N.Y. Comp. Codes R. & Regs. tit. 18 § 441.22

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

Section 441.22 - Health and medical services

(a)

(1) Each authorized agency is responsible for providing comprehensive medical and health services for every foster child in its care.

(2) Each authorized agency is responsible for providing comprehensive behavioral health services to every foster child placed in its care in a congregate setting in accordance with the standards set forth in this paragraph and as directed by the Office of Children and Family Services.

(i) Initial assessments/screenings.

(a) Within 72 hours of the child being placed in an agency's congregate care program the child must be screened using a validated, industry accepted instrument for, at minimum, suicidality; chemical dependence requiring immediate medical intervention; and any current prescribed medications. Also, within 72 hours, an individualized crisis intervention plan must be developed with the child. Such plan must be child specific and include preferred de-escalation strategies and interventions to address acute physical behavior and to reduce the risk of physical or psychological harm to such child. For the purposes of this section, a congregate care program includes an institution, group residence, group home, and agency operated boarding home.

(b) The individualized crisis intervention plan must be reviewed after each incident involving the child for which the crisis intervention plan is used. Upon review, the plan should be updated if necessary. Additionally, the individualized crisis intervention plan must be reviewed at each treatment team meeting and updated as necessary.

(c) Within 30 days of a child being placed within an agency's congregate care program, the agency, utilizing a qualified mental health professional, must utilize validated industry accepted instruments to assess the child for service needs related to mental, behavioral, and developmental health; education; social and family connections; substance use/abuse, and sexual assault/trafficking. Such assessments must include consideration for the youth's sexual orientation and gender identity where developmentally appropriate. These assessments/evaluations must be documented in the child's case record and utilized to inform planning for the child and their family in a way that protects sensitive information.

(ii) Support team and plans. Within 30 days of the child being placed in a congregate care setting, a support team must meet to develop the child's support plan which must be reviewed and/or updated on a regular basis as defined below:

(a) The support plan must be reviewed with the child and their parent/guardian or discharge resource every 30 days, and updated if/when necessary

(b) The support team must meet and review/update if necessary, at the following intervals:

(I) For youth 12 years old and younger by days 30, 90, 180, and then every 30 days thereafter(II) For youth 13 years old and older by days 30, 90, 210, 330, and then every 30 days thereafter

(c) The support team must consist of, at minimum, the child (when age appropriate); the child's parent/guardian or discharge resource, as appropriate; a clinical team member who works with the child; the child's agency case planner; and when available, the case manager. Other parties who should be considered for members of the team include, but are not limited to, other medical personnel relevant to the care or treatment of the child; agency education staff; home school district representatives; agency child care staff with strong knowledge of the child; and other relevant service providers.

(d) The support team must document the review and any changes to the child's support plan within seven calendar days of the support team meeting.

(e) The support plan must include: treatment goals that are achievable and quantifiable, and in a manner understood by the child; clear objectives to assist the child in achieving said goals; and specific roles for staff in assisting the child in achieving the goals.

(f) The support plan must also contain a review of any medications the child is prescribed; if the child is prescribed psychiatric medications, the support team in consultation with the prescribing psychiatrist and/or a medical professional must note all medications, including dosage, as well as any changes regarding these medications from previous months; the support team must also note any effects, both assumed positive effects and side effects, of the prescribed medications.

(g) The support plan must be responsive to the individual child's expressed sexual orientation, gender and gender identity.

(iii) The individualized crisis intervention plan and the support plan required by this paragraph must be recorded in the child's case record.

(iv) Ongoing services. Where indicated mental, behavioral, and substance use/abuse services must be provided on a regular basis. The services may be delivered in individual and group modalities. At a minimum such services must include:

(a) a determination by a qualified mental health professional regarding the frequency of the service and the modality or modalities that must be used. Such determination must be based on a professional assessment and document in the child's case record.

(b) group sessions must be incorporated into the program schedule and be conducted by staff trained in the curriculum, treatment, and topics being facilitated.

(c) Any exceptions to the above referenced mandates must be documented by the child's clinician in their treatment plan.

(b)Assessment and testing of children under the age of thirteen in foster care for HIV infection. The terms AIDS, HIV infection, HIV-related illness and HIV-related test are defined in section 360-8.1 of this Title.

(1) Assessment for risk factors for HIV infection. Each child under the age thirteen in foster care must be assessed for risk factors related to HIV infection. Youth, ages thirteen and older must be offered an HIV test as part of their periodic medical assessments.

(2) Within five business days of a child under the age of thirteen entering foster care, the authorized agency must complete an initial assessment of the child's risk for HIV infection based on the risk factors set forth in this subdivision.

(3) The assessment of a child's risk for HIV infection must be made by a medical provider or by designated agency staff with basic information and training regarding HIV and AIDS, knowledge of the risk factors associated with HIV infection, the HIV-related testing available and the confidentiality provisions regarding HIV-related information. The assessment of a child's risk for HIV infection must be appropriate for the age and developmental stage of the child and must include a review of the medical and psychosocial history available at the time to determine whether one or more of the following risk factors related to HIV infection exists.

(i) Risk factors in the medical and psychosocial history of the family related to an infant or child and associated with direct perinatal transmission of HIV infection at birth include:

(a) that this child had a positive drug toxicology or symptoms of drug withdrawal at birth;

(b) that this child had a positive test for syphilis at birth;

(c) that a sibling of this child has a diagnosis of HIV infection, initially tested positive for HIV infection but later seroreverted to negative, or died due to an HIV-related illness or AIDS;

(d) that this child has symptoms consistent with HIV infection;

(e) that this child was abandoned at birth and no risk history is available ; or

(f) that the biological mother of this child has or had a positive HIV status.

(ii) Risk factors related to the child and associated with the child's behavior or other means of direct transmission of HIV infection after the child's birth. The assessment of these risk factors may include discussions with the child, when appropriate for the age and developmental stage of the child, in addition to the required review of the medical and psychosocial history available at the time. These risk factors include:

(a) that this child has been sexually abused;

(b) that this child has engaged in high risk sexual activity such as behavior that includes but is not necessarily limited to unprotected anal, vaginal or oral sex ;

(c) that this child has a history of sexually transmitted diseases, such as syphilis, chlamydia, gonorrhea, hepatitis B, or genital herpes;

(d) that this child is known or reported to have had multiple sex partners or known, reported to or suspected to have been sex trafficked ;

(e) that this child is known or reported to inject illegal drugs or share needles, syringes or other equipment involved in drug use or body piercing; or

(f) that this child is known or reported to use non-injection illegal drugs, such as crack cocaine.

(iii) Risk factors for HIV in the medical and psychosocial history of the family related to the child's biological parent, or sexual partners of the child's biological parent. These risk factors are relevant generally to an infant or young child if they occurred before the child was born and placed the child at risk of HIV infection through perinatal transmission at birth. Risk factors include the biological parent's diagnosis of HIV infection, symptoms consistent with HIV infection, or death due to HIV-related illness or death; and for biological parents not diagnosed with HIV, one or more of the following occurring since their last HIV test:

(a) Condomless anal or vaginal intercourse without HIV pre-exposure prophylaxis with partners whose HIV status is unknown, who have untreated HIV, or who do not have an undetectable viral load while on treatment for HIV;

(b) At least one bacterial STI in the previous 12 months;

(c) Injecting substances for purposes not prescribed, including hormones, or having sexual partners who report injecting substances for purposes not prescribed;

(d) Transactional sex, or history or risk of sex trafficking, such as sex for money, drugs, housing, or other goods, or having sexual partners who report transactional sex;

(e) Multiple or anonymous sexual partners, or having partners who report multiple or anonymous sexual partners;

(f) Sexual activity at sex parties or other high-risk venues, or having partners who report sexual activity at sex parties or other high-risk venues; or

(g) Recreational use of mood-altering substances during sex, such as but not limited to alcohol, methamphetamine, cocaine, and ecstasy.

(iv) Risk factors for HIV related to the child and associated with the child's behavior or other means of direct transmission of HIV infection after the child's birth. The assessment of these risk factors may include discussions with the child, when appropriate for the age and developmental stage of the child, in addition to the required review of the medical and psychosocial history available at the time. Risk factors for the child include one or more of the following occurring since their last HIV test:

(a) Condomless anal or vaginal intercourse without HIV pre-exposure prophylaxis with partners whose HIV status is unknown, who have untreated HIV, or who do not have an undetectable viral load while on treatment for HIV;

(b) At least one bacterial STI in the previous 12 months;

(c) Injecting substance for purposes not prescribed, including hormones, or having sexual partners who report injecting substances for purposes not prescribed;

(d) Transactional sex, or history or risk of sex trafficking, such as sex for money, drugs, housing, or other goods, or having sexual partners who report transactional sex;

(e) Multiple or anonymous sexual partners, or having partners who report multiple or anonymous sexual partners;

(f) Sexual activity at sex parties or other high-risk venues, or having partners who report sexual activity at sex parties or other high-risk venues; or

(g) Recreational use of mood-altering substances during sex, such as but not limited to alcohol, methamphetamine, cocaine, and ecstasy.

(v) The risk factors set forth in subparagraphs (i) and (ii) of this paragraph are not applicable to a child born in New York or any other jurisdiction that conducted a newborn screen that included a HIV test.

(4) Procedures relating to HIV-related testing. If a child is determined through the required assessment to have one or more risk factors for HIV infection, designated agency staff must must refer the child to an appropriate medical provider prior to the child's initial comprehensive medical examination required by paragraph (1) of subdivision (c) of this section for the purpose of offering HIV testing in accordance with applicable HIV testing standards. The referral to the appropriate medical provider must include information on the risk factors identified in the risk assessment.

(5) Additional assessments of a child under the age of thirteen in foster care.

(i) Each periodic medical examination of a child required pursuant to subdivision (f) of this section that occurs after the initial assessment of the child pursuant to paragraph (2) of this subdivision must include an assessment of all HIV risk factors and annually thereafter to coincide with the child's annual periodic medical exam.

(ii) All other HIV risk factors will be addressed by the medical providers appropriately as and if they occur before the next periodic medical exam.

(iii) If it is determined at a service plan review or periodic medical examination of the child that referral to an appropriate medical provider for the offer of HIV-related testing of the child is recommended, the authorized agency must refer the child to an appropriate medical provider within five business days of the recommendation determination consistent with the process set forth in paragraph (4) of this subdivision.

(6) Medical services and counseling. If a child tests positive for HIV infection, the authorized agency must:

(i) refer the child for appropriate medical services; and

(ii) provide or arrange for appropriate psychological and other support services for the child and/or the child's family and/or the child's foster family, as applicable.

(7) Documentation of HIV-related testing of a child in foster care. Information regarding any HIV-related testing of a child in foster care and the results of such testing must be documented in the medical history of the child within the uniform case record in accordance with sections 428.3 of this Title and 441.22 of this Part. Such information must be provided only to those persons or entities authorized to have access to HIV-related information concerning the foster child in accordance with subdivision (o) of this section, section 357.3 of this Title, and article 27-F of the Public Health Law, including:

(i) the certified or approved foster parents or prospective adoptive parents of the child in accordance with section 357.3 of this Title and section 373-a of Social Services Law;

(ii) the child, consistent with article 27-F of the Public Health Law; and

(iii) the parents or guardian of the foster child, the child's written release for such disclosure must be obtained in accordance with section 360-8.1 of this Title before any information concerning the HIV-related test is provided to the child's birth parents or guardian.

(8) Recruitment of families to provide foster or adoptive homes for HIV. Authorized agencies operating foster boarding home programs or adoption programs must include in their community relations recruitment efforts, as required by sections 421.10 and 443.2 of this Title, information regarding the need for families who are able and motivated to care for foster children with HIV when such need is indicated as a result of the assessment and testing required by this subdivision.

(c)

(1) Initial medical examination upon admission into foster care. Each child admitted into foster care must be given a comprehensive medical examination within 30 days after admission. When records are available to document that such an examination has been completed within 90 days prior to admission into care, and the authorized agency has obtained such records and determines that the child's health status does not warrant a second comprehensive examination within 30 days after admission into foster care, the local social services district may waive the initial medical examination required by this paragraph.

(2) When an initial medical examination is required, the examination must be comprehensive in accordance with current recommended medical practice, taking into account the age, environmental background and development of the child. Such an examination must include the following:

(i) a comprehensive health and developmental history;

(ii) a comprehensive unclothed physical examination;

(iii) an assessment of the child's immunization status and the provision of immunizations as necessary;

(iv) an appropriate vision assessment;

(v) an appropriate hearing assessment;

(vi) appropriate laboratory testing;

(vii) a dental screening; and

(viii) observation for child abuse and maltreatment which, if suspected, must be reported to the Statewide Central Register of Child Abuse and Maltreatment as mandated by section 413 of the Social Services Law.

Laboratory tests may include complete blood count, urinalysis, tuberculin skin test, X-rays, HIV related tests, where performed in a manner consistent with article 27-F of the Public Health Law, and lead, sickle cell, and venereal disease screening at the direction of a physician when indicated on the basis of the child's age, medical history, environmental background and physical/developmental condition.

(3) The comprehensive medical examination described in paragraph (2) of this subdivision must be completed within 30 days:

(i) after a child is accepted into foster care, unless records are available to document that such an examination has been completed within 90 days prior to admission into care and the initial medical examination is waived by the authorized agency; or

(ii) after a foster child returns to foster care if more than 90 days have passed and the child:

(a) was discharged from care, either on a trial basis or on a permanent basis; or

(b) was absent from care without leave.

(4) The comprehensive medical examination described in paragraph (2) of this subdivision may be conducted at any time at the discretion of the authorized agency when:

(i) there are concerns about a foster child's health when such child returns to care within 90 days after:

(a) being discharged from care, either on a trial basis or on a permanent basis; or

(b) being absent from care without leave; or

(ii) a child is transferred to the care of another agency and the receiving agency determines that a comprehensive medical examination may be necessary to assist in the formulation of the child's service plan.

(d) Prior to accepting a foster child into care in cases of voluntary placement, or within 10 days after admission into care in emergency or court-ordered placements, authorization in writing must be requested from the child's parent or guardian for routine medical and/or psychological assessments, immunizations and medical treatment, and for emergency medical or surgical care in the event that the parent or guardian cannot be located at the time such care becomes necessary. Such authorization must become a permanent part of the child's medical record. If written authorization cannot be obtained from the child's parent or guardian in cases of involuntary placements, the local social services commissioner may provide written authorization where authorized in accordance with section 383-b of the Social Services Law.

(e) Prior to accepting a child into care or within 10 days after admission into care, authorization must be requested from the child's parent or guardian for release of the child's past medical records. If written consent for release of such records cannot be obtained, the local social services commissioner may authorize release of such records. Diligent efforts must be made by the authorized agency to obtain such records by submitting a written request, along with the appropriate authorization, to the various doctors and/or hospitals known to have previously treated the child. When a preschool child is placed in foster care, diligent efforts must be made to obtain the child's birth record from the hospital where the child was born or from another hospital in possession of such record. Upon receipt, such record must be included in the uniform case record.

(f)

(1) Each foster child must have complete periodic individualized medical examinations, the results of which must be maintained in the child's uniform case record. Such examinations must be provided according to the following schedule:

(i) for children aged 0-1 year: at 2-4 weeks; 2-3 months; 4-5 months; 6-7 months; 9-10 months;

(ii) for children aged 1-6 years: at 12-13 months; 14-15 months; 16-19 months; 23-25 months; 3 years; 4 years; 5 years; and

(iii) for children aged 6-21 years: at 6 years; 8-9 years; 10-11 years; 12-13 years; 14-15 years; 16-17 years; 18-19 years; and 20 years.

(2) Such examinations must follow current recommended medical practice and be consistent with the needs of the child as determined by the child's physician. Every examination must include the following, as appropriate by age:

(i) a comprehensive health and developmental history;

(ii) a comprehensive unclothed physical examination;

(iii) an assessment of immunization status and provision of immunizations as necessary;

(iv) each periodic medical examination of a child that occurs after the initial assessment of the child for risk factors related to HIV infection in accordance with subdivision (b) of this section, must include an assessment by designated agency staff of whether HIV-related testing of the child is recommended based on the child's medical history and any information regarding the child obtained since the initial assessment of the child, the prior service plan review of the child or the prior periodic medical examination of the child, as applicable;

(v) an appropriate vision assessment;

(vi) an appropriate hearing assessment;

(vii) laboratory tests as appropriate for specific age groups or because the child presents a history or symptoms indicating such tests are necessary;

(viii) dental care screening and/or referral. All children up to age three should have their mouths examined at each medical examination and, where appropriate, should be referred for dental care. All children three years of age or over must have a dental examination by a dentist annually and must be provided with any dental care as needed; and

(ix) observation for child abuse and maltreatment which, if suspected, must be reported to the Statewide Central Register of Child Abuse and Maltreatment as mandated by section 413 of the Social Services Law.

(g) When the medical examination indicates a condition requiring follow-up care as determined by the child's physician, the agency responsible for the child's care must provide or arrange for such follow-up care as recommended by the child's physician.

(h)

(1) Within 60 days of the acceptance into foster care of a child who is eligible for medical assistance, the local social services district must notify in writing the child's foster parent(s), or the institution, group residence, group home or agency boarding home where the child is residing of the availability of child/teen health plan services (C/THP). All families eligible for C/THP services must also be informed in writing at least annually of the availability of such services in accordance with section 508.4(a) of this Title.

(2) The local social services district is responsible for assuring that a current listing of the names and locations of medical providers offering examinations, diagnosis and treatment to children eligible for C/THP is made available to foster parents and to other authorized agencies upon request.

(i) For a foster child placed with a child-caring agency having an established Medicaid per diem rate agreement, C/THP services must be provided in accordance with that agency's per diem rate agreement and may not be claimed separately.

(j)

(1) Each authorized agency responsible for the care of a child must inform the foster parent(s) of the comprehensive health history, current health status and health care needs of the foster child when the child is placed in the home, including:

(i) the requirements for type and frequency of medical examinations;

(ii) the agency's procedures for obtaining medical care in cases of suspected illness;

(iii) the agency's procedures for securing emergency medical treatment; and

(iv) information related to whether the child has had an HIV-related test or been diagnosed as having AIDS, an HIV-related illness or an HIV infection. The terms AIDS, HIV-related test, HIV-related illness and HIV infection are defined in section 360-8.1 of this Title.

(2) Each authorized agency must inform the foster parent(s) that assistance is available in scheduling appointments with and providing transportation to providers of medical care on behalf of the foster children placed in their care if such assistance is requested.

(k) For each child in foster care, an authorized agency must maintain a continuing individual medical and dental history within the uniform case record, which must include:

(1) Form DSS-711, Child's Medical Record, or copies of a comparable physician's medical record form. Such form must record the results of the initial medical examination and must be maintained as a continuous and permanent medical history for children placed in foster care. For children in the care of a voluntary agency for whom the local social services district has responsibility, the agency must maintain a continuous and permanent medical and dental history, and the local social services district must maintain a current copy of such history in its files.

(2) Form DSS-704, Medical Report on Mother and Infant. Such form must be used to record the child's birth history, as available from the appropriate hospital, for each preschool child placed in foster care, either in the direct care of the local social services district or in the care of voluntary agencies.

(3) Form DSS-3306, Progress Notes. Such form must be maintained in the uniform case record by the agency providing care to a child and must include a summary of activities related to medical and dental appointments, examinations and services, including records of referrals and transportation provided.

(4) Timely entry of the appropriate data related to medical examination appointments.

(5) Documentation that an assessment has been made in accordance with subdivision (b) of this section for risk factors related to HIV infection, and that, if one or more risk factors have been identified, procedures have been followed to obtain the necessary written informed consent and to arrange for the HIV-related testing of the child. Results of such testing must be included in the medical history of the child within the uniform case record.

(l)

(1) Each foster parent providing care for an adolescent who is 12 years of age or over must be informed in writing within 30 days of placement of the child in the home, and annually thereafter, of the availability of social, educational and medical family planning services for the adolescent in accordance with section 463.2 of this Title.

(2) Each authorized agency, in accordance with section 463.2 of this Title, may, with the prior approval of the local commissioner of social services or upon the delegation of such responsibility by the local social services district, make the offer of family-planning services to all foster children for whom such services would be appropriate and provide such services upon request of the foster child. Such offer may be made orally as long as it is also made in writing.

(m) Upon the transfer of any foster child to the care of another voluntary agency, the agency with which the child was previously placed must provide to the receiving agency a summary of the child's health history and the medical records received from the child's physician.

(n)Medical examination upon discharge from care.

Each child discharged from care to another planned living arrangement with a permanency resource must have a comprehensive medical examination prior to discharge, unless the child has undergone such an examination within one year prior to the date of discharge.

(o) Upon a child's discharge from foster care, the local social services district is responsible for ensuring that:

(1) in accordance with section 357.3 of this Title, a comprehensive health history of the child is provided to the child's parents or guardian or to a child, at no cost, if the child is discharged to his or her own responsibility. Such a history must include, but not be limited to, conditions or diseases believed to be hereditary, where known; drugs or medication taken during pregnancy by the biological mother, where known; immunizations received by the child in foster care and prior to placement in care, where known; medications dispensed to the child while in care and prior to placement in care, where known; allergies the child is known to have exhibited while in care and prior to placement in care, where known; diagnostic tests, including developmental or psychological tests and evaluations given to the child while in care and prior to placement in care, where known, and their results; any follow-up treatment provided to the child prior to placement in care, where known; or provided to the child while in care or still needed by the child; and laboratory tests, including tests for HIV, and the results, where known, except that confidential HIV-related information must not be disclosed to the child's parent or guardian without a written release from the child if the child has capacity to consent as defined in section 360-8.1(a)(8) of this Title and in article 27-F of the Public Health Law. The conditions for the written release authorizing such disclosure are described in section 360-8.1(g) of this Title and in article 27-F of the Public Health Law. The term confidential HIV-related information is defined in section 360-8.1(a)(5) of this Title and in article 27-F of the Public Health Law;

(2) the importance of comprehensive and periodic medical assessments and follow-up treatment is discussed with the child's parents or guardian, or with children discharged to their own care;

(3) assistance is offered to the child's parent(s) or guardian or the child in finding a physician or medical provider organization in an appropriate location through referrals to and/ or lists of such medical providers required to be maintained by social services districts in accordance with section 508.6 of this Title;

(4) diligent effort is made to obtain the name and address of the physician or medical organization who will be providing medical services to the child; and

(5) a copy of the child's comprehensive health history is provided to the child's medical provider when identified.

(p) If a foster child is discovered to have an elevated blood lead level, the authorized agency is responsible for notifying the department and the local health department.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 441.22

Amended New York State Register June 17, 2015/Volume XXXVII, Issue 24, eff. 6/17/2015

Amended New York State Register December 23, 2015/Volume XXXVII, Issue 51, eff. 12/23/2015

Amended New York State Register March 31, 2021/Volume XLIII, Issue 13, eff. 3/31/2021