N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 511-2.7

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

Section 511-2.7 - Program Operations

(a) Admission

(1) To be eligible for admission to the CMHRS program, an individual must meet medical necessity criteria as outlined in the Medicaid State Plan Children and Family Treatment and Support Services Provider Manual for Children's Behavioral Health Early and Periodic Screening and Diagnostic Treatment (EPSDT) Services. Such criteria require that the individual be:

(i) under the age of 21;

(ii) exhibiting symptoms of mental illness or have a mental health diagnosis consistent or corresponding with the current edition of the DSM; and

(iii) recommended for admission by a licensed practitioner of the healing arts (LPHA).

(2) Upon a decision to admit a child to a CMHRS program, documentation shall be written to include the following:

(i) recommendation for service(s) from a LPHA that is signed and dated and includes an explanation of the medical necessity for the service based on a assessment of needs;

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

(iii) admission diagnosis, if applicable; and

(iv) signature of a CMHRS staff.

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

(i) the reason for not admitting the individual;

(ii) any referrals made to other programs or services; and

(iii) notification to the referral source or recommending LPHA of the determination no to admit and of any referrals made to other programs or services.

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

(5) The program's admission process, including any criteria governing participation in the program, shall be clearly described and available for review by the child, their family or other collaterals.

(6) 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 a child under a court order issued pursuant to section 9.60 of the Mental Hygiene Law.

(b) Staffing

(1) A provider of service shall continuously have an adequate number and appropriate mix of staff to carry out the objectives and to assure the outcomes of the program. The provider shall have a staffing plan with the appropriate qualified staff to meet the needs of population served.

(2) Agency must maintain documentation of staff qualifications, including training, clinical experience with children diagnosed with or experiencing symptoms of a mental health disorder.

(3) Agency must provide regular supervision. Such supervision shall address quality of care provided and ongoing staff development.

(4) Agency must maintain an adequate and appropriate number of qualified staff in proportion to the number of children served.

(5) Staffing shall be provided in accordance with required qualifications outlined in the Medicaid State Plan Children and Family Treatment and Support Services Provider Manual for Children's Behavioral Health Early and Periodic Screening and Diagnostic Treatment (EPSDT) Services.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 511-2.7

Adopted New York State Register July 17, 2019/Volume XLI, Issue 29, eff. 7/17/2019