New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIV - Office for People With Developmental Disabilities
Part 690 - Day Treatment Services to Persons with Developmental Disabilities
Section 690.3 - Intent
Universal Citation: 14 NY Comp Codes Rules and Regs ยง 690.3
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Principles of compliance.
(1)
The day treatment facility is required to provide or ensure provision of a
planned combination of diagnostic, treatment and habilitation services in
accordance with the comprehensive functional assessment (see glossary) of each
person's needs. Allowable services (see glossary), delivered by qualified
professionals (see glossary) or appropriately supervised paraprofessional or
direct care staff (see glossary), include:
(i) independent living services (see
paragraph [a][2] of this subdivision);
(ii) medical oversight services (see section
690.5[b][1]
of this Part);
(iii) nursing
services;
(iv) nutrition
services;
(v) occupational therapy
services;
(vi) physical therapy
services;
(vii) psychology
services;
(viii) self-care
services;
(ix) social work
services;
(x) speech pathology
services; and
(xi) therapeutic
recreational services.
(2) Where clinically appropriate, and
incorporated into the person's individual program plan (see glossary), a day
treatment facility may elect to provide, as part of the allowable services in
the area of independent living or other category, active treatment-based
activities of a therapeutic prevocational nature. Included here, for example,
might be training in the performance of an assembly task to improve
manipulation skills, training in the performance of a sorting task to improve
cognitive discrimination skills, etc. However, this excludes those
activities/interventions which have a purely vocational (i.e.,
work-for-pay) purpose. Therapeutic prevocational activities are eligible for
reimbursement through the Medical Assistance Program as part of a day treatment
facility's allowable services if:
(i) The
activities/interventions are documented in a written individual program plan
and conform to the requirements for the provision of active treatment (see
glossary).
(ii) The activities in
which persons are engaged are primarily therapeutic and individualized in
nature (i.e., the treatment goal is the amelioration of a
developmental skill deficit, or developmental skill enhancement, rather than
the production of a product), and the activities are chosen, approved or
developed by the interdisciplinary treatment team (see glossary) on the basis
of clinical judgement related to the person's needs.
(iii) The activities engaged in are not
performed as part of contract work (see glossary) for which the day treatment
facility in particular, has made any commitments for itself, its staff, or the
participants.
(iv) The activities
engaged in by persons at the facility do not generate any outside income which
accrues to the day treatment facility.
(v) In accordance with the Department of
Labor regulations, if the therapeutic activity/intervention results in a
saleable product or an economic benefit to any party, the person(s) must be
recompensed in accordance with New York State's Wage and Hour Law
requirements.
(3) As
part of the day treatment facility's reimbursement, allowable services shall be
provided as needed on a regular basis (though not necessarily on a daily
basis), to person(s)/people attending the day treatment facility in accordance
with an individual program plan and, in the case of occupational and physical
therapy, by specific written medical prescription.
(i) The frequency and intensity of service
delivery shall be based on the needs indicated in each person's comprehensive
functional assessment.
(ii) Medical
oversight, nursing, psychology, social work, speech pathology, occupational
therapy and physical therapy services as specified in the program plans of the
facility's participants, may be provided directly or through contract or letter
of agreement, but the costs for such services are to be considered as part of
the day treatment facility's reimbursement.
(iii) Transportation to and from the facility
is a separately reimbursable service until June 30, 1996. Effective July 1,
1996, such transportation shall be the responsibility of the day treatment
provider.
(iv) The level of all
services provided shall be based on a person's assessed needs and in accordance
with the treatment plans (see glossary) contained in the individual program
plan.
(v) The facility shall
encourage and facilitate the coordination of service delivery among each
person's major day and residential providers.
(4) Each of the allowable services set forth
in this Part shall be provided either directly by the facility or through
contract or agreement with other providers, and may be delivered through group
or individual activities, as indicated in a person's individual program plan.
(i) Where required by law, all contractual
service providers shall have a valid operating certificate or applicable
licensure/certification issued by the appropriate State agency.
(ii) Services provided by the facility or to
the facility by outside agencies or parties shall meet the applicable
requirements of this Part. Contracts or agreements for these services shall
state that these standards will be met.
(5) It is generally expected that most
person(s)/people receiving full or half-day day treatment services are having
their basic needs for day treatment services accommodated. However, it is
realized that in individual cases, the person's need for clinical supports may
extend beyond the day treatment facility's scope or duration of responsibility.
In such cases, and in other appropriate circumstances, a person may receive a
day treatment service and a Part 679 (of this Title) certified clinic treatment
service on the same day. In such cases, it shall be the responsibility of both
the day treatment and the clinic treatment provider to ensure adherence to
these requirements.
(i) A person admitted to a
day treatment facility and receiving full, half or collocated
(a.k.a., partial - see section
690.1[d][2]
of this Title) day treatment services five or fewer days per week, may, as
needed, receive a Part 679 clinic treatment service on the same day as the day
treatment visit in the clinical areas of audiology, special medical, routine
medical, and dentistry without any restriction. This presumes that the person
receives the full duration of day treatment visit being claimed, and the clinic
treatment service(s) is/are provided outside of the time the person is at the
day treatment setting. Nothing herein shall preclude such clinical services
being delivered as part of a program plan-specified community integration
opportunity which meets the requirements of paragraph (6) of this
subdivision.
(ii) A person
participating in fewer than five full days per week of day treatment, may
receive a claimable Part 679 (of this Title) clinic treatment service on those
days he/she does not attend day treatment. Such clinic service(s) may consist
of any clinical discipline treatment area(s) deemed necessary and appropriate,
other than a comprehensive interdisciplinary assessment (see section
679.5[c][6]
of this Title). Said comprehensive assessment is required to be provided by the
day treatment provider as part of its admission and initial and/or annual
programming process.
(a) For second opinion
purposes, and where the person's needs are particularly complex and/or
intractable or resistive to conventional treatment interventions, a person in
day treatment may receive a claimable clinic treatment in-depth
discipline-specific assessment visit on a same day he/she is receiving a full
or half day treatment visit.
(b) It
is expected that the day treatment facility or other referral agent will
provide, and that the clinic treatment facility will keep on file, the
documentation substantiating the person's need (e.g.,
diagnostic clarification and/or new treatment recommendations) for the
discipline specific assessment and the reasons why the day treatment facility's
means for this type of assessment are inadequate.
Note:
Unavailability of day treatment qualified professionals due to recruitment problems, is not sufficient justification.
(iii) A day treatment facility may
make arrangements with a clinic treatment facility to provide specific day
treatment "allowable" services, but only the day treatment facility shall
submit a claim for such services and then must pay the clinic treatment
facility provider directly for the service that was provided.
(iv) A same day clinic visit for any
authorized Part 679 (of this Title) clinical service is allowable if the person
receiving a full or half day treatment visit also has clinical needs which are
clearly separate from his/her participation in the day treatment facility
(i.e., related primarily to the person's residence/home). The
residential facility's plan of service for the person shall clearly articulate
the use of a Part 679 (of this Title) clinic to deliver the
residentially-needed clinical support service(s). In addition:
(a) For both ICF/DDs and community
residences, the residential provider must clearly be able to demonstrate upon
request or audit that the services for which the residential provider is being
reimbursed through its residential rate/fee, are clearly separate from
(i.e., not duplicative of the additional services received by
the person through the Part 679 (of this Title) clinic;
(b) All facilities involved (day treatment,
clinic treatment, and residence) shall be able to document their efforts at
integration and coordination of the services with each other, to ensure that
the persons are provided necessary services in the most economical and
efficient fashion available.
(v) A person participating in collocated day
treatment (a.k.a., partial day treatment - see section
690.1[d][2]
of this Title), may receive a clinic treatment service (other than per
subparagraph [i] of this paragraph) only on the days when he/she is not
receiving the collocated service. In addition, the clinic service must be
necessary to support the person's living situation.
(6) The provision of isolated, off-site day
treatment services is not permitted. However, where clinically appropriate and
incorporated into the person's individual program plan, a day treatment
facility may provide, as part of the allowable services in the area of
independent living or other category, an individualized, programmatically sound
community integration opportunity which extends the facility's habilitation
environment in accordance with the following requirements:
(i) The community integration opportunity
shall be individually, and primarily designed to meet the developmental skill
or behavioral needs and preferences of the person involved, and shall be
documented in the person's individual program plan.
(ii) The community integration opportunity
shall be planned and implemented so that the skill or behavior activities
originate at the certified day treatment site (or satellite); that said
activities that take place during the period of transportation to the community
integration setting; that said activities take place at the setting and during
the period of transportation from the setting; and that said activities end at
the certified day treatment site (or satellite).
Note:
This does not presume or require that the same activities, interventions, or skills be conducted/addressed throughout the duration of the community integration opportunity or its segments, nor does it presume continuous interaction. It does presume that the community integration opportunity is only part of the person's daily day treatment experience.
(iii) Each particular community
integration opportunity (i.e., the activity and its associated
outcome) shall be time limited (as specified by the IT, but in any event, no
longer than one year), and focused on the initiation or enhancement of a
specific developmental skill(s) or behavior(s) appropriate for increasing the
person's independent functioning in the community. Such experiences shall not
be for the sole purposes of placing the person in another setting/alternative
or for facilitating the person's adaptation to a new setting/alternative
without an emphasis on objectives to facilitate specific developmental skill(s)
or behavior(s).
(b) Standards of certification.
(1) OPWDD shall verify, where community
integration opportunities have been utilized, that the appropriate treatment
plans document the habilitation activities being carried out during the various
phases of each opportunity.
(2)
OPWDD shall verify that, where applicable, the day treatment program has
coordinated the provision of allowable day treatment services with other
significant services received by the person outside of the day treatment
facility.
(3) OPWDD shall verify
where the day treatment facility is utilizing pre-vocational skills training
materials or activities, that said materials/activities are not part of a
contract work arrangement that binds the day treatment facility, its staff or
service recipients to any production obligations.
(4) OPWDD shall verify that the outcomes of
individualization, inclusion, independence and productivity have been
considered as part of the overall program planning process for the person and
incorporated, as appropriate, into various treatment activities, interventions
and/or therapies addressing skill and behavioral development.
(5) OPWDD shall verify that, where the IT has
chosen to include pre-vocational services as part of the person's overall day
treatment services, the plan for said services includes the clinical
justification as to why such pre-vocational activities/interventions/therapies
are appropriate to meeting the person's needs for the time in
question.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
