N.Y. Comp. Codes R. & Regs. tit. 14 § 587.4

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

Section 587.4 - Definitions

(a)Recipient-related definitions.

(1)Adult is an individual 18 years old and over.

(2)Child is an individual up to 18 years of age and may include an 18-year-old individual while such individual is currently enrolled in an outpatient program serving children with a diagnosis of emotional disturbance.

(3)Collateral persons are members of the recipient's family or household, or significant others who regularly interact with the recipient and are directly affected by or have the capability of affecting his or her condition and are identified in the treatment or psychiatric rehabilitation service plan as having a role in treatment and/or identified in the preadmission notes as being necessary for participation in the evaluation and assessment of the recipient prior to admission. A group composed of collaterals of more than one recipient may be gathered together for purposes of goal-oriented problem solving, assessment of treatment strategies and provision of practical skills for assisting the recipient in the management of his or her illness.

(4)Current impairment in functioning with severe symptoms means a child must have experienced at least one of the following within the past 30 days:

(i) serious suicidal symptoms or other life-threatening self-destructive behaviors; or

(ii) significant psychotic symptoms (hallucinations, delusion, bizarre behaviors); or

(iii) behavior caused by emotional disturbances that placed the child at risk of causing personal injury or significant property damage; or

(iv) behavior caused by emotional disturbances that placed the child at substantial risk of removal from the household.

(5)Designated mental illness diagnosis is a DSM-III-R diagnosis (or ICD-9-CM equivalent) other than (i) alcohol or drug disorders, (ii) developmental disabilities, (iii) organic brain syndromes, or (iv) social conditions (V-Codes). V-Code 61-20 Parent-Child problem is included for eligibility for services in clinic treatment programs serving children with a diagnosis of emotional disturbance. ICD-9-CM categories and codes that do not have an equivalent in DSM-III-R are not included as designated mental illness diagnoses.

(6)Dual diagnosis refers to those individuals with a designated mental illness diagnosis, in accordance with this paragraph, and a diagnosis of alcohol or drug disorders, developmental disabilities, or organic brain syndrome. Such individuals are considered eligible for treatment in outpatient programs specifically for treatment of their designated mental illness with consideration of their associated clinical needs.

(7)Dysfunction with regard to adults means deficits in self-care, activities of daily living, interpersonal relations, adaptation to change or task performance in work or work-like settings. With regard to children, dysfunction also includes deficits in adaptation to school, family or other residential settings.

(8)Serious emotional disturbance means a child or adolescent has a designated mental illness diagnosis according to the most current Diagnostic and Statistical Manual of Mental Disorders (DSM) and has experienced functional limitations due to emotional disturbance over the past 12 months on a continuous or intermittent basis. The functional problems must be moderate in at least two of the following areas or severe in at least one of the following areas:

(i) ability to care for self (e.g., personal hygiene; obtaining and eating food; dressing; avoiding injuries); or

(ii) family life (e.g., capacity to live in a family or family like environment; relationships with parents or substitute parents, siblings and other relatives; behavior in family setting); or

(iii) social relationships (e.g., establishing and maintaining friendships; interpersonal interactions with peers, neighbors and other adults; social skills; compliance with social norms; play and appropriate use of leisure time); or

(iv) self-direction/self-control (e.g., ability to sustain focused attention for a long enough period of time to permit completion of age-appropriate tasks; behavioral self-control; appropriate judgment and value systems; decision-making ability); or

(v) ability to learn (e.g., school achievement and attendance; receptive and expressive language; relationships with teachers; behavior in school).

(9)Utilization review authority means a person or persons designated by an outpatient program to perform the function of utilization review in accordance with section 587.6(l) of this Part and Part 588 of this Title.

(b)Program definitions.

(1)Behavioral health organization or BHO means an entity selected by the Commissioner of the Office of Mental Health and the Commissioner of the Office of Alcoholism and Substance Abuse Services pursuant to section 365-m of the New York State Social Services Law to provide administrative and management services for the purposes of conducting concurrent review of behavioral health admissions to inpatient treatment settings, assisting in the coordination of behavioral health services, and facilitating the integration of such services with physical health care.

(2)Child and family clinic plus provider means a licensed clinic that has been approved by the Office of Mental Health to provide child and family clinic plus services.

(3)Concurrent review means the review of the clinical necessity for continued inpatient behavioral health services, resulting in a non-binding recommendation regarding the need for such continued inpatient services.

(4)Off-site locations for purposes of providing outpatient services and reimbursement means any sites in the community where a recipient may require services.

(5)Program capacity means the number of recipients who can be on-site at a given time.

(6)Program space means discrete space dedicated to the purpose of the outpatient program and includes all space used by recipients enrolled in the program.

(7)Provider of service means the entity which is responsible for the operation of a program. Such entity may be an individual, partnership, association or corporation. For purposes of this Part, unless otherwise noted, the term also applies to a psychiatric center or institute operated by the Office of Mental Health.

(8)Satellite location of a primary program means a physically separate adjunct site to a certified clinic treatment program, continuing day treatment program, day treatment program serving children or intensive psychiatric rehabilitation treatment program which provides either a full or partial array of outpatient services on a regularly and routinely scheduled basis (full or part time).

(c)Service definitions.

(1)Activity therapy means therapy designed to assist a recipient in developing the functional skills and social and environmental supports needed to function more successfully in current or intended life environments (i.e., living, learning, working and social). Such therapy should provide an opportunity for a recipient to practice the skills and build or sustain the supports needed to improve functioning.

(2)Assessment is the continuous clinical process of identifying an individual's behavioral strengths and weaknesses, problems and service needs, through the observation and evaluation of the individual's current mental, physical and behavioral condition and history. The assessment shall be the basis for establishing a diagnosis, treatment plan or psychiatric rehabilitation service plan.

(3)Case management services are the process of linking the individual to the service system and monitoring the provision of services with the objective of continuity of care and service. Case management includes the following components:

(i) Linking. The process of referring the individual to all required services and supports as specified in the individual service plan.

(ii) Case-specific advocacy. The process of interceding on behalf of the individual to gain access to needed services and supports.

(iii) Monitoring. The process of observing the individual to assure that needed services and supports are received.

(4)Carved-out services are those specialized services that are not included in the benefit package of a managed care provider, other than a duly authorized managed special care provider, for all current and future managed care enrollees, regardless of aid category. Such services are long term services for individuals with chronic illnesses and include the following:

(i) day treatment programs;

(ii) continuing day treatment programs;

(iii) intensive psychiatric rehabilitation programs;

(iv) partial hospitalization;

(v) comprehensive Medicaid case management (CMCM);

(vi) rehabilitation services provided to a resident of OMH rehabilitation treatment services;

(vii) services provided to children with serious emotional disturbances in designated clinics.

(5)Child and family clinic plus services are mental health screening, comprehensive assessment, in-home services and evidence-based treatment.

(6)Clinical support services are services provided to collaterals, by at least one therapist, with or without recipients for the purpose of providing resources and consultation for goal oriented problem solving, assessment of treatment strategies and provision of skill development to assisting the recipient in management of his or her illness.

(7)Comprehensive assessment is an assessment that follows the American Academy of Child and Adolescent Psychiatry practice parameters for comprehensive assessment and includes the regular and methodical use of psychometric tools. This will include collecting the recipient's mental health history, and any current signs and symptoms of mental illness or emotional disturbance, identification of child and family strengths, and the assessment of the data to determine the recipient's mental health status and need for treatment.

(8)Crisis intervention services are activities and interventions, including medication and verbal therapy, designed to address acute distress and associated behaviors when the individual's condition requires immediate attention.

(9)Discharge planning is the process of planning for termination from a program or identifying the resources and supports needed for transition of an individual to another program and making the necessary referrals, including linkages for treatment, rehabilitation and supportive services based on assessment of the recipient's current mental status, strengths, weaknesses, problems, service needs, the demands of the recipient's living, working and social environment, and the client's own goals, needs and desires.

(10)Evidence-based treatment is the application of therapeutic and/or psychopharmacological approaches that have been scientifically proven to be effective in the treatment of specific emotional disturbances.

(11)Family treatment means therapeutic interventions designed to treat the recipient's psychiatric condition (whether the recipient is an adult or a minor) to address family issues that have a direct impact on the symptoms experienced by the recipient, and to promote successful problem solving, communication, and understanding between a recipient and family members as it relates to the recipient's symptoms, treatment, and recovery.

(12)Health screening service is the gathering of data concerning the recipient's medical history and any current signs and symptoms, and the assessment of the data to determine his or her physical health status and need for referral for noted problems. The data may be provided by the recipient or obtained with his or her participation. The assessment of the data shall be done by a nurse practitioner, physician, physician's assistant, psychiatrist or registered professional nurse. The assessment of physical health status shall be integrated into the patient's treatment plan.

(13)In-home services are clinic services of a minimum duration of 30 minutes provided by a qualified mental health professional to a child and/or his or her family, pursuant to his or her treatment plan, within the child's or family's living environment.

(14)Medication therapy means prescribing and/or administering medication, reviewing the appropriateness of the recipient's existing medication regimen through review of records and consultation with the recipient and/or family or caregiver, and monitoring the effects of medication on the recipient's mental and physical health.

(15)Medication education means providing recipients with information concerning the effects, benefits, risks and possible side effects of a proposed course of medication.

(16)Mental health screening is a broad-based approach to identify children and adolescents with emotional disturbances and intervene at the earliest possible opportunity.

(17)Preadmission screening is the initial face-to-face process of contacting, interviewing and evaluating a potential recipient of mental health services to determine the individual's need for services.

(18)Psychiatric rehabilitation goal setting is the process by which a recipient selects a specific environment in which he or she intends to live, work, learn, and/or socialize. The psychiatric rehabilitation goal identifies a specific environment, specific time frames, and is mutually agreed upon by the recipient and the staff.

(19)Psychiatric rehabilitation treatment means therapeutic interventions designed to increase the functioning of a person with psychiatric disabilities so that he or she can succeed in a community environment of living, working, learning and social relationships.

(20)Psychiatric rehabilitation functional and resource assessment is the process by which the recipient and practitioner develop an understanding of the skills the recipient can and cannot perform and the social and environmental resources that are available related to achieving the recipient's psychiatric rehabilitation goals.

(21)Psychiatric rehabilitation readiness determination means an interview and observation process which evaluates rehabilitation readiness based on a recipient's perceived need, motivation, and awareness of the process involved in making a change in his or her life.

(22)Psychiatric rehabilitation service planning is the process of designing and continuously revising an individualized program to assist the patient in obtaining and maintaining a psychiatric rehabilitation goal.

(23)Psychiatric rehabilitation skills and resource development is the process of improving a recipient's use of skills and arranging for or adapting social and environmental resources necessary to achieve a psychiatric rehabilitation goal.

(24)Psychiatric rehabilitation support services are consultation and technical assistance services provided to collaterals, by at least one therapist, with or without recipients. The purpose of this service is to enhance the capacity of the collateral to serve as a resource in assisting the recipient to achieve or maintain his or her psychiatric rehabilitation goal.

(25)Referral means a post-assessment planning activity with the objective of referring or directing an individual to a program providing the appropriate services.

(26)Rehabilitation readiness development is the process of building a recipient's skills to proceed with the rehabilitation goal-setting process. This service might include confidence building activities, self-awareness activities, or trial visits to various environments.

(27)Social training is an activity whose purpose is to assist a child in the acquisition or development of age-appropriate social and interpersonal skills.

(28)Socialization is an activity whose purpose is to develop, improve or maintain a child's capacity for social or recreational involvement by providing age-appropriate opportunities for development, application and practice of social or recreational skills.

(29)Supportive skills training is the development of physical, emotional and intellectual skills needed to cope with mental illness and the performance demands of personal care and community living activities. Such training is provided through direct instruction techniques including explanation, modeling, role playing and social re-inforcement interventions.

(30)Symptom management, as a service for adults, means the development and provision of appropriate skills and techniques specific to the individual recipient's condition to enable him or her to recognize the onset of psychiatric symptoms and engage in activities designed to prevent, manage, or reduce such symptoms.

(31)Symptom management, as a service for children, means a set of skill building interventions, adjunct to verbal therapy.

(32)Task and skill training is a nonvocational activity whose purpose is to enhance a child's age-appropriate skills necessary for functioning in home, school and community settings. Task and skill training activities shall include, but not be limited to, personal care, budgeting, shopping, transportation, use of community resources, time management, and study skills.

(33)Treatment planning is the process of developing, evaluating and revising an individualized course of treatment based on an assessment of the recipient's diagnosis, behavioral strengths and weaknesses, problems, and service needs.

(34)Verbal therapy means providing goal oriented therapy including psychotherapy, behavior therapy, family and group therapy and other face-to-face contacts between staff and recipients designed to address the specific dysfunction of the recipient as identified in his or her treatment plan. As a service in a program serving children with a diagnosis of emotional disturbance, play therapy and expressive art therapy may also be included.

(d)Staffing definitions.

(1)Clinical staff are all staff members who provide services directly to recipients. Students and trainees may qualify if they are participating in a program leading to a degree or certificate appropriate to the goals, objectives and services of the outpatient program and are supervised in accordance with the policies governing the training program and are approved as part of the staffing plan by the Office of Mental Health.

(2)Professional staff are individuals who are qualified by credentials, training and experience to provide supervision and direct service related to the treatment of mental illness and shall include the following:

(i)Credentialed alcoholism and substance abuse counselor is an individual who is currently credentialed by the New York State Office of Alcoholism and Substance Abuse Services in accordance with Part 853 of this Title.

(ii)Creative arts therapist is an individual who is currently licensed as a creative arts therapist by the New York State Education Department or who has a master's degree in a mental health field from a program approved by the New York State Education Department, and registration or certification by the American Art Therapy Association, American Dance Therapy Association, National Association of Music Therapy or American Association for Music Therapy.

(iii)Marriage and family therapist is an individual who is currently licensed as a marriage and family therapist by the New York State Education Department.

(iv)Mental health counselor is an individual who is currently licensed as a mental health counselor by the New York State Education Department.

(v)Nurse practitioner is an individual who is currently certified as a nurse practitioner by the New York State Education Department.

(vi)Occupational therapist is an individual who is currently licensed as an occupational therapist by the New York State Education Department.

(vii)Pastoral counselor is an individual who has a master's degree or equivalent in pastoral counseling or is a Fellow of the American Association of Pastoral Counselors.

(viii)Physician is an individual who is currently licensed as a physician by the New York State Education Department.

(ix)Physician's assistant is an individual who is currently registered as a physician's assistant or a specialist's assistant by the New York State Education Department.

(x)Psychiatrist is an individual who is currently licensed as a physician by the New York State Education Department and who is certified by, or eligible to be certified by, the American Board of Psychiatry and Neurology.

(xi)Psychoanalyst is an individual who is currently licensed as a psychoanalyst by the New York State Education Department.

(xii)Psychologist is an individual who is currently licensed as a psychologist by the New York State Education Department. Individuals who have obtained at least a master's degree in psychology may be considered professional staff for the purposes of calculating professional staff and full time equivalent professional staff but may not be assigned supervisory responsibility.

(xiii)Registered professional nurse is an individual who is currently licensed as a registered professional nurse by the New York State Education Department.

(xiv)Rehabilitation counselor is an individual who has either a master's degree in rehabilitation counseling from a program approved by the New York State Education Department or current certification by the Commission on Rehabilitation Counselor Certification.

(xv)Social worker is an individual who is either currently licensed as a licensed master social worker or as a licensed clinical social worker by the New York State Education Department or has a master's degree in social work from a program approved by the New York State Education Department.

(xvi)Therapeutic recreation specialist is an individual who has either a master's degree in therapeutic recreation from a program approved by the New York State Education Department or registration as a therapeutic recreation specialist by the National Therapeutic Recreation Society.

(3) Other professional disciplines may be included as professional staff with the prior written approval of the Office of Mental Health, when individuals in such disciplines shall have specified training or experience in the treatment of individuals diagnosed with mental illness.

(4)Licensed practitioner means a person defined in paragraph (2) of this subdivision who is licensed by the New York State Education Department.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 587.4

Amended, New York State Register, Volume XXXVI, Issue 22, effective 6/4/2014