Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Initial determination.
(1)An individual who appears at the service seeking treatment or
evaluation shall have an initial determination made and documented in a written
record by a qualified health professional, or other clinical staff under the
supervision of a qualified health professional, which states the following:
(i) that the individual is documented as less
than twenty-one (21) years of age on the date of admission and appears to be in
need of substance use disorder services;
(ii) that the individual appears to be free
of serious communicable diseases that can be transmitted through ordinary
contact; and
(iii) that the
individual appears not to be in need of acute hospital care, acute psychiatric
care, Part 816 crisis services or other services which cannot be provided in
conjunction with treatment at the facility or would prevent them from
participating in substance use disorder treatment.
(2) The initial determinations made pursuant
to the above shall be based upon provider records, reports from other providers
and face-to-face contact with the individual, all of which must be
documented.
(b)
Level of care determination. If an individual is determined to
be appropriate for substance use disorder treatment services, a level of care
determination utilizing the OASAS level of care determination protocol, shall
be made by a clinical staff member. The level of care determination shall be
made no later than one patient day after the patient's first on-site visit to
the program and documented in the patient record.
(c)
Prohibition against
discrimination. Individual's may not be denied admission to the
service consistent with the provisions of Part 815 of this Title.
(d)
Additional requirements for the
admission of Medicaid eligible individuals. A provider must obtain
preadmission approval as follows prior to admitting Medicaid eligible
individuals to the program.
(1) The Office
shall establish a pre-admission review team ("ART") that shall use the
requirements of this Section to review each individual candidate to determine
their appropriateness for admission. If deemed appropriate for admission, the
ART shall certify that the individual seeking admission is in need of this
level of residential treatment for substance use disorder. The ART shall be
operated in accordance with the procedures established by the Office and shall
at a minimum consist of a Physician, a Social Worker licensed and currently
registered as such by the New York State Education Department, and a
Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
(2) Except in emergency circumstances, the
service provider must obtain approval from the ART prior to admitting a
Medicaid eligible individual. Emergency admissions are authorized only when an
individual appears for treatment meeting the admission criteria and meets one
of the following conditions:
(i) the
individual has a history of recurrent use outside of a structured 24-hour
setting;
(ii) the individual is
unable to access transitional services in the community; or
(iii) the individual is without appropriate
housing.
(3) Under no
circumstances should an individual be admitted on an emergency basis or
otherwise if they are in medical or psychiatric crisis or if they are in need
of withdrawal services and an appropriate referral for such services is
made.
(e)
Admission criteria.
(1) To
be admitted to the program it must be determined that ambulatory services in
the community do not meet the needs of the individual recipient or the
individual's environment is not conducive to recovery.
(2) If the individual is deemed inappropriate
for service, unless the individual is already receiving substance use disorder
services from another provider, a referral and connection to a more appropriate
service provider shall be made. The reasons for denial of admission must be
provided to the individual and documented in a written record maintained by the
service provider.
(3) The decision
to admit shall be made by a staff member who is a qualified health professional
authorized by the program governing authority to admit individuals. The name of
the qualified health professional who made the admission decision, along with
the date of admission, must be documented in the patient record.
(4) There must be a notation in the case
record that the patient received a copy of the program's rule and regulations,
including patient rights and a summary of federal confidentiality requirements,
and a statement that notes that such rules were discussed with the patient, and
that the patient indicated that they understood them.
(5) All prospective patients must be informed
that admission to a program is on a voluntary basis and a prospective patient
is free to discharge themselves from the service at any time. For prospective
patients under an external mandate, the potential consequences for premature
discharge must be explained, including that the external mandate does not alter
the voluntary nature of admission and continued treatment.
(6) Individuals under the age of eighteen may
be admitted without the consent of a parent or legal guardian under certain
circumstances in accordance with Mental Hygiene Law Section
22.11.