New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter V - Medical Facilities
Subchapter A - Medical Facilities-minimum Standards
Article 1 - General
Part 404 - INTEGRATED OUTPATIENT SERVICES
Section 404.9 - Integrated Care Services
Universal Citation: 10 NY Comp Codes Rules and Regs ยง 404.9
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Primary Care Services
(1)
General
Principles. Integrated services providers of primary care services
shall effectively meet patient physical health needs by:
(i) providing patient care in a continuous
manner by the same health care practitioner, whenever possible;
(ii) appropriately referring to other health
care facilities or health care practitioners for services not
available;
(iii) identifying,
assessing, reporting and referring cases of suspected or confirmed child abuse
or maltreatment;
(iv) identifying,
assessing, reporting and referring cases of suspected or confirmed domestic
violence;
(v) ensuring that all
staff receive education in the identification, assessment, reporting and
referral of cases of suspected child abuse or maltreatment or domestic
violence; and
(vi) developing a
written plan of treatment which shall be periodically revised, as necessary, in
consultation with other health care professionals.
(2)
Provision of Primary Care
Services
(i) All primary care
services shall be provided in a manner that safely and effectively meets the
needs of the patients served in the integrated care services program.
(ii) Integrated care services programs
delivering primary care services must have sufficient staff and appropriate
equipment to deliver primary care services.
(iii) Integrated services providers
delivering primary care services shall conduct periodic reviews of its
integration of primary care services with behavioral health services as part of
its overall quality assurance program.
(iv) Integrated services providers delivering
primary care services shall assign a medical director to be responsible for the
primary care services.
(v) Primary
care services provided within the specialty of OB/GYN are limited to routine
gynecologic care and family planning provided pursuant to 10 NYCRR Part
753.
(vi) Primary care services
shall not include prenatal care, dental services or ambulatory surgery which
includes any procedure that requires more than minimal sedation or local
anesthesia, unless specifically authorized by the Department of
Health.
(vii) For integrated
services providers providing primary care, practitioners, or their delegate,
shall provide their patient complete and current information concerning his or
her diagnosis, treatment and prognosis in terms the patient can be reasonably
expected to understand, and necessary for the patient to give informed consent
prior to the start of any nonemergency procedure or treatment or both. An
informed consent shall include, at a minimum, the provision of information
concerning the specific procedure or treatment or both, the reasonably
foreseeable risks involved, and alternatives for care or treatment, if any, as
a reasonable medical practitioner under similar circumstances would disclose in
a manner permitting the patient to make a knowledgeable decision. A patient
also may refuse treatment to the extent permitted by law, and if so, shall be
fully informed of the medical consequences of his/her
action.
(b) Mental Health Services
(1)
General
principles.
(a) For adult patients,
integrated services providers of mental health care shall effectively meet
patient mental health care needs by diagnosing and treating an individual's
mental illness, working with the individual in developing a plan of care
designed to minimize symptoms and adverse effects of illness, maximize
wellness, and promote recovery toward the achievement of life goals such as,
but not limited to, education and employment.
(b) For integrated services providers of
mental health care that serve children, effective care includes early
assessment and identification of childhood emotional disturbances, and
engagement of the child and family in the development of a plan of care
designed to minimize the symptoms and adverse effects of illness, maximize
wellness, assist the child in developing a resilient and hopeful approach to
school, family, and community, and maintain the child in his or her natural
environment.
(2)
Provision of Mental Health Services
Integrated services providers of mental health care shall offer each of the following mental health services, to be provided consistent with patients' conditions and needs, and which include:
(i) Outreach;
(ii) Crisis Intervention:
(a) mental health crisis intervention
services must be available 24 hours a day/7 days per week.
(b) after hours coverage may be provided
directly by the integrated services provider or pursuant to a clinical services
contract, as defined in 14 NYCRR§ 599(f), which must require, at a
minimum, that in the event of a crisis, the nature of the crisis and any
measures taken to address such crisis are communicated to the primary care
clinician or other designated clinician involved in the individual's treatment
in the primary care component of the integrated services provider on the next
business day.
(iii)
Psychotropic medication treatment, including injectable psychotropic medication
administration for adult patients;
(iv) Psychotherapy services, including but
not limited to:
(a) Individual
psychotherapy;
(b)
Family/Collateral psychotherapy;
(c) Group psychotherapy; and
(d) Complex Care
Management.
(3)
The following optional services may be offered:
(i) Developmental testing (for children and
adolescents);
(ii) Psychological
testing;
(iii) Psychiatric
consultation; or
(iv) Injectable
Psychotropic medication administration for patients who are
minors.
(4) Integrated
services providers delivering mental health services shall conduct periodic
reviews of the integration of primary care and/or substance use disorder
services as part of its overall quality assurance program.
(c) Substance Use Disorder Services
(1)
General Principles.
Integrated services providers of substance use disorder treatment shall
effectively meet patient substance use disorders needs by diagnosing and
treating an individual's substance use disorders, working with the individual
in developing a plan of care to achieve goals identified in the individual's
treatment plan and promote recovery.
(2)
Provision of Substance Use
Disorder Services. For purposes of this subdivision, the term
"clinical staff" shall mean staff who provide services directly to patients as
prescribed in the treatment plan; including licensed medical staff,
credentialed or licensed staff, non-credentialed staff, non-licensed staff and
student interns.
(3) Integrated
services providers of substance use disorder services shall offer, at a
minimum, each of the following services, to be provided consistent with
patients' conditions and needs:
(i)
Assessments;
(ii) Counseling, which
can be delivered via two distinct methods:
(a) Individual counseling, which is a
face-to-face service between a clinical staff member and a patient focused on
the needs of the patient to be delivered consistent with the treatment/recovery
plan, its development, or emergent issues. Individual counseling must be
provided with a frequency and intensity consistent with the individual needs of
each unique patient, as prescribed by the responsible clinical staff member;
and
(b) Group counseling, which is
a face-to-face service between one or more clinical staff member and multiple
patients at the same time, to be delivered consistent with patient
treatment/recovery plans, their development, or emergent issues. Group
counseling must contain no more than 15 patients in each group counseling
session.
(iii) Education
about, orientation to, and the opportunity for participation in, available and
relevant peer support and mutual assistance groups; and
(iv) Chemical abuse and dependence awareness
and relapse prevention.
(4) An integrated services provider of
substance use disorder services shall:
(i)
promote the achievement and maintenance of recovery from substance use disorder
and abuse;
(ii) improve functioning
and development of necessary recovery management skills so the patient can be
treated in the least intensive environment; and
(iii) develop individualized
treatment/recovery plans to support the achievement and maintenance of recovery
from substance use disorder and abuse, the attainment of economic
self-sufficiency (including, where appropriate, the ability to sustain
long-term productive employment), and improvement of the patient's quality of
life.
(5) Integrated
services providers of substance use disorder services may offer:
(i) Collateral services;
(ii) Complex care coordination;
(iii) Medication administration and
management;
(iv) Outreach;
and
(v) Peer support
services.
(6) Integrated
services providers delivering substance use disorder services shall conduct
periodic reviews of the integration of primary care and/or mental services as
part of its overall quality assurance program.
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