N.Y. Comp. Codes R. & Regs. tit. 14 § 590.8

Current through Register Vol. 46, No. 51, December 18, 2024

Section 590.8 - Admission and discharge procedures

(a) The program of services shall be provided through a person-centered process with shared decision making.

(b) The program of services shall be informed by the understanding that implicit bias may affect the assessment, diagnosis, treatment, and discharge planning of Black, Indigenous, People of Color (BIPOC) and other marginalized individuals.

(c) Each comprehensive psychiatric emergency program shall maintain admission and discharge criteria which are consistent with its goals and objectives, and which are subject to the approval of the Office of Mental Health. Each admission shall be conducted in accordance with the provisions of section 9.40 of the Mental Hygiene Law and on the forms prescribed therefor.

(d) Admission and retention of individuals.

(1) Any person receiving a triage and referral visit must be examined by a staff physician or psychiatric nurse practitioner as soon as practicable and in any event within six hours after being received into the emergency room.

(2) Any person receiving a full emergency visit must be examined by a staff physician as soon as practicable and in any event within six hours after being received into the emergency room.

(3) The director of the comprehensive psychiatric emergency program may, in accordance with section 9.40 of the Mental Hygiene Law, involuntarily receive and retain in an extended observation bed any person alleged to have a mental illness which is likely to result in serious harm to the person or others and for whom immediate observation, care and treatment in the comprehensive psychiatric emergency program is appropriate. Retention in an extended observation bed shall not exceed 72 hours, which shall be calculated from the time such person is initially received into the emergency room of the comprehensive psychiatric emergency program.

(4) No person may be involuntarily retained in a comprehensive psychiatric emergency program for more than 24 hours unless the person is admitted to an extended observation bed in accordance with section 9.40 of the Mental Hygiene Law.

(5) Any person with a need of medical or surgical care or treatment which cannot be provided in the comprehensive psychiatric emergency program, shall not remain in the comprehensive psychiatric emergency program for a period exceeding eight hours. Within eight hours such person shall be accepted by the host hospital or a hospital with an affiliation agreement pursuant to section 590.7(b)(3) of this Part for appropriate observation or treatment in accordance with applicable regulations of the Department of Health (10 NYCRR section 405.19).

(e) Information gathering for comprehensive and effective care.

(1) The program shall access the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) or other available electronic health records or database(s) to identify the individual's treatment providers and prior medication use and/or treatment engagement history.

(2) The program shall document efforts to identify and contact with the individual's consent, the individual's treatment team and other relevant providers (e.g., housing providers, care coordination, managed care organizations), and collaterals. In accordance with HIPAA and section 33.13 of the Mental Hygiene Law, the program shall attempt to obtain the authorization of the individual or someone authorized to make health care decisions on the individual's behalf to access, use and disclose personal health information from collaterals or other data sources as outlined in this subdivision. If the authorization of the individual cannot practicably be obtained due to incapacity or emergency circumstance, program staff may, in the exercise of professional judgment, determine whether the access, use, or disclosure is necessary to prevent imminent, serious harm to the individual. If so, only that personal health information that is necessary to protect the individual from the anticipated harm or which is in the best interest of the individual may be accessed, used, or disclosed. The reasons for the access, use, or disclosure must be appropriately documented in the clinical record.

(3) The program shall attempt to obtain collateral information on all individuals unless the presentation is due to a non-emergent reason, including but not limited to an asymptomatic individual presenting for a medication refill. When contacting collaterals staff shall assess whether the source of collateral information is able to provide sufficient high-quality information to determine risk, symptomatology and functioning in the community, treatment history, engagement in treatment, and ongoing stressors. If the source of collateral information is not able to provide sufficient high-quality information, attempts shall be made to identify and contact additional sources of collateral information.

(4) The program shall access the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) or other available electronic health records or database(s) to identify the individual's treatment providers and prior medication use and/or treatment engagement history with consent as required. In the event of incapacity or emergency circumstance, staff may temporarily access a PSYCKES clinical profile, for the limited purposes authorized by this section and in accordance with PSYCKES Policies and Procedures.

(5) The program shall access all other available information network databases to review relevant information on the individual with appropriate consent as may be required and in accordance with the database policy or as authorized by other policy, law or regulation.

(6) A practitioner or designee, as defined by article 33 of the Public Health Law, from the program shall review the I-STOP and PMP registry to obtain the controlled substance prescription history of each admitted individual.

(7) The program shall check PSYCKES to see if the individual has a psychiatric advance directive (PAD), wellness plan, or preferred contacts. The program shall obtain appropriate consent as required to access the full view of the PAD, wellness plan, or preferred contacts. In the event of incapacity or emergency circumstance, staff may temporarily access a PSYCKES clinical profile, for the limited purposes authorized by this section and in accordance with PSYCKES Policies and Procedures. If the individual does not have a PAD, the program shall provide a copy and explanation of the PAD. If the individual chooses to complete a PAD, it shall be placed in their chart.

(f) Screening and assessment

(1) All individuals must be screened for suicide risk using a validated instrument. Positive screens must be followed by a suicide risk assessment by a licensed professional trained in assessing suicide risk.

(2) Each comprehensive psychiatric emergency program (CPEP) must have policies regarding violence risk and screening. All individuals must be screened, and the CPEP policy must describe a process for subsequent assessment and intervention in the case of a positive screen. As part of the screening, all individuals must be asked about access to firearms or other weapons.

(3) All individuals over 12 years old must be screened for substance use using a validated instrument. Positive screens shall be followed by an assessment for high risk substance use and substance use disorder by a licensed professional or CASAC working within their scope of practice.

(4) A determination must be made as to whether an individual has complex needs.

(5) Assessments shall be strength-based and person-centered.

(g) The commissioner or his or her designee may prevent new admissions to the comprehensive psychiatric emergency program emanating from emergency medical services, ambulance services and law enforcement if a conclusion is reached that the ability of the program to deliver quality service would be jeopardized.

(1) The commissioner or his or her designee shall review the continued necessity for such prevention at least once every 24 hours according to a mutually developed plan.

(2) The comprehensive psychiatric emergency program shall develop a contingency plan with other local affiliated hospitals, emergency medical services and law enforcement for the prevention of new admissions during periods of high demand and overcrowding.

(3) Where a comprehensive psychiatric emergency program prevents new admissions pursuant to this paragraph, the comprehensive psychiatric emergency program must notify the appropriate OMH Field Office according to a mutually developed plan.

(h) Discharge criteria.

The provisions of section 29.15 of the Mental Hygiene Law shall not apply to the discharge of an individual from a comprehensive psychiatric emergency program, however:

(1) Discharge planning shall be conducted for all persons discharged from a comprehensive psychiatric emergency program who have been determined to require additional mental health services after triage and referral or full emergency visit and for those persons admitted to extended observation beds who require additional mental health services.

(2) Discharge planning criteria shall include at least the following activities prior to discharge from the comprehensive psychiatric emergency program:

(i) When determining whether an individual is ready for discharge and the most appropriate discharge setting, the whole clinical presentation and history, as well as the availability of existing services and supports in the individual's community, must be considered. This includes if an individual resides in a residential program licensed by the office or supportive housing.

(ii) The discharge plan shall be developed through shared decision making in a person-centered process and must reflect individual strengths and level of social support and address psychiatric, substance use disorder, chronic medical, and social needs. The plan must also address relevant information obtained from collateral sources of information.

(iii) For discharges of individuals with complex needs, the CPEP must provide a verbal clinical sign-out on the day of discharge, or as soon as possible thereafter, to the receiving outpatient behavioral health treatment program and, if applicable, the residential program licensed or funded by the office or Office of Addiction Services and Supports, Office for Persons with Developmental Disabilities or the Department of Health where the individual will reside after discharge. This must be done in accordance with section 33.13 of the Mental Hygiene Law.

(iv) The CPEP must send a discharge summary detailing the presenting history of present illness (HPI), hospital course, and other relevant information to the outpatient, residential, or long-term care program within seven days of discharge, in accordance with section 33.13 of the Mental Hygiene Law.

(v) If the individual is enrolled in outpatient (e.g., Health Home Care Coordination or Specialty Mental Health Care Management (Health Home Plus)), residential care management (e.g., OMH licensed or funded supportive housing or residential treatment), or has an active AOT order, CPEP staff must coordinate discharge plan details and timing with care managers.

(vi) For individuals with complex needs enrolled in a MCO Plan who are eligible but not enrolled in intensive care management or are enrolled in care management but need intensive care management, CPEP staff must call the MCO and inform the MCO of the discharge.

(vii) Prior to discharge, and in accordance with section 33.13 of the Mental Hygiene Law, the CPEP shall schedule and confirm a follow up appointment with an identified provider to occur within seven calendar days following discharge. If, after making diligent efforts, a CPEP cannot identify an aftercare provider with an available appointment within seven calendar days, the CPEP shall document its efforts and schedule the appointment for as soon as possible thereafter. A referral to a walk-in intake clinic is insufficient to meet this requirement. Individuals who are leaving the CPEP against medical advice, or who state they do not wish to receive aftercare services, shall be provided information about available treatment options and have an appointment scheduled whenever possible. When an appointment for mental health services cannot be made within seven calendar days, crisis outreach teams or other available comprehensive psychiatric emergency program staff shall provide crisis outreach until the initial appointment occurs and such services shall be reimbursed pursuant to section 591.4 of this Title.

(viii) completion of referrals to other community services providers, including peer support services, in collaboration with the individual receiving services and comprehensive psychiatric emergency program staff, to address the person's identified needs.

(ix) each individual shall be given the opportunity to participate in the development of his or her discharge plan. Absent the objection of the person and when clinically appropriate, reasonable attempts shall be made to contact collaterals for their participation in the discharge planning program. However, no person or family member shall be required to agree to the person's discharge. A notation shall be made in the person's record if such person objects to the discharge plan or any part thereof.

(x) All individuals must be screened for suicidality prior to their discharge. Individuals with an elevated risk of self-harm or suicide must have a community suicide safety plan completed before discharge. Lethal means shall be identified and a plan for restriction addressed in the Safety Plan. The CPEP shall document their work with collaterals to implement the plan to restrict lethal means and confirm completion prior to discharge.

(xi) Discharge of individuals with an elevated risk of violence shall include, to every extent possible, close collaboration with current and new outpatient treatment providers, residential providers if applicable, and the county DCS if applicable to incorporate strategies to address violence risk factors and access to weapons into the overall discharge plan in accordance with section 33.13 of the Mental Hygiene Law.

(xii) Individuals who meet criteria for any substance use disorder shall be offered pharmacological interventions, if appropriate, and referred to a new or existing provider who can continue treatment for their substance use disorder.

(3) The comprehensive psychiatric emergency program shall verify that after-care appointment(s) occurred and follow up with individuals to ensure satisfactory linkage to care. Until linkage to care is completed, or for other clinically-indicated reasons, comprehensive psychiatric emergency program staff shall provide crisis outreach services to ensure individuals are safe and stable in the community and continue to provide support, care and assistance with linkage to follow up care. Such services shall be reimbursed pursuant to section 591.4(f) of this Title.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 590.8

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