reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.5 - Service Categories and Requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) CMHRS programs shall be responsible for
				  assuring the delivery of the following services for children deemed eligible
				  for receipt: Other Licensed Practitioner, Community Psychiatric Supports and
				  Treatment, Psychosocial Rehabilitation, Family Peer Support Services, and Youth
				  Peer Support and Training.
(b) Each
				  of the following services must be offered directly by CMHRS programs:
(1)
Other Licensed Practitioner
				  (OLP)
services are clinical services provided by Non-Physician
				  Licensed Behavioral Health Practitioners (NP-LBHP) as defined in this Part. OLP
				  services include assessment, treatment planning, psychotherapy and crisis
				  intervention activities to address symptoms of mental illness in children for
				  whom disorders have not yet been diagnosed, as well as for children with an
				  existing diagnosis. OLP services, including assessment and treatment planning
				  for the provision of psychotherapy, may be provided independently by any
				  NP-LBHP authorized by New York State law to provide psychotherapy.
(2)
Community Psychiatric Support and
				  Treatment (CPST)
services are goal-directed supports and
				  solution-focused interventions intended to achieve identified goals or
				  objectives as set forth in a treatment plan. CPST is designed to provide
				  community-based services to children/youth and families who may have difficulty
				  engaging in formal office settings, but can benefit from community based
				  rehabilitative services. CPST is a comprehensive service that is supportive in
				  nature in order to educate and assist families regarding mental health
				  challenges and barriers, and includes Intensive Interventions, Crisis
				  Avoidance, Intermediate Term Crisis Management, Strengths-Based Service
				  Planning, Rehabilitative Psychoeducation, and Rehabilitative
				  Supports.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.6 - Certification

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A provider of
				  service intending to operate a CMHRS program must obtain an initial operating
				  certificate issued by the Office in accordance with this Part. Renewals of such
				  operating certificates shall be issued for terms of up to three years.
(b) Designated providers of FPSS,
				  YPST and PSR who are not providing OLP and CPST do not require licensure under
				  this Part.
(c) Each CMHRS program
				  shall be authorized by an operating certificate. In addition, if a program is
				  operating from multiple sites, each site shall be authorized by a discrete
				  operating certificate. For each site, the operating certificate shall specify:
(1) the CMHRS services to be
				  provided;
(2) the location of the
				  program's site;
(3) the hours of
				  operation of the program;
(4) the
				  program's capacity; and
(5) the
				  term of the operating certificate.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.7 - Program Operations

Current through Register Vol. 46, No. 28, July 10, 2024
(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).
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.8 - Treatment Planning

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Treatment planning shall be an ongoing and individualized process to ensure the
				  services included within the treatment plan are medically necessary and to
				  track the child's progress towards stated goals and objectives. The treatment
				  plan shall be developed and updated in collaboration with the child and family
				  in accordance with and individualized to the unique needs, goals and
				  preferences of the child and the child's family.
(b) The treatment plan for a child shall be
				  developed by the CMHRS program. For any rehabilitative service(s) provided
				  pursuant to formal agreement with a designated provider, the development and
				  ongoing review of the treatment plan shall include regular collaboration and
				  coordination in accordance with protocols and procedures outlined in such
				  agreement.
(c) The treatment plan
				  shall include identification and documentation of the following:
(1) The child's mental health diagnosis or
				  symptoms of a mental illness exhibited by the child; or a notation that the
				  diagnosis may be found in a specific assessment document in the child's case
				  record;
(2) The child's needs and
				  strengths;
(3) The child's
				  treatment goals and objectives and the specific services, service components or
				  activities necessary to accomplish those goals and objectives, as well as their
				  projected frequency and duration;
(4) The name and title of the staff providing
				  the specific services; and
(5)
				  Criteria for determining when the child should be discharged from the
				  services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.9 - Case Records

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The CMHRS
				  Program shall maintain a case record for each child admitted and receiving
				  CMHRS services provided directly and/ or pursuant to formal agreement with a
				  designated provider. In the case of agreements between a CMHRS program and
				  designated provider, the designated provider may also maintain a separate case
				  record for the purposes of quality assurance, monitoring and billing.
(b) The CMHRS program shall ensure proper
				  exchange of information between providers to facilitate coordination of
				  care.
(c) There shall be a complete
				  case record maintained for each child admitted to the program. Such case record
				  shall be maintained in accordance with recognized and acceptable principles of
				  recordkeeping as follows:
(1) Case record
				  entries shall be legible and non-erasable;
(2) Electronic records which use accepted
				  mechanisms for clinician signatures and are maintained in a secure manner, may
				  be utilized. Such records may be kept in lieu of a hard copy case
				  record;
(3) Case records shall be
				  periodically reviewed for quality and completeness; and
(4) All entries in case records shall be
				  dated and signed by appropriate staff.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.12 - Medicaid Reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
Reimbursement for children's behavioral health and health
					 services must be in accordance with the rates established by the Department of
					 Health and approved by the Director of the Division of Budget. The rates can be
					 found on the New York State Department of Health website.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.13 - Premises

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The CMHRS
				  program may deliver services in the home, community-based or other site-based
				  settings when appropriate, in order to provide for individualized service
				  delivery consistent with the child's conditions and needs.
(b) The CMHRS program shall provide services
				  in settings that are adequate and appropriate in accordance with the following:
(1) All CMHRS programs shall allocate
				  adequate space for the number of persons served by the program when provided on
				  site.
(2) All CMHRS programs shall
				  provide for sufficient types and arrangements of spaces to provide individual
				  and group activities consistent with the program's capacity and purpose.
(i) All CMHRS shall provide for controlled
				  access to and maintenance of records.
(ii) All CMHRS programs shall provide for
				  appropriate furnishings and equipment consistent with the purpose of the
				  program.
(3) All CMHRS
				  programs shall provide services in settings that are conducive to meeting
				  treatment goals/objectives, accommodating to the child's conditions and needs,
				  safe and accessible for the child and staff, and assure privacy for the
				  delivery of services.
(4) The
				  provider of service shall possess a Certificate of Occupancy in accordance with
				  the Building Code of New York State and the Property Maintenance Code of New
				  York State (19 NYCRR Chapter XXXIII, Subchapter A, Parts 1221 and 1226) or
				  comparable local codes.
(5) The
				  provider of service shall consider the use of appropriate features and
				  equipment that enable the accessibility of persons with physical disabilities,
				  consistent with the population being served by the program.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.14 - Quality Improvement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				  provider of service shall have an organized quality assurance program designed
				  to enhance individual care through the ongoing objective assessment of
				  important aspects of the child's care and the correction of identified
				  problems. The quality assurance program shall provide for the following:
(1) identification of problems or concerns
				  related to the care of individuals including, but not limited to, compliance
				  with the treatment plan;
(2)
				  objective assessment of the cause and scope of the problems or concerns,
				  including the determination of priorities for both investigating and resolving
				  problems and concerns. Priorities shall be related to the degree of adverse
				  impact on the care provided to individuals that can be expected if the problems
				  or concerns remain unresolved;
(3)
				  recommendations related to implementation of decisions or actions that are
				  designed to eliminate, insofar as possible, identified problems; and
(4) monitoring to assess whether or not the
				  desired result has been achieved and sustained.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.15 - Local Planning

Current through Register Vol. 46, No. 28, July 10, 2024
The provider of service shall participate as required with
					 the local governmental unit in local planning processes pursuant to sections 41.05 and
					 41.16  of
					 the Mental Hygiene Law.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 511 - Early Periodic Screening, Diagnostic and Treatment Services for Children › Subpart 511-2 - Children's Mental Health Rehabilitation Services Program › Section 511-2.16 - Audit

Current through Register Vol. 46, No. 28, July 10, 2024
In programs, which are not operated by State or local
					 government, there shall be an annual audit, pursuant to a format prescribed by
					 the Office of Mental Health, of the financial condition and accounts of the
					 program performed by a certified public accountant who is not a member of the
					 governing body or an employee of the program. Government-operated programs
					 shall comply with applicable laws concerning financial accounts and auditing
					 requirements.
Incorporation by reference.The provisions of 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
which have been incorporated
					 by reference in this Part, have been filed in the Office of the Secretary of
					 State of the State of New York, the publication so filed being the document
					 entitled:
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
, published in June
					 2018, and any subsequent updates. This document incorporated by reference may
					 be examined at the Office of the Department of State, 99 Washington Avenue,
					 Albany, NY 12231 or obtained from the Office of Mental Health Records Access
					 Officer, 44 Holland Avenue, Albany, NY 12229.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.1 - Background and intent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
				establishes certification standards for personalized recovery-oriented services
				(PROS) programs. The purpose of PROS programs is to assist individuals in
				recovering from the disabling effects of mental illness.
(b) The Office of Mental Health shall issue
				operating certificates to programs that meet the standards set forth in this
				Part. Certification in and of itself does not confer eligibility to receive
				financial support from any governmental source. In order to qualify for
				reimbursement under the medical assistance program, PROS programs must comply
				with the standards specified in section
				512.11  of
				this Part.
(c) In order to be
				eligible for payments pursuant to title 11 of article 5 of the Social Services
				Law, a PROS program must be certified to provide services by the Office of
				Mental Health in addition to meeting the requirements of title XIX of the
				Social Security Act.
(d) This Part
				establishes rates of payment made by government agencies pursuant to title 11
				of article 5 of the Social Services Law for the participation of individuals in
				an eligible PROS program.
(e) The
				rates of payment established pursuant to this Part are intended to be adequate
				to meet the costs of an efficiently and economically operated
				program.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.2 - Legal base

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Sections 7.09 (b) and
				31.04 (a)  of the Mental
				Hygiene Law give the commissioner the power and responsibility to plan,
				establish and evaluate programs and services for the benefit of individuals
				with mental illness, and to adopt regulations that are necessary and proper to
				implement matters under his or her jurisdiction.
(b) Section 41.05  of the Mental Hygiene Law provides
				that a local governmental unit shall direct and administer a local
				comprehensive planning process for its geographic area in which all providers
				of service shall participate and cooperate through the development of
				integrated systems of care and treatment for people with mental
				illness.
(c) Subdivision (a) of
				section 43.02  of the Mental Hygiene Law provides
				that payments under the Medical Assistance Program for programs approved by the
				Office of Mental Health shall be at rates certified by the Commissioner of
				Mental Health and approved by the Director of the Division of the
				Budget.
(d) Subdivision (b) of
				section 43.02  of the Mental Hygiene Law gives the
				commissioner authority to request from operators of facilities certified by the
				Office of Mental Health such financial, statistical and program information as
				the commissioner may determine to be necessary.
(e) Subdivision (c) of section 43.02  of the Mental Hygiene Law gives the
				Commissioner of Mental Health the authority to adopt rules and regulations
				relating to methodologies used in establishment of schedules of rates for
				payment.
(f) Sections 364 (3) and
				364-a (1)  of the Social
				Services Law give the Office of Mental Health responsibility for establishing
				and maintaining standards for medical care and services in facilities under its
				jurisdiction, in accordance with cooperative arrangements with the Department
				of Health.
(g) Section 365-m  of the Social Services Law
				authorizes the Commissioner of the Office of Mental Health and the Commissioner
				of the Office of Alcoholism and Substance Abuse Services, in consultation with
				the Department of Health, to contract with regional behavioral health
				organizations to provide administrative and management services for the
				provision of behavioral health services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.3 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall apply to any provider of service that has
				  been certified to operate or proposes to operate a PROS program that must be
				  certified by the Office of Mental Health.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.4 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Admission date
				is the day that the PROS program completes and submits a PROS registration form
				on behalf of a PROS participant, using the registration system approved by the
				office.
(b) Adult means an
				individual 18 years of age or older.
(c) 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.
(d) Capacity means the
				maximum number of people to whom a PROS program can provide services at any
				given time.
(e) Carved-out services
				means those special care services that are not included in the benefit package
				of a managed care provider, for all managed care enrollees, regardless of aid
				category.
(f) Clinical staff means
				all staff members, including any recipient employees, who provide services
				directly to individuals admitted to PROS programs or their collaterals.
				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 PROS program, 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.
(g)
				Collateral means a person who is:
(1) a
				significant other or member of the PROS participant's family or household,
				academic, workplace or residential setting, who regularly interacts with the
				individual and is directly affected by, or has the capability of affecting, his
				or her condition; and
(2)
				identified in the individualized recovery plan, and approved by the individual,
				as having a role in services and/or is identified in the pre-admission notes as
				being necessary for participation in the evaluation and assessment of the
				individual prior to admission; and
(3) not a staff member of the PROS program or
				any other mental health service provider except when the staff member is
				participating in services in his or her role as the recipient's collateral, and
				not in his or her staff member role.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.6 - Certification

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A provider of
				service intending to operate a PROS program must obtain an initial operating
				certificate issued by the office in accordance with Part 551 of this Title.
				Renewals of such operating certificates shall be issued for terms of up to
				three years.
(b) PROS programs
				shall be licensed as one of the following program types:
(1) comprehensive PROS:
(i) with clinical treatment; or
(ii) without clinical treatment; or
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.7 - Program operations

Current through Register Vol. 46, No. 28, July 10, 2024
(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.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.8 - Documentation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Case records.
(1) There shall be a complete case record
				maintained for each person admitted to a PROS program. Such case record shall
				be maintained in accordance with recognized and acceptable principles of
				recordkeeping as follows:
(i) any case record
				entries shall be legible and non-erasable;
(ii) case records shall be periodically
				reviewed for quality and completeness; and
(iii) all entries in case records shall be
				dated and signed by appropriate staff.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.10 - Rights of pros participants

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				Individuals participating in a PROS program certified pursuant to this Part are
				entitled to the rights defined in this subdivision. A provider of service shall
				be responsible for the protection of these rights.
(1) Individuals participating in a PROS
				program have the right to an individualized recovery plan and to participate to
				the fullest extent consistent with his or her capacity in the establishment and
				revision of that plan.
(2)
				Individuals have the right to a full explanation of the services provided in
				accordance with their IRP.
(3)
				Participation in a PROS program is voluntary and individuals are presumed to
				have the capacity to consent to such participation. The right to participate
				voluntarily in and to consent to participation in a PROS program shall be
				limited only pursuant to a court order in accordance with applicable provisions
				of law.
(4) The confidentiality of
				individuals' clinical records shall be maintained in accordance with section 33.13  of the Mental Hygiene Law and
				applicable Federal law and regulations.
(5) PROS participants and other qualified
				persons shall be assured access to their clinical records consistent with
				section 33.16  of the Mental Hygiene Law and
				applicable Federal law and regulations.
(6) Individuals have the right to receive
				clinically appropriate care and treatment that is suited to their needs and
				skillfully, safely and humanely administered with full respect for their
				dignity and personal integrity.
(7)
				Individuals have the right to receive services in a non-discriminatory manner,
				and to be treated in a way that acknowledges and respects their cultural
				environment.
(8) Individuals have
				the right to a maximum amount of privacy consistent with the effective delivery
				of services.
(9) Individuals have
				the right to freedom from abuse and mistreatment by staff.
(10) Individuals have the right to be
				informed of the provider's grievance policies and procedures, and to initiate
				any questions, complaints or objections accordingly.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.11 - Medicaid reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				General reimbursement requirements for PROS providers.
(1) Reimbursement shall be made only for
				individuals who:
(i) are in pre-admission
				status pursuant to section
				512.7(c)(4) 
				of this Part;
(ii) are registered
				in a PROS program pursuant to section
				512.7(c)(13) 
				of this Part; or
(iii) are
				collaterals of persons who are registered in a PROS program, or are in
				pre-admission status.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.12 - Rates of payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Rates of
				payment shall be established on a prospective basis.
(b) Each rate of payment established pursuant
				to this section shall be a monthly rate determined by the commissioner and
				approved by the Division of the Budget.
(c) For purposes of this section, the
				Downstate Region shall mean the following counties: Bronx, Kings, New York,
				Queens, Richmond, Nassau, Putnam, Rockland, Suffolk and Westchester.
(d) For purposes of this section, the Upstate
				Region shall mean those counties of New York State that are not listed in
				subdivision (c) of this section.
(e) Effective April 1, 2015, the monthly base
				rate and component add-on schedules for PROS programs are as follows:
(1) Comprehensive PROS programs:
(i) for programs operated in the Downstate
				Region:
Monthly Base Rate*
Component Add-On
Pre-Adm
Level 1
Level 2
Level 3
Level 4
Level 5
IR
ORS
CT
2-12 Units
13-27 Units
28-43 Units
44-60 Units
61+ Units
$153.37
$235.57
$554.35
$790.93
$868.11
$1,000.44
$415.39
$355.88
$279.68
(ii)
				for programs operated in the Upstate Region:
Monthly Base Rate*
Component Add-On
Pre-Adm
Level 1
Level 2
Level 3
Level 4
Level 5
IR
ORS
CT
2-12 Units
13-27 Units
28-43 Units
44-60 Units
61+ Units
$140.35
$214.53
$504.24
$719.77
$787.94
$910.24
$377.55
$324.80
$254.63
* The Monthly Base Rate is determined by the total PROS units
				  associated with a single PROS participant and his or her collateral(s) in a
				  given month.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.13 - Premises

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The provider of
				service shall maintain premises that are adequate and appropriate for the safe
				and effective operation of a PROS program in accordance with the following:
(1) A PROS program shall allocate adequate
				space for the number of persons served by the program.
(2) All PROS programs shall provide for
				sufficient types and arrangements of spaces to provide individual and group
				activities consistent with the program's capacity and purpose.
(3) All comprehensive PROS programs offering
				clinical treatment shall provide for controlled access to and maintenance of
				medication and supplies in accordance with applicable Federal and State laws
				and regulations.
(4) All PROS
				programs shall provide for controlled access to and maintenance of
				records.
(5) All PROS programs
				shall provide for appropriate furnishings and equipment consistent with the
				purpose of the program.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.14 - Quality improvement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				provider of service shall establish a process to collect and analyze data on
				program and individual outcomes. A process shall be established for the routine
				use of such data for decision-making purposes. In association with the
				achievement of individual outcomes and reviews of related processes, providers
				of service are encouraged to use evidence-based practices.
(b) The office, in conjunction with local
				governmental units, will develop a plan regarding oversight and evaluation
				criteria for PROS programs, including the development of performance
				indicators.
(1) Each local governmental unit
				shall decide the level of its participation in the oversight and evaluation of
				PROS programs. Such participation shall include the execution of signed
				agreements between the local governmental unit and each PROS program in the
				geographic area served by the local governmental unit. Such provider agreements
				may include performance indicators specified by the local governmental unit and
				approved by the office.
(2) If the
				local governmental unit and the PROS provider are unable to execute an
				agreement in accordance with paragraph (1) of this subdivision, the office
				shall review the situation and, if warranted, may execute an agreement directly
				with the PROS provider. If the office determines that such an agreement will be
				executed, it will so notify the local governmental unit.
(3) In the event that the PROS program is
				operated by the local governmental unit, the PROS program shall execute a
				provider agreement with the office.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.15 - Waivers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Requirements
				for psychiatric coverage associated with comprehensive PROS programs with
				clinical treatment may be waived under the following circumstances:
(1) the office, in consultation with the
				local governmental unit, may approve the use of a physician in lieu of a
				psychiatrist in circumstances where the PROS program can demonstrate that a
				psychiatrist is unavailable to meet the requirement. Such physician shall have
				specialized training or experience in the treatment of mental illness;
				or
(2) if the requirements of
				paragraph (1) of this subdivision cannot be met, the office, in consultation
				with the local governmental unit, may approve a plan for the provision of an
				equivalent level of care which shall include, but not be limited to, a
				physician who does not have specialized training or experience in the treatment
				of persons with mental illness and at least a licensed psychologist, nurse
				practitioner, registered professional nurse or licensed social worker who is
				experienced in the treatment of adults with a diagnosis of mental
				illness.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.16 - Transition to part 512

Current through Register Vol. 46, No. 28, July 10, 2024
(a) PROS
				programs shall be implemented in accordance with a schedule established by the
				Office of Mental Health, in consultation with the local governmental
				unit.
(b) Outpatient providers
				which are certified as a continuing day treatment or intensive psychiatric
				rehabilitation treatment program pursuant to Part 587 of this Title, and are
				obtaining certification pursuant to this Part, may continue to operate pursuant
				to the requirements of Part 587 until four months after the effective date of
				the PROS provider's initial operating certificate issued pursuant to Part 551
				of this Title. Notwithstanding this transition period, applicable co-enrollment
				reimbursement limitations pursuant to section
				512.11(f) 
				of this Part shall become effective upon the effective date of the PROS
				provider's initial operating certificate issued pursuant to Part 551 of this
				Title. In accordance with the licensure category under which individual
				reimbursement claims are submitted, providers shall adhere to the applicable
				documentation and service requirements of either this Part, or Parts 587 and
				588 of this Title.
(c) Until such
				time as the PROS registration system can be used to enforce the co-enrollment
				limitations established pursuant to this Part, the provisions of section
				512.11(g) 
				of this Part, as they relate to the recovery of Medicaid, shall not become
				effective until three months after the effective date of the PROS provider's
				initial operating certificate issued pursuant to Part 551 of this Title.
				Notwithstanding this exception, co-enrollment limitations as they pertain to
				multiple providers operated by the same sponsor shall become effective upon the
				effective date of the PROS provider's initial operating certificate issued
				pursuant to Part 551 of this Title.
(d) To allow a period of adjustment to the
				professional staffing requirements established pursuant to this Part, staff
				employed by a provider at the time of its application for an operating
				certificate pursuant to Part 551 of this Title shall be deemed to have met the
				requirements of section
				512.7(d)(2) 
				of this Part, during the provider's first 18 months of operation, subject to
				the following conditions:
(1) such staffing
				plan shall be described in the application for an operating certificate
				pursuant to Part 551 of this Title;
(2) programs must employ at least one
				full-time professional staff member; and
(3) when a staff member included in the
				staffing plan pursuant to paragraph (1) of this subdivision leaves the
				provider's employment, he or she shall be replaced with an individual who will
				bring the program closer to compliance with section
				512.7(d) 
				of this Part.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.17 - Enforcement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A provider of
				service shall exercise due diligence in complying with the requirements of this
				Part.
(b) The office shall review
				the program and practices of the provider of service in order to facilitate
				determinations as to whether providers are exercising the requisite due
				diligence and are otherwise in compliance with this Part.
(c) If, based on a review of the program and
				practices of a provider of service, the office determines that a provider of
				service is not exercising due diligence in complying with the requirements of
				this Part, the office shall give notice of the deficiency to the provider of
				service and may also initiate the following:
(1) request that the provider of service
				prepare a plan of correction, which plan shall be subject to approval by the
				office; and
(2) provide such
				technical assistance as the office deems necessary to assist the provider of
				service in developing and implementing an appropriate plan of
				correction.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.18 - Audits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each provider
				of services shall comply with Part 552 of this Title--audits of Office of
				Mental Health licensed or operated facilities, programs or units, which
				established standards for the administration of audits.
(b) Providers of service shall cooperate
				during the performance of audits conducted by the New York State Department of
				Health, and shall provide access to any such records and reports
				requested.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.19 - Behavioral health organizations

Current through Register Vol. 46, No. 28, July 10, 2024
Providers shall cooperate with the designated regional
				  behavioral health organizations and shall be authorized pursuant to section 33.13 (d)  of the Mental
				  Hygiene Law to exchange clinical information concerning clients with such
				  organizations. Information so exchanged shall be limited to the minimum
				  necessary in light of the reason for the disclosure. Such information shall be
				  kept confidential and any limitations on the release of such information
				  imposed on the party giving such information shall apply to the party receiving
				  such information.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 512 - Personalized Recovery Oriented Services › Section 512.20 - Target population services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Individuals who
				are target population members as defined in Section
				512.4  of
				this Part must meet the standard eligibility criteria for enroll- ment in PROS
				in accordance with Section
				512.7  of this
				Part.
(b) Effective April 1, 2014,
				the following additional provisions shall apply to PROS providers that are
				providing services to target population members.
(1) Reimbursement for services to target
				population members who are in continuous pre-admission status is limited to
				four consecutive months, whether or not the individual is ultimately admitted
				to the program. Programs will be reimbursed for pre-admission services for
				target population members at the existing pre-admission rate plus 25
				percent.
(2) Medicaid may reimburse
				the Intensive Rehabilitation (IR) component add-on for up to 50 percent of a
				provider's total number of monthly base rate bills submitted annually. IR
				services provided to target population members shall not count toward the 50
				percent limitation for Medicaid reimbursement.
(3) The following Community Rehabilitation
				and Support (CRS) services will offer an enhanced reimbursement when delivered
				off site, on separate days, to target population members:
(i) Basic skills living training;
(ii) Benefits and financial
				management;
(iii) Community living
				exploration;
(iv) Information and
				education regarding self help; and
(v) Wellness self management.
(4) If two or three of the
				identified CRS services are delivered off site to target population members in
				a calendar month, programs will be reimbursed at the base rate plus $135.33
				(upstate) or $150.37 (downstate), effective April 1, 2015. If four or more of
				the identified CRS services are delivered off site to target population members
				in a calendar month, programs will be reimbursed at the base rate plus $270.67
				(upstate) or $300.73 (downstate), effective April 1, 2015.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 513 - Limits On Administrative Expenses And Executive Compensation › Section 513.1 - Background and intent

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of this Part is to implement Executive Order No.
				  38, issued by Governor Andrew Cuomo on January 18, 2012, by exercising the
				  authority of the Commissioner of the Office of Mental Health to issue
				  regulations governing the use of State funds and State-authorized payments in
				  connection with providing program services to members of the public. E.O. No.
				  38 provides for a limit on administrative expenses and executive compensation
				  of providers of program services in order to meet the State's ongoing
				  obligation to ensure the proper use of taxpayer dollars and the most effective
				  provision of such services to the public.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 513 - Limits On Administrative Expenses And Executive Compensation › Section 513.3 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part:
(a) Administrative expenses are those
				expenses authorized and allowable pursuant to applicable agency regulations,
				contracts or other rules that govern reimbursement with State funds or
				State-authorized payments that are incurred in connection with the covered
				provider's overall management and necessary overhead that cannot be attributed
				directly to the provision of program services.
(1) Such expenses include but are not limited
				to the following expenses, if otherwise authorized and allowable pursuant to
				applicable agency regulations, contracts or other rules that govern
				reimbursement with State funds or State-authorized payments:
(i) that portion of the salaries and benefits
				of staff performing administrative and coordination functions that cannot be
				attributed to particular program services, including but not limited to the
				executive director or chief executive officer, financial officers such as the
				chief financial officer or controller and accounting personnel, billing,
				claiming or accounts payable and receivable personnel, human resources
				personnel, public relations personnel, administrative office support personnel,
				and information technology personnel, where such expenses cannot be attributed
				directly to the provision of program services;
(ii) that portion of legal expenses that
				cannot be attributed directly to the provision of program services;
				and
(iii) that portion of expenses
				for office operations that cannot be attributed directly to the provision of
				program services, including telephones, computer systems and networks,
				professional and organizational dues, licenses, permits, subscriptions,
				publications, audit services, postage, office supplies, conference expenses,
				publicity and annual reports, insurance premiums, interest charges and
				equipment that is expensed (rather than depreciated) in cost reports, where
				such expenses cannot be attributed directly to the provision of program
				services.
New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 513 - Limits On Administrative Expenses And Executive Compensation › Section 513.5 - Limits on executive compensation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Limits on executive compensation. Except
				if a covered provider has obtained a waiver pursuant to section
				513.6  of this
				Part, a covered provider as defined in this regulation shall not use State
				funds or State-authorized payments for executive compensation given directly or
				indirectly to a covered executive in an amount greater than $199,000 per annum,
				provided, however, that the office shall review this figure annually to
				determine whether adjustment is necessary based on appropriate factors and
				subject to the approval of the Director of the Division of the Budget.
				Commencing on July 1, 2013, the limits on executive compensation pursuant to
				this Part shall be effective and applicable to each covered provider on the
				first day of each covered provider's respective covered reporting
				period.
(b) Except if a covered
				provider has obtained a waiver pursuant to section
				513.6  of this
				Part, where a covered provider's executive compensation given to a covered
				executive is greater than $199,000 per annum (including not only State funds
				and State-authorized payments but also any other sources of funding), and
				either:
(1) greater than the 75th percentile
				of that compensation provided to comparable executives in other providers of
				the same size and within the same program service sector and the same or
				comparable geographic area as established by a compensation survey identified,
				provided, or recognized by the office and the Director of the Division of the
				Budget; or
(2) was not reviewed and
				approved by the covered provider's board of directors or equivalent governing
				body (if such a board or body exists) including at least two independent
				directors or voting members (or, where a duly authorized compensation committee
				including at least two independent directors or voting members conducted such
				review on behalf of the full board, such actions were not reviewed and ratified
				by such board), or such review did not include an assessment of appropriate
				comparability data;
then such covered provider shall be subject to the penalties
				  set forth in section
				  513.8  of
				  this Part. To determine whether a covered provider may be subject to penalties,
				  such provider shall provide, upon request by the office or its designee,
				  contemporaneous documentation in a form and level of detail sufficient to allow
				  such determination to be made.