N.Y. Comp. Codes R. & Regs. tit. 14 § 580.3

Current through Register Vol. 46, No. 53, December 31, 2024

Section 580.3 - Definitions

For purposes of this Part:

(a)Child, for purposes of this Part, means an individual under 18 years of age.

(b)Collaterals means an individual who is a member of the individual's family, legal guardian or household, or other individual who interacts with the person and is directly affected by or has the capability of affecting their condition and is identified in the individual's treatment plan as having a role in treatment or is necessary for participation in the evaluation and assessment of the recipient prior to admission, including housing providers and shall also include any psychiatric advance directive (PAD).

(c)Commissioner means the Commissioner of Mental Health.

(d)Credentialed Alcoholism and Substance Abuse Counselor (CASAC) means an individual who has a current valid credential issued by the New York State Office of Addiction Services and Supports (OASAS), or a comparable credential, certificate or license from another recognized certifying body as determined by the OASAS.

(e)Individual with Complex Needs shall mean individuals who have one or more of the following:

(1) Demonstrates high utilization of inpatient, crisis, or emergency services, as indicated by:

(i) three or more mental health inpatient hospitalizations in the past year; or

(ii) four or more mental health presentations to an emergency department (ED) or comprehensive psychiatric emergency program (CPEP) in the past year; or

(iii) three or more medical/surgical hospitalizations in the last year and carrying a diagnosis of schizophrenia or bipolar disorder.

(2) Discharge from an office-licensed residential treatment facility (RTF) in the past year.

(3) Discharge from inpatient level of care where the length of stay was greater than 60 days at an office-operated psychiatric center in the past year.

(4) Current enrollment in, or discharge from in the past year, Assertive Community Treatment (ACT), including but not limited to Adult ACT, Youth ACT, Young Adult ACT, Shelter-partnered ACT, Forensic ACT.

(5) Currently receiving services from Critical Time Intervention (CTI), Safe Options Supports (SOS), Pathway Home, Intensive Mobile Treatment (IMT), Home Based Crisis Intervention, or other high-intensity ambulatory services.

(6) Eligible for or current enrollment in Health Home Plus Care Management Services.

(7) Eligible for or current enrollment in High Fidelity Wrap around Care Management in Health Homes Serving Children; eligible for or current enrollment in Children's Home and Community Based Services Waiver for children with Serious Emotional Disturbance (SED)

(8) An active Assertive Outpatient Treatment order or an order that expired in the past year.

(9) Experiencing high-risk social needs, including, but not limited to, current homelessness, criminal or juvenile justice involvement, and child welfare involvement in the past year.

(10) Clinical determination by staff in the licensed program that on presentation the individual has an elevated risk of suicide, violence and/or overdose.

(11) Has a current complexity clinical flag in the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES).

(12) Experiencing other factors that the licensed program determines would significantly interfere with the individual's ability to maintain stability in the community after discharge.

(f)Utilization Review shall mean the review to determine whether health care services that have been provided, are being provided or are proposed to be provided to an individual, whether undertaken prior to, concurrent with or subsequent to the delivery of such services are medically necessary.

(g)Governing Body shall mean a group of people who are legally responsible for establishing and implementing policies related to the operations and management of the facility.

(h)Interventional Therapies shall mean procedural-based treatments that aim to identify and then correct dysfunctional brain circuits, including, but not limited to, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), vagus nerve stimulation (VNS), and transcranial direct current stimulation (tDCS).

(i)Intensive care management shall mean a care management program that provides mobile, community-based support, with duration and frequency of visit meeting client needs. Services are provided in clients home or residence, community settings, health care settings including emergency department, hospital, and primary care settings to support access, engagement, quality, and coordination of care to meet clients' health care and basic needs. Examples of intensive care management include Critical Time Intervention, Assertive Community Treatment, and Health Home Plus services, and other services designated by the office as meeting criteria for intensive care management services.

(j)I-STOP/PMP shall mean Internet System for Tracking Over-Prescribing/Prescription Monitoring Program.

(k)Managed Care (MCO) shall mean an organization certified under article 44 of the Public Health Law or article 43 of the Insurance Law, including organizations certified to provide comprehensive health services plans to individuals eligible for the medical assistance program under title 11 of article 5 of the Social Services Law or child health plus under title 1-A of article 25 of the Public Health Law. For purposes of this section, MCO shall also mean any other insurer or entity authorized to issue health insurance policies or which provides health insurance benefits within or outside the State of New York, or an entity administering benefits on the insurer or entity's behalf, or a plan providing services under title XVIII of the federal Social Security Act, that provides or administers coverage to an individual receiving inpatient treatment in a facility licensed pursuant to this section.

(l)Office means the New York State Office of Mental Health.

(m)On duty, for purposes of this Part, shall include the individual being physically present or on-call and available which includes the ability to come on-site as needed.

(n)Person-centered process shall mean that an individual participates to every extent possible, in the planning of their services and makes choices about the services and supports that they receive.

(o)Psychiatric advance directive shall mean a legal document that details a person's preferences for future mental health treatment decisions and names an individual to make treatment decisions if the person is in a crisis and unable to make decisions.

(p)Psychiatric inpatient unit of a general hospital or unit means any part of a hospital, as defined in article 28 of the Public Health Law, operated for the purpose of providing a program of 24-hour professional care and treatment to persons with mental illness.

(q)PSYCKES shall mean the Psychiatric Services and Clinical Knowledge Enhancement System, a secure, HIPAA-compliant web-based platform developed by OMH for sharing Medicaid billing claims and encounter data, other health-related data, and other data and documents entered by providers and individuals.

(r)Shared decision making shall mean a process whereby staff and the individual work together to select treatments and services based on the individual's preferences, interests, strengths, needs, clinical evidence, and are designed to empower the individual.

(s)SHIN-NY/QE shall mean the Statewide Health Information Network for New York which facilitates the secure electronic exchange of individual health information, connects healthcare professionals statewide and connects New York's qualified entities (QEs) and regional health information organization networks (RHIOs) that store and share individual health information.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 580.3

Amended New York State Register August 17, 2016/Volume XXXVIII, Issue 33, eff. 8/17/2016

Amended New York State Register December 18, 2024/Volume XLVI, Issue 51, eff. 12/18/2024