Current through Register Vol. 46, No. 39, September 25, 2024
(a) Eligibility of an individual to receive
services of the community support services program shall be certified by a
nurse, psychiatrist, psychologist or social worker as defined in section
575.4 of
this Part.
(b) Eligibility of an
individual to receive services of the community support services program shall
be determined in accordance with the following criteria:
(1) the individual is at least 18 years of
age; and
(2) is functionally
disabled as a result of mental illness as defined in section
575.4 of
this Part; and
(3) is in serious
jeopardy to remain in the community without the provision of community support
services; and
(4) meets one of the
permanent criteria of subdivision (c) of this section; or
(5) meets one of the categorical criteria of
subdivision (d) of this section.
(c) Permanent eligibility to receive services
of the community support services program shall be determined when an
individual meets at least one of the following criteria:
(1) one consecutive six-month stay in an
inpatient psychiatric facility. For purposes of calculating six consecutive
months, the following time periods shall not be considered an interruption of
the continuous period:
(i) discharge and
return to inpatient status within 48 hours;
(ii) placement in a family care home and
return to an inpatient unit within 30 days;
(iii) return from leave without consent or
escape within 72 hours; or
(iv) a
maximum of 30 days of leave status within the six months of continuous
inpatient hospitalization.
(2) Two psychiatric inpatient stays of any
length during the preceding two years in an inpatient psychiatric facility. For
purposes of counting two admissions of any length within the past two years,
the following criteria shall apply:
(i) the
individual was an inpatient on the date 24 months prior to receiving community
support services. Such admission associated with that inpatient stay shall be
counted as one of the two needed to establish eligibility; and
(ii) the individual returns to an inpatient
psychiatric facility from a family care home after 30 days from the initial
date of placement, excluding returns to medical/-surgical units. Such return to
an inpatient psychiatric facility shall be counted as one admission;
(3) three or more admissions to an
Office of Mental Health operated or licensed outpatient program or a forensic
satellite unit operated by the Office of Mental Health within the preceding 18
months; or three or more contacts with crisis or emergency mental health
services within the preceding 18 months; or a combination of three or more
admissions or contacts within the preceding 18 months. For purposes of counting
three or more admissions or contacts, the following criteria shall apply:
(i) each admission or contact shall be a
result of a separate episode or acute symptomatology of a mental
illness;
(ii) no more than two
admissions or two contacts or a combination of one admission and one contact
shall be considered within any three-month period;
(iii) if the individual were receiving
outpatient services on the date 18 months prior to receiving community support
services, the admission associated with that commencement of services may be
counted as one of the three admissions necessary to establish
eligibility;
(iv) if contact with
crisis or emergency mental health services results in an admission to a
certified mental health program, the contact and admission shall be counted as
only one of the three necessary to establish eligibility;
(v) for purposes of this section, the term
admission shall mean a provider of services has conducted a face-to-face
evaluation and assessment of the need for services of an individual who is not
on its active caseload, that the provider of services has accepted such
individual for treatment, and that a treatment plan has been developed for such
individual in accordance with Part 585 of this Title; and
(vi) for purposes of this section, the term
contact shall mean the receipt of crisis or emergency services which must
include a face-to-face evaluation, an assessment of the need for services, and
a referral to a program certified in accordance with Part 585 of this Title for
appropriate mental health services;
(4) receipt of Supplemental Security Income
(SSI) or Social Security Disability Insurance (SSDI) benefits. Such individuals
must have been initially determined to be eligible for such benefits prior to
65 years of age;
(5) a six-month
consecutive residency in a qualified residence;
(6) a six-month consecutive residency in a
designated adult home;
(7) receipt
of services from on outpatient program licensed or operated by the Office of
Mental Health by an individual whose eligibility has been waived. Such
individual shall have participated in the program at least once in each quarter
of the immediate past 12 months, such participation beginning April 1, 1987;
and
(8) an individual determined to
be eligible for community support services based upon a prior history of
psychiatric inpatient hospitalization during the immediate past 12 months. Such
individuals may be eligible for permanent status pursuant to this subdivision
beginning April 1, 1988.
(d) Categorical eligibility to receive
services of the community support services program shall be determined when an
individual meets at least one of the following criteria:
(1) homeless;
(2) homeless and living in designated
shelter;
(3) a resident of a
designated adult home for less than six months;
(4) a resident of a qualified residence for
less than six months;
(5) a
resident of a designated single room occupancy residence;
(6) an inpatient of a State-operated
psychiatric center scheduled for placement within 90 days to an Office of
Mental Health licensed or operated community residence, family care home or
residential care center for adults shall be eligible for comunity support
services excepting those mental health services, other than day training,
certified by Part 585 of this Title, in accordance with the following:
(i) the individual shall be identified by the
State psychiatric hospital, as documented in his or her treatment plan, as
appropriate for and scheduled to enter a community residence, family care home
or residential care center for adults within 90 days;
(ii) the individual shall be identified by
the community residence, family care home or the residential care center for
adults as being scheduled to enter such facility within 90 days;
(iii) the individual shall have this
categorical status extended for an additional 90 days if unexpected delays
occur with the placement. Any such extensions shall be subject to prior
approval by the commissioner or his designee.
(e) An individual who qualifies for community
support services under the categorical eligibility criteria of this section
shall be considered eligible for community support services for the duration of
their participation in the community support services program.
(f) An individual who qualifies for community
support services under the categorical eligibility criteria of this section
shall continue to be eligible for community support services for a period of
one year after receiving such services.
(g) An individual who is homeless, a resident
of a designated shelter for the homeless, or a resident of a designated adult
home shall be eligible for on-site rehabilitative and outreach community
support services.
(1) Such individual shall
be eligible for these community support services without an eligibility
certification or determination.
(2)
Eligibility certification or determination of such individuals shall continue
to be actively pursued and documented by the provider of services when
clinically appropriate.
(h) Community support services will be made
available to all eligible individuals as defined in this section without
discrimination because of age, creed, color, national origin, sex, disability,
marital status or arrest or criminal accusation not presently pending against
that individual which was followed by a termination of that criminal action or
proceeding in favor of the individual, as defined in subdivision two of section 160.50 of the Criminal Procedure Law,
unless such discrimination is in fact a segregation based on legitimate
clinical needs and concerns and not a complete denial of the provision of
services.
