psychoeducation/intensive family support;

(ii) integrated treatment for dual disorders;

(iii) intensive rehabilitation goal acquisition; and

(iv) intensive relapse prevention.

(5) In order to receive Medicaid-reimbursed integrated treatment for dual disorders as part of the IR component, the individual must also be receiving clinical treatment services within the PROS program or from another OMH- licensed clinic. If the individual is not receiving clinical treatment services directly within the PROS program, the PROS program shall document that the services provided by the clinic are integrated with those provided by the PROS program. Such integration shall include, at a minimum, the ongoing exchange of information, documentation of progress and outcomes related to the services provided by the clinic, and shall indicate the name of the treating psychiatrist or nurse practitioner at such clinic who will be collaborating with a designated member of the PROS clinical staff.

(6) An IR component, as part of a limited license PROS program, shall include, at a minimum, intensive rehabilitation goal acquisition services. Such services shall be limited to employment and education-oriented goals.

(7) When IR services are provided in a group format, such group size shall not exceed, on a regular and routine basis, eight members. However, family psychoeducation/intensive family support services provided in a group format may include up to 16 group members, if the group is co-facilitated by at least two staff members. Pursuant to section 512.11(c)(2)(ii) and (iii) of this Part, a PROS program may, within the specified limits, allow group sizes to exceed eight members, or 16 members for family psychoeducation/intensive family support groups, on an occasional basis, and still use the service to satisfy the service frequency requirement of section 512.11(b)(11) of this Part or the IR service requirement of section 512.11(c)(2)(i) of this Part for some group participants.

(8) An ORS component shall include, at a minimum, ongoing rehabilitation and support services.

(9) Clinical treatment is intended to enhance the array of available services offered within other PROS program components. The following services shall be available:

(i) clinical counseling and therapy;

(ii) health assessment;

(iii) medication management;

(iv) symptom monitoring; and

(v) psychiatric assessment.

(10) Providers offering medication management services shall consider the full range of atypical antipsychotic medications, available at the time when prescribing medication. Such providers shall conduct, or arrange for, any associated blood analysis, when so indicated.

(11) Any additional services delivered by a PROS program that are clinically appropriate shall be considered as optional and shall be subject to prior review and written approval of the office. Such services may include, but are not limited to, cognitive remediation services.

(c) Admission and registration.

(1) Admission criteria must conform to applicable State and Federal law governing non-discrimination. Admission criteria shall not exclude individuals because of past histories of incarceration or substance abuse. A provider of service shall not deny access to services by an otherwise appropriate individual solely on the basis of multiple diagnoses or a diagnosis of HIV infection, AIDS, or AIDS-related complex.

(2) The program's admission process, including any criteria governing participation in the program, shall be clearly described and available for review by participants, their families or significant others.

(3) Providers of service shall not use coercion in regard to program admission or discharge, referrals to other programs, or the level of service provision, provided that nothing in this paragraph shall be interpreted to affect or otherwise impact the delivery of services to an individual under a court order issued pursuant to section 9.60 of the Mental Hygiene Law.

(4) Prior to admission to a PROS program, pre-admission screening services may be provided. During such time, the individual shall be considered to be in pre-admission status.

(5) To be eligible for admission to a PROS program, a person must:

(i) be 18 years of age or older;

(ii) have a designated mental illness diagnosis;

(iii) have a functional disability due to the severity and duration of mental illness; and

(iv) be recommended for admission by a licensed practitioner of the healing arts (LPHA). The recommendation must be in writing, must be signed and dated, and must include an explanation of the medical need for PROS services.

(a) If the LPHA making the recommendation is not a member of the PROS program staff, the recommendation must include the LPHA license number.

(b) If the LPHA making the recommendation is a member of the PROS program staff, the recommendation must include the identification of the PROS components that will initially meet the individual's needs and the LPHA must sign the screening and admission note.

(6) Admission of an eligible individual to a PROS program shall be based upon service availability, and not based upon an individual's ability to pay for such services.

(7) Upon a decision to admit an individual to a PROS program, a screening and admission note shall be written. Such note shall include the following:

(i) reason for admission;

(ii) primary service-related needs and services to meet those needs;

(iii) admission diagnosis, and

(iv) signature of a professional member of the PROS staff.

(8) After admission, the initial service recommendation plan shall be developed by or under the supervision of a member of the professional staff in partnership with the individual. The initial service recommendation plan identifies the individual's primary service needs and a list of services in which he or she will participate and remains valid for up to 60 days or until the IRP is completed. The initial service recommendation plan shall be considered part of the admission documentation and shall be maintained in the case record as a separate document, distinct from the IRP.

(9) When admission is not indicated, a notation shall be made of the following:

(i) the reason for not admitting the individual; and

(ii) any referrals made to other programs or services.

(10) Upon a decision to admit an individual to a PROS program, a recipient attestation form shall be completed. Such form shall be dated and signed by the individual, which indicates his or her choice to participate in the PROS program and specified program components.

(11) Upon admission of an individual and the completion of the recipient attestation form, the PROS program shall complete and submit a PROS registration form, using the registration system approved by the office.

(i) Such registration process must include the identification of the specific PROS program components in which the individual will be participating.

(ii) Individuals may register in multiple PROS programs for unduplicated components of service. However, in no event shall an individual be registered for clinical treatment only.

(12) The PROS admission date for an individual shall be the date that the PROS program submits a completed registration pursuant to this subdivision.

(13) Upon confirmation of acceptance of the registration request on behalf of an individual, such individual shall be considered registered in the PROS program, effective on the date provided by the office. Individuals who are registered in a PROS program are not restricted to the limitations of pre-admission billing pursuant to section 512.11 of this Part.

(14) If a registration request on behalf of an individual is denied, such individual shall be discharged from the PROS program. The discharge summary shall identify any referrals made to other programs or services.

(d) Staffing.

(1) A PROS provider shall continuously employ an adequate number and appropriate mix of clinical staff consistent with the objectives of the program and the intended outcomes. Such staff may include persons who are also recipients of service from a PROS program, subject to the requirements of paragraph (9) of this subdivision and section 512.9 of this Part.

(2) PROS providers shall maintain an adequate and appropriate number of professional staff relative to the size of the clinical staff.

(i) A comprehensive PROS provider shall be deemed to have met such standard if at least 40 percent of the total clinical staff full-time equivalents (FTEs) are represented by professional staff.

(ii) A limited license PROS program shall be deemed to have met such standard if at least 20 percent of the total clinical staff FTEs are represented by professional staff.

(3) For the purpose of calculating professional staff ratios, a provider may include staff credentialed by the United States Psychiatric Rehabilitation Association (USPRA) for up to 20 percent of the total number of required professional staff.

(4) For comprehensive PROS programs, at least one of the members of the provider's professional staff shall be a licensed practitioner of the healing arts and shall be employed on a full-time basis.

(5) For limited license PROS programs, at least one of the members of the provider's professional staff shall be employed on a full-time basis.

(6) IR services shall be provided by, or under the direct supervision of, professional staff.

(7) PROS providers shall maintain an adequate and appropriate number of staff in proportion to the number of individuals served. Providers shall be deemed to have met such standard if their staffing ratios, based on average attendance, are at least in accordance with the following:

(i) for CRS, a ratio of one clinical staff member to every 12 individuals receiving CRS group services;

(ii) for IR, a ratio of one clinical staff member to every eight individuals receiving IR group services;

(iii) for ORS, a case load of no more than 22 individuals per clinical staff member; and

(iv) for comprehensive PROS programs with clinical treatment, the following additional standards shall apply:

(a) PROS staffing must include a minimum of.125 FTE psychiatrist and.125 FTE registered professional nurse for every 40 individuals receiving clinical treatment services; and

(b) additional psychiatry, nursing and other staff shall be included, as necessary, to meet the volume and clinical needs of persons receiving clinical treatment services;

(v) programs may use nurse practitioners in psychiatry to partially offset the requirement for psychiatrist coverage pursuant to clause (iv)(a) of this paragraph, consistent with the following requirements:

(a) all programs must maintain a minimum .125 FTE psychiatrist;

(b) after having met the minimum .125 FTE psychiatrist required in clause (a) of this subparagraph, programs may elect to substitute nurse practitioner in psychiatry FTE for the additional required psychiatrist FTE at a ratio not to exceed 50 percent of the total psychiatry requirement;

(c) programs must ensure clinical collaboration between the nurse practitioner in psychiatry and a psychiatrist who is employed by the sponsor, consistent with New York State Education Law governing the licensure of nurse practitioners;

(d) nurse practitioners used to offset required psychiatrist staffing must be certified as nurse practitioners in psychiatry;

(e) nurse practitioner in psychiatry FTE may not be used to simultaneously satisfy the nurse staffing requirement pursuant to clause (iv)(a) of this paragraph, and to offset the psychiatrist staffing requirement.

(8) All staff shall be afforded regular supervision. Such supervision shall address quality of care provided and ongoing staff development.

(9) A PROS provider may use recipient employees. In such circumstances, the following requirements shall apply:

(i) Recipient employees shall be included in the PROS provider's staffing plan.

(ii) PROS participants may perform a variety of non-paid functions related to the operation of the program as part of the program's therapeutic environment when such functions are identified in the person's individualized recovery plan. Non-paid functions of PROS participants shall not be reflected in the PROS provider's staffing plan.

(iii) Recipient employees shall adhere to the same requirements, pursuant to this Part, which are applicable to other PROS employees.

(iv) Recipient employees shall receive training regarding the principles and requirements of confidentiality, ethics and boundaries, and work place harassment.

(v) Ongoing supervision of recipient employees shall address, as warranted, boundary issues, transition between roles, and potential conflicts of interest.

(e) Individualized recovery planning process.

(1) The individualized recovery planning process shall be carried out by, or under the direct supervision of, a member of the professional staff. Such process is intended to be reflective of person-centered planning principles and shall therefore be conducted in collaboration with the individual and any persons the individual has identified for participation.

(2) The individualized recovery planning process shall address the differences in individuals' cognitive abilities and/or learning style, culture, gender, age and other issues that may impact service delivery.

(3) The individualized recovery planning process shall include, but not be limited to, the following activities:

(i) meetings with the PROS participant and relevant others;

(ii) identification and completion, within 45 days of the individual's admission date, of all required screenings or assessments, as determined based on the PROS Components in which the individual has enrolled;

(iii) linkage and coordination activities with other service providers for the purpose of assessing plan progress and assuring integration of services; and

(iv) development of an individualized recovery plan (IRP).

(4) An initial IRP shall be developed within 60 days of the individual's admission date.

(5) Each individual's IRP shall be reviewed for progress as follows:

(i) Six month review and update of the IRP: programs are required to conduct a review and update of the IRP at least every six months or sooner if conditions warrant it. This review and update should result in a new IRP reflective of the individual's progress or lack of progress toward his or her goal and must be signed by all required parties, including:

(a) PROS participant;

(b) clinical staff member who prepared the IRP;

(c) professional staff member if the clinical staff member who prepared the IRP is not a professional; and

(d) physician or nurse practitioner in psychiatry, if the individual is enrolled in the clinical component.

(ii) Three month review of IR/ORS services: reviews must be conducted every three months to determine the need for continuation of IR or ORS services. This review concerns the continuation of the IR or ORS services and does not require that the complete IRP be reviewed.

(6) Each IRP Review should result in an IRP Review Summary. This summary provides the justification for any changes to be made within the IRP and/or justification for parts of the IRP that will remain the same for the next review period.

(7) For individuals receiving IR or ORS services, the IR or ORS services identified in the IRP shall be assessed for continued need, at a minimum, every three months. The decision to continue or discontinue the service shall be documented and include the following:

(i) reason for the decision;

(ii) signature of the individual; and

(iii) signature of the clinical staff member assessing the need for continued service. If the clinical staff member who conducted the assessment is not a member of the professional staff, the signature of the professional staff member who supervised the staff member must also be recorded.

(8) If a PROS participant is receiving PROS services from multiple PROS providers:

(i) the provider of CRS services shall be responsible for forwarding copies of the IRP and related updates to the provider of IR or ORS services; and

(ii) the provider of IR or ORS services shall be responsible for developing an IR or ORS plan which shall be a component of the IRP, and which is consistent with the IRP developed by the provider of CRS services.

(9) If a PROS participant receives PROS services only from one PROS provider, and receives only IR or ORS services, the provider of IR or ORS services shall be responsible for the completion, review and update of an IRP pursuant to the requirements of this subdivision.

(10) If a PROS participant receives solely ORS services from a comprehensive PROS, the provider shall be responsible only for completing a psychiatric rehabilitation assessment with an employment focus and for developing an IRP that is reflective of an employment support goal. The provider is not required to complete a relapse prevention plan with the individual, but may do so. All other documentation requirements still pertain.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 512.7

Amended New York State Register August 26, 2015/Volume XXXVII, Issue 34, eff.8/26/2015