N.Y. Comp. Codes R. & Regs. tit. 14 § 575.6

Current through Register Vol. 46, No. 45, November 2, 2024

Section 575.6 - Standards pertaining to eligibility

(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.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 575.6