New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIII - Office of Mental Health
Part 576 - Standards Pertaining To Payment For Residential Treatment Facilities For Children And Youth
Section 576.6 - Standards pertaining to reserved bed days
Universal Citation: 14 NY Comp Codes Rules and Regs ยง 576.6
Current through Register Vol. 46, No. 39, September 25, 2024
(a) The purpose of reserving a bed and making payment for the days for which a bed is reserved is to make provision for the continued availability of services in the same residential treatment facility for residents who are temporarily hospitalized or who are on leave of absence for a therapy day. A bed may be reserved only for a resident who has been residing in the residential treatment facility for at least 15 consecutive days since the resident's current initial admission to the residential treatment facility.
(1) A bed may be reserved for a
resident who is temporarily hospitalized for medical or psychiatric care if the
following conditions are met:
(i) The resident
is admitted to a hospital, other than a residential treatment facility, which
is currently licensed or otherwise authorized to operate pursuant to the laws
of the jurisdiction in which the hospital is located.
(ii) The resident is expected, on the day of
admission to the hospital, to return to the residential treatment facility in
no more than 15 calendar days.
(iii) The residential treatment facility
notifies the hospital by telephone, and confirms in writing in accordance with
procedures prescribed by the Office of Mental Health, that the resident's bed
is being reserved and that the hospital must notify the residential treatment
facility during the period that the bed is being reserved of any change in the
resident's condition which affects the date of discharge.
(a) On or before the morning of the fourth
day of hospital care, the hospital shall notify the residential treatment
facility of the resident's anticipated discharge date.
(b) If following the 3rd day and before the
16th day of temporary hospitalization, it becomes necessary to adjust the
planned discharge date as a result of either a change in the resident's
condition or the availability of additional clinical information, the hospital
shall immediately advise the residential treatment facility by
telephone.
(iv) The bed
reservation shall be extended under the following conditions:
(a) For a resident temporarily hospitalized
for medical care the bed reservation shall be extended for up to five
additional days, if granting such extension will permit the resident to return
to the residential treatment facility within 20 days of the date of admission
to the hospital.
(b) For a resident
temporarily hospitalized for psychiatric care the bed reservation shall be
extended for up to 15 additional days, if granting such extension will permit
the resident to return to the residential treatment facility within 30 days of
the date of admission to the hospital.
(v) Payment for reserved bed days for
temporary hospitalization shall be requested as follows:
(a) When reserved bed days do not exceed 15
days for any single hospital stay and the resident returns immediately to the
residential treatment facility payment may be requested without prior
authorization.
(b) When a bed
reservation has been extended in accordance with clause (iv) (a) or (b) of this
paragraph, and the resident returns immediately to the residential treatment
facility, the residential treatment facility must request prior authorization
from the Office of Mental Health to request payment for the actual period the
bed was reserved.
(vi)
The bed reservation shall be terminated under the following conditions:
(a) If the planned discharge date determined
during the first 3 days of hospitalization is more than 15 days from the day of
admission to the hospital, the bed reservation shall be terminated.
(b) If the planned discharge date determined
following the third day of temporary hospitalization is more than 15 days from
the day of admission to the hospital or, more than 20 days for medical care or
more than 30 days for psychiatric care for bed reservations extended in
accordance with clause (iv)(a) or (b) of this paragraph, the bed reservation
shall be terminated.
(c) If the
resident is discharged from the hospital and does not return to the residential
treatment facility, the bed reservation shall be terminated on the day the
resident is discharged from the hospital.
(vii) All of the above provisions in this
paragraph are subject to a vacancy rate of no more than 5% or 2 vacant beds,
whichever is greater, on the first day of resident's hospitalization from
either the residential treatment facility or the distinct unit of the
residential treatment facility, to which the resident is expected to return. A
distinct unit will require specific admission criteria listed on the
residential treatment facility's operating certificate but will not require a
separate reimbursement rate for the unit. When computing a vacancy rate, the
RTF must disregard beds that have been reserved for other patients.
(2) A bed may be reserved for a
resident who is on a leave of absence for a therapy day if the following
conditions are met:
(i) The residential
treatment facility has written policies and procedures governing leaves of
absence for therapy days. Such policies and procedures are subject to the
approval of the Office of Mental Health.
(ii) The leave of absence for a therapy day
is in conformance with such policies and procedures.
(iii) The leave of absence for a therapy day
is provided for in the resident's individual treatment plan.
(iv) The number of days for which a bed is
reserved for any individual whether she/he is a resident in one or more
residential treatment facility does not exceed 75 days in any 12-month
period.
(v) The resident is not
admitted to a hospital, other medical facility or another residential treatment
facility.
(vi) The resident returns
from the leave of absence for a therapy day and is not discharged within 24
hours of return.
(3) A
bed may not be reserved as a direct result of a labor dispute occurring within
the residential treatment facility.
(b) Certain requirements of this section may be waived by the Office of Mental Health.
(1)
A request for a waiver must be submitted to the office and must justify the
need for waiver and include such other information or documentation as the
Office of Mental Health may require.
(2) The Office of Mental Health may grant a
request for waiver of a requirement if it determines that the request is
appropriate and reasonable and that the waiver of the request is in the best
interests of the resident and the residential treatment facility.
(3) The circumstances in which waiver of a
requirement may be requested are as follows:
(i) The requirement that a bed may be
reserved only for a resident who has been residing in the residential treatment
facility for at least 15 consecutive days (see subdivision (a) of this
section).
(ii) The disallowance of a
bed reservation for a resident who is discharged while on a leave of absence
for a therapy day or within 24 hours of return may be waived if the discharge
was not anticipated on the day of departure from the residential treatment
facility and at the time of discharge the resident is determined to no longer
be in need of residential treatment facility services (see subparagraph
(a)(2)(vii) of this section).
(c) Special limits, subject to the approval of the State Commissioner of Social Services, may be established on an individual basis, based on the recommendation of the Office of Mental Health . The circumstances in which the application of special limits may be requested are as follows:
(1) The limit of 20 calendar
days for a resident who is temporarily hospitalized for medical care may be
extended if such extension is expected to permit the resident to return to the
residential treatment facility (see clause [a][1][iv][a ] of this
section).
(2) The limit of 30
calendar days for a resident who is temporarily hospitalized for psychiatric
care may be extended if such extension is expected to permit the resident to
return to the residential treatment facility (see clause [a][1][iv][ b] of this
section).
(d) The Commissioner of Mental Health may waive any of the standards pertaining to reserved bed cays in individual cases under special conditions except those standards requiring the approval of the Commissioner of Social Services as provided for in subdivision (c) of this section.
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