N.Y. Comp. Codes R. & Regs. tit. 14 § 593.6

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

Section 593.6 - Service authorization and planning requirements

(a) In order to receive reimbursement for the provision of community rehabilitation services to an individual, the provider of service must ensure that the individual has been authorized in writing by a physician, prior to or upon admission, to receive services as provided by the program. The written authorization must be retained as a part of the individual's case record. The physician's authorization must:

(1) be based upon appropriate clinical information and assessment of the individual. The initial authorization must include a face-to-face assessment;

(2) delineate the maximum duration of the authorization to receive such services; and

(3) specify that the individual is in need of community rehabilitation services as defined in section 593.4(b) of this Part.

(b) Service authorizations which are renewed must be signed by a physician, physician assistant, or nurse practitioner in psychiatry. Service authorizations must be renewed as follows:

(1) every six months for individuals residing within congregate residences and residential programs for children and adolescents. The reauthorization for a child or adolescent must include a face-to-face contact with the physician, physician assistant or nurse practitioner in psychiatry who signs and renews the service authorization;

(2) every 12 months for individuals residing within an apartment program; and

(3) upon transfer to a different category of adult program (i.e., congregate to apartment or apartment to congregate). The authorization renewal must, in the case of a transfer from congregate to apartment, occur upon the expiration date of the current authorization or in the case of a transfer from apartment to congregate, within six months of admission to the new program or the expiration of the current authorization, whichever comes first.

(c) Community rehabilitation services shall be provided in accordance with a service plan developed within four weeks of admission to the program. At the time of admission an admission note must be prepared by a qualified mental health staff person which, at a minimum, indicates a description of the needs of the individual as well as a brief description of the community rehabilitation services necessary to meet these needs during the initial period after admission.

(d) Such plan shall be developed by the staff of the program, resident and any collateral identified for participation in planning, as appropriate. The service plan must be reviewed and signed by a qualified mental health staff person. The service plan development process should facilitate mutual agreement on a planned course of action which, at a minimum, identifies the following:

(1) statement of service goals and objectives;

(2) identification of the community restorative services to be provided;

(3) proposed time periods;

(4) efforts to coordinate services with other providers, as appropriate; and

(5) approval of the resident, as documented by his or her signature (or the signature of the person who has legal authority to consent to health care on behalf of the resident) provided, however, that the lack of such signature shall not constitute noncompliance with this requirement if the reasons for non-participation and/or non-approval by the resident are documented in the progress note.

(e) Progress notes shall be recorded by staff members who are authorized by the program. Such notes shall be prepared at least monthly and shall indicate the type of community rehabilitation services which have been provided, any significant events which have occurred and, if appropriate, any recommendations for changes to the goals and objectives of the service plan.

(f) The service plan shall be reviewed at least every three months with the initial review occurring three months from the date of admission. The review shall include participation of staff involved in the provision of community rehabilitation services to the resident, the resident and/or if appropriate and approved by the resident, the resident's family or other collateral. Such review shall include the following:

(1) assessment of the progress of the resident in regard to mutually agreed upon goals and objectives in the service plan;

(2) recommendations for adjustment of goals and objectives, time periods for achievement, intervention strategies for the initiation of discharge planning; and

(3) review of the service plan and signed approval by a qualified mental health staff person.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 593.6