N.Y. Comp. Codes R. & Regs. tit. 14 § 590.4

Current through Register Vol. 46, No. 53, December 31, 2024

Section 590.4 - Definitions

(a) General.

(1)Commissioner means the Commissioner of Mental Health.

(2) Individual with Complex Needs shall mean individuals who have one or more of the following:

(i) Demonstrates high utilization of inpatient, crisis, or emergency services, as indicated by:

(a) three or more mental health inpatient hospitalizations in the past year; or

(b) four or more mental health presentations to an emergency department (ED) or comprehensive psychiatric emergency program (CPEP) in the past year; or

(c) three or more medical/surgical hospitalizations in the last year and carrying a diagnosis of schizophrenia or bipolar disorder.

(ii) Discharge from an office-licensed residential treatment facility (RTF) in the past year.

(iii) Discharge from inpatient level of care where the length of stay was greater than 60 days at an office-operated psychiatric center in the past year.

(iv) Current enrollment in, or discharge from in the past year, Assertive Community Treatment (ACT), including but not limited to Adult ACT, Youth ACT, Young Adult ACT, Shelter-partnered ACT, Forensic ACT.

(v) Currently receiving services from Critical Time Intervention (CTI), Safe Options Supports (SOS), Pathway Home, Intensive Mobile Treatment (IMT), Home Based Crisis Intervention, or other high-intensity ambulatory services.

(vi) Eligible for or current enrollment in Health Home Plus Care Management Services

(vii) Eligible for or current enrollment in High Fidelity Wrap around Care Management in Health Homes Serving Children; eligible for or current enrollment in Children's Home and Community Based Services Waiver for children with Serious Emotional Disturbance (SED)

(viii) An active Assertive Outpatient Treatment order or an order that expired in the past year.

(ix) Experiencing high-risk social needs, including, but not limited to, current homelessness, criminal or juvenile justice involvement, and child welfare involvement in the past year.

(x) Clinical determination by staff in the licensed program that on presentation the individual has an elevated risk of suicide, violence, and/or overdose.

(xi) Has a current complexity clinical flag in the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES).

(xii) Experiencing other factors that the licensed program determines would significantly interfere with the individual's ability to maintain stability in the community after discharge.

(3)General hospital shall be defined as in article 28 of the Public Health Law.

(4)Office means the Office of Mental Health.

(5)Rural areas, for the purposes of this Part, means any city, town, village, community, organization or other group in a county with a population under 200,000.

(6)Voluntary agency shall be defined as in article 41 of the Mental Hygiene Law.

(b) Services.

(1)Collaterals means an individual who is a member of the individual 's family, legal guardian or household, or other individual who interacts with the individual and is directly affected by or has the capability of affecting their condition and is identified in the comprehensive psychiatric emergency plan as having a role in treatment and/or is necessary for participation in the evaluation and assessment of the recipient prior to admission, and shall also include any psychiatric advance directive (PAD) .

(2)Crisis outreach means face to face psychiatric emergency services provided outside an emergency room setting which includes evaluation, assessment and stabilization services. Crisis outreach services include but are not limited to therapeutic communication, coordination with identified supports, psychiatric consultation, safety planning, referral, linkage, peer services. Crisis outreach services may be provided outside the emergency room of the hospital, in the community or in other clinical areas within the hospital, for purposes of face to face visits with individuals discharged from the comprehensive psychiatric emergency program. Crisis outreach does not have to result in a visit or admission to the comprehensive psychiatric emergency program. For individuals discharged from the comprehensive psychiatric emergency program, crisis outreach includes face to face contact with a mental health professional for purposes of facilitating an individual's community tenure prior to engagement or re-engagement with community-based providers.

(3)Extended observation bed means a bed located in or adjacent to the emergency room of a comprehensive psychiatric emergency program designed to provide, for a period up to 72 hours, a safe environment for an individual who, in the opinion of the examining physicians, requires extensive evaluation, assessment, or stabilization of the person's acute psychiatric symptoms.

(4)Full emergency visit means a face to face interaction between a n individual and a psychiatrist and other clinical staff as necessary to determine a n individual's current psychosocial and medical condition. It must include a psychiatric diagnostic examination; psychosocial assessment; and medical examination; which results in a comprehensive psychiatric emergency treatment plan and a discharge plan when comprehensive psychiatric emergency program services are completed. It may include other examinations and assessments as clinically indicated by the individual 's presenting problems. Full emergency visit shall be provided to individuals whose presenting symptoms are initially determined to be serious and where the clinical staff determine commencement of treatment shall begin immediately, and/or where staff are evaluating a person for retention in an extended observation bed or admission to a psychiatric inpatient unit.

(5)I-STOP and PMP registry shall mean the prescription monitoring program registry as provided for in for in Public Health Law § 3343-a, the use of which is to inform a practitioner, as defined by article 33 of the Public Health Law, that the individual may be under treatment with a controlled substance by another practitioner, consistent with Public Health Law § 3371.

(6)Intensive Care Management shall mean a care management program that provides mobile, community-based support, with duration and frequency of visits meeting client needs. Services are provided in home or residences, community settings, health care settings including emergency department, hospital, and primary care settings to support access, engagement, quality, and coordination of care to meet clients' health care and basic needs. Examples of Intensive Care Management include Critical Time Intervention, Assertive Community Treatment, and Health Home Plus services, and other services designated by the office as meeting criteria for Intensive Care Management services.

(7)Managed Care (MCO) shall mean an organization certified under article 44 of the Public Health Law or article 43 of the Insurance Law, including organizations certified to provide comprehensive health services plans to individuals eligible for the medical assistance program under title 11 of article 5 of the Social Services Law or Child Health Plus under title 1-A of article 25 of the Public Health Law. For purposes of this section, MCO shall also mean any other insurer or entity authorized to issue health insurance policies or which provides health insurance benefits within or outside the State of New York, or an entity administering benefits on the insurer or entity's behalf, or a plan providing services under title XVIII of the federal Social Security Act, that provides or administers coverage to an individual receiving inpatient treatment in a facility licensed pursuant to this section

(8)Medical examination means an examination conducted as part of a comprehensive psychiatric emergency program's full emergency visit, conducted by an appropriately credentialed professional employed by the comprehensive psychiatric emergency program or emergency department. Such medical examination shall include:

(i) A History and Physical which may be obtained either from the individual or systems including but not limited to the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) or Electronic Health Records (EHR) and includes at a minimum:

(a) past medical history;

(b) review of systems (physical systems);

(c) review of medications and allergies; and

(d) assessment of vital signs.

(ii) Where clinically indicated:

(a) a targeted physical exam, and

(b) orders for laboratory and other diagnostic studies.

(9)On duty means the professional is physically present in the building and accessible.

(10)Person-centered process shall mean that an individual participates to every extent possible, in the planning of their services and makes choices about the services and supports that they receive.

(11)PSYCKES shall mean the Psychiatric Services and Clinical Knowledge Enhancement System, a secure, HIPAA-compliant web-based platform developed by the Office of Mental Health (OMH) for sharing Medicaid billing claims and encounter data, other health-related data, and other data and documents entered by providers and individuals.

(12)Psychiatric advance directive shall mean a legal document that details a person's preferences for future mental health treatment decisions and names an individual to make treatment decisions if the person is in a crisis and unable to make decisions.

(13)Received means the individual has completed all required registration materials upon entry to the comprehensive psychiatric emergency program, and a record has been created for such individual.

(14)Restraint means the term restraint as such term is defined in section 526.4 of this Title.

(15)Satellite facility means a medical facility providing psychiatric emergency services that is managed and operated by a general hospital who holds a valid operating certificate for a comprehensive psychiatric emergency program and is located away from the central campus of the general hospital. A satellite facility at minimum must provide crisis intervention services including triage and referral and full emergency visits and/or extended observation bed services.

(16)Seclusion means the term seclusion as such term is defined in section 526.4 of this Title.

(17)Shared decision making shall mean a process whereby staff and the individual work together to select treatments and services based on the individual's preferences, interests, strengths, needs, clinical evidence, and are designed to empower the individual.

(18)SHIN-NY/QE shall mean the Statewide Health Information Network for New York, which facilitates the secure electronic exchange of individual health information, connects healthcare professionals statewide and connects New York's qualified entities (QE), regional health information organization networks (RHIO) that store and share protected health information.

(19)Triage means a determination upon presentation by a staff member that an individual shall receive an evaluation, or when appropriate, referral to other nonmental health services.

(20)Triage and referral means a face to face interaction between a n individual and a staff physician, preferably a psychiatrist, or psychiatric nurse practitioner to determine the scope of emergency service required. This interaction shall include a psychiatric diagnostic examination. It may result in further comprehensive psychiatric emergency program evaluation or treatment activities on the individual's behalf or discharge from the comprehensive psychiatric emergency program. For those persons who are discharged from the comprehensive psychiatric emergency program and who require additional mental health services triage and referral must include a discharge plan.

(c) Staffing.

(1)Clinical staff are all staff members who provide services directly to individuals. Students and trainees may qualify if they are participating in a program leading to a degree or certificate appropriate to the goals, objectives and services of the comprehensive psychiatric emergency program and are supervised in accordance with the policies governing the training program and are included in the staffing plan approved by the Office of Mental Health.

(2)Professional staff, for the purpose of this Part, are individuals who are qualified by credentials, training and experience to provide supervision and direct service related to the treatment of mental illness in a comprehensive psychiatric emergency program and may include the following:

(i)Creative arts therapist is an individual who is currently licensed as a creative arts therapist by the New York State Education Department or possesses a creative arts therapist permit from the New York State Education Department.

(ii)Credentialed Alcoholism and Substance Abuse Counselor (CASAC) means an individual who has a current valid credential issued by the New York State Office of Addiction Services and Supports (OASAS), or a comparable credential, certificate or license from another recognized certifying body as determined by the OASAS.

(iii)Licensed practical nurse is an individual who is currently licensed as a licensed practical nurse by the New York State Education Department or possesses a licensed practical nurse permit from the New York State Education Department

(iv)Licensed psychoanalyst is an individual who is currently licensed as a psychoanalyst by the New York State Education Department or possesses a permit from the New York State Education Department.

(v)Marriage and family therapist is an individual who is currently licensed as a marriage and family therapist by the New York State Education Department or possesses a permit from the New York State Education Department.

(vi)Mental health counselor is an individual who is currently licensed as a mental health counselor by the New York State Education Department or possesses a permit from the New York State Education Department.

(vii)Nurse practitioner is an individual who is currently certified as a nurse practitioner by the New York State Education Department or possesses a permit from the New York State Education Department.

(viii)Nurse practitioner in psychiatry (referred to as Psychiatric Nurse Practitioner in statute) is an individual who is currently certified as a nurse practitioner with an approved specialty area of psychiatry (NPP) by the New York State Education Department or possesses a permit from the New York State Education Department.

(ix)Physician is an individual who is currently licensed as a physician by the New York State Education Department.

(x)Physician assistant is an individual who is currently registered as a physician assistant by the New York State Education Department or possesses a permit from the New York State Education Department.

(xi)Psychiatrist is an individual who is currently licensed as a physician by the New York State Education Department and who is certified by, or eligible to be certified by, the American Board of Psychiatry and Neurology.

(xii)Psychologist is an individual who is currently licensed as a psychologist by the New York State Education Department.

(xiii)Registered professional nurse is an individual who is currently licensed as a registered professional nurse by the New York State Education Department.

(xiv)Rehabilitation counselor is an individual who has either a master's degree in rehabilitation counseling from a program approved by the New York State Education Department or current certification by the Commission on Rehabilitation Counselor Certification.

(xv)Social worker is an individual who is either currently licensed as a licensed master social worker or as a licensed clinical social worker by the New York State Education Department or has a master's degree in social work from a program approved by the New York State Education Department.

(3)Certified peer specialist means an individual who is certified as a peer in New York State from a certifying authority recognized by the commissioner of the office.

(4)Certified recovery peer advocate means an individual who holds a certification issued by an entity approved and recognized by the commissioner of OASAS.

(5)Certified or credentialed family peer advocate means and individual who is credentialed as a peer in New York State from a certifying authority recognized by the commissioner of the office or OASAS.

(6)Certified or credentialed youth peer advocate means an individual who is credentialed as a peer in New York state from a certifying authority recognized by the commissioner of the office or OASAS.

(7) Other professional disciplines may be included as professional staff, provided that the discipline is approved as part of the staffing plan submitted to the Office of Mental Health. The discipline shall be from a field related to the treatment of mental illness. For rural areas, individuals who have obtained at least a master's degree in psychology may be considered professional staff for the purposes of calculating professional staff but may not be assigned supervisory responsibility.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 590.4

Amended New York State Register August 17, 2016/Volume XXXVIII, Issue 33, eff. 8/17/2016

Amended New York State Register May 19, 2021/Volume XLIII, Issue 20, eff. 5/5/2021

Amended New York State Register December 18, 2024/Volume XLVI, Issue 51, eff. 12/18/2024