N.Y. Comp. Codes R. & Regs. tit. 14 § 583.5

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

Section 583.5 - Residential Treatment Facility (RTF) Eligibility and Authorization Requirements

(a) Applications for an eligibility determination and authorization to access residential treatment facility services shall be in a form and format specified by the office or commissioner's designee.

(b) In order for a child or youth to be found eligible and authorized to access residential treatment services they must meet the following criteria:

(1) be between the age of 5 years old and 20 years old;

(2) have an intelligence quotient equal to or greater than 51;

(3) meet the criteria for voluntary admission in accordance with section 9.13 of the Mental Hygiene Law;

(4) have a current primary diagnosis of a designated mental illness;

(5) meet criteria for serious emotional disturbance; and

(6) meet all medical necessity criteria for residential treatment facility services.

(i) Medical necessity criteria determinations shall comply with the Code of Federal Regulations, title 42, section 441.153 as incorporated by reference in Part 502.2 of this Title. Medical necessity criteria shall also meet the CFR 42 section 441.152 Certification of Need requirements where the child or youth is an applicant or recipient of medical assistance pursuant to Social Services Law, title 11, article 5 as incorporated by reference in Part 502.2 of this Title.

(ii) Medical Necessity criteria includes the following:

(a) outpatient, community-based, and other out of home interventions available, do not meet the treatment needs of the child or youth;

(b) the child or youth is experiencing a severity of psychiatric need which requires proper care and treatment of the child or youth's psychiatric condition on an inpatient basis in a residential treatment facility under the direction of a physician;

(c) care and treatment provided by residential treatment facility services can reasonably be expected to improve the child or youth's condition or prevent further regression so that residential treatment facility services will no longer be needed, provided that a poor prognosis shall not in itself constitute grounds for a denial of determination of eligibility if treatment in a residential treatment facility offers can be expected to effect a change in prognosis.

(c) Eligibility criteria to obtain authorization to access residential treatment facility services delivered by a residential treatment facility developed in collaboration with the office and the Office for People With Developmental Disabilities, to serve children or youth with a designated mental illness and an intellectual and/or development disability, shall be exempt from paragraphs (2) and (4) of subdivision (b) of this section.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 583.5

Amended New York State Register July 3, 2024/Volume XLVI, Issue 27, eff. 7/3/2024