N.Y. Comp. Codes R. & Regs. tit. 14 § 582.3

Current through Register Vol. 46, No. 51, December 18, 2024

Section 582.3 - Definitions

For purposes of this Part.

(a)Abused child in residential care means a child in residential care who:

(1) is subjected to any of the following acts, regardless of whether such act results in injury, when such act is committed by a custodian of the child, is not accidental and does not constitute emergency physical intervention necessary to protect the safety of any person: punched, shaken, cut or bitten;

(ii) the display of a weapon, or other object that could reasonably be perceived by the child as a means for the infliction of pain or injury, in a manner that constitutes a threat of physical pain or injury;

(iii) the use of corporal punishment;

(iv) the withholding of nutrition or hydration as punishment; or

(v) the unlawful administration of any controlled substance as defined by article 33 of the Public Health Law, or any alcoholic beverage, as defined by section 3 of the Alcoholic Beverage Control Law, to the child; or

(2) is inflicted, by other than accidental means, with a reasonably foreseeable injury that causes death or creates a substantial risk of death, serious or protracted disfigurement, serious or protracted impairment of his or her physical, mental or emotional condition, or serious or protracted loss or impairment of the function of any organ; or

(3) is subjected to a reasonably foreseeable and substantial risk of injury, by other than accidental means, which would be likely to cause death, serious or protracted disfigurement, serious or protracted impairment of his or her physical, mental or emotional condition, or serious or protracted loss or impairment of the function of any organ; or

(4) is the victim of any sexual offense, as described in the Penal Law.

(b)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

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

(d)Collaterals means an individual who is a member of the individual's family or household, or other individual who interacts with the individual 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 and/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).

(e)Commissioner means the Commissioner of Mental Health.

(f)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.

(g)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.

(h)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.

(i)Custodian means the director, operator, employee or volunteer of a hospital or a consultant or an employee or volunteer of a corporation, partnership, organization or governmental entity which provides goods or services to the hospital pursuant to a contract or other arrangement that permits such person to have regular and substantial contact with children in residential care, as such term is defined in section 412-a of the Social Services Law.

(j)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.

(k)Hospital means the in-patient services of a freestanding psychiatric facility that has been certified by the Office of Mental Health to provide such services excluding any facility established by article 7 or article 10 of the Mental Hygiene Law.

(l)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).

(m)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 as designated by the office as meeting criteria for Intensive Care Management.

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

(o)Maltreated child means a child under the age of 18 years who is in residential care and identified as a neglected child.

(p)Mental or emotional injury or impairment and impairment of mental or emotional condition, means a substantial diminution of a child's psychological or intellectual functioning which is determined by a physician, psychologist, psychiatric nurse practitioner, licensed clinical or master social worker, or licensed mental health counselor.

(q)Neglected child in residential care means a child who:

(1) experiences an impairment of his or her physical, mental or emotional condition or is subjected to a substantial risk of such impairment because he or she has not received:

(i) adequate food, clothing, shelter, medical, dental, optometric or surgical care, consistent with the rules or regulations of the office, provided that the facility has reasonable access to the provision of such services and that necessary consents to any such medical, dental, optometric or surgical treatment have been sought and obtained from the appropriate individuals;

(ii) access to educational instruction in accordance with the provisions of article 65 of the Education Law; or

(iii) proper supervision or guardianship, consistent with the rules or regulations of the office; or

(2) is inflicted with a physical, mental or emotional injury, excluding a minor injury, by other than accidental means, or is subjected to the risk of a physical, mental or emotional injury, excluding minor injury, by other than accidental means, where such injury or risk of injury was reasonably foreseeable; or

(3) is inflicted with a physical, mental or emotional injury, excluding minor injury, by other than accidental means, or is subjected to the substantial risk of a physical, mental or emotional injury, excluding minor injury, by other than accidental means, as a result of a failure to implement an agreed upon plan of prevention and remediation; or

(4) is subjected to the intentional administration of any prescription or non-prescription drug other than in substantial compliance with a prescription or order issued for the child by a licensed, qualified health care practitioner.

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

(s)Physical injury or impairment and impairment of physical condition, means any confirmed harm, hurt, or damage resulting in a significant worsening or diminution of the child's condition.

(t)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.

(u)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.

(v)Psychiatric advance directive (PAD) 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.

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

(x)Residential care means care provided to a child in a hospital, as such term is defined in this section.

(y)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.

(z)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 § 582.3

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