N.Y. Comp. Codes R. & Regs. tit. 14 § 680.5

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

Section 680.5 - Admission criteria

(a) Only individuals whose needs can be met by the specialty hospital shall be admitted to it. The number admitted shall not exceed the specialty hospital's certified capacity to provide adequate programming.

(b) All admissions to the specialty hospital shall require the prior approval of the commissioner. Request for such prior approval shall be submitted on the forms and in the format acceptable to the commissioner and shall document that all admission criteria and procedures have been met. The commissioner shall process all such requests for prior approval without undue delay.

(c) A specialty hospital shall admit only individuals with developmental disabilities who have a diagnosis of intellectual disability, autism, cerebral palsy, epilepsy or neurological impairment; and who manifest at least one severe deficit in adaptive behavior (see section 680.13 of this Part). Such individual's developmental disability must have originated before the individual's 22nd birthday. In addition, such individuals shall manifest a health care problem which requires more than three hours of daily individualized attention from health care staff (see section 680.13 ).

(d) Individuals admitted to a specialty hospital shall require simultaneous assessment or treatment for their health care needs and structured programming for their developmental disabilities. A specialty hospital covered under this regulation shall admit only individuals who have had a comprehensive assessment (see section 680.13 ) within the 90 days prior to admission. This assessment shall have identified both the individual's developmental disability (ies) and health care needs which will require more than three hours of daily individualized attention from health care staff. In addition, there shall be an identification of the specific service(s) required by the individual in terms of type and frequency and a declaration of the service outcomes to be achieved which are congruent with the conditions necessitating admission. A current individual program plan developed by a State developmental center for the individual within the 90 days prior to admission is considered as complying with this requirement. However, prior admission to a developmental center shall not be a requirement for eligibility for a specialty hospital.

(1) This requirement may be waived in an emergency situation which poses a danger of death or irreversible disability to the individual. However, in such instances, the condition necessitating the emergency admission must be identified and assessed prior to admission.

(2) In an emergency admission situation, the comprehensive assessment shall be completed within 15 calendar days of admission.

(e) The specialty hospital shall admit only those individuals who, due to their medical condition, cannot be placed in a less restrictive environment that is able to provide both medical treatment and active programming, because of their need for the services provided by the specialty hospital.

(f) Individuals with developmental disabilities with an acute health care need(s) (see section 680.13 ) that prohibits active programming for their developmental disability(ies) shall not be admitted to the specialty hospital.

(g) A correspondent (see section 680.13 ) shall be identified for each individual prior to admission to the specialty hospital.

(h) Individuals shall be admitted for a maximum stay of six months. One extension of no more than six months may be made at the recommendation of the Utilization Review Committee. Any further extension requires both the recommendation of the Utilization Review Committee and the consent of the commissioner.

(i) At the time of admission, the type of placement and proposed location (if known) shall be identified and documented in the individual's record for preparation for each individual's placement subsequent to leaving the specialty hospital.

(1) Prior to admission, there shall be a written plan of placement identifying time frames and persons responsible to reasonably assure the readiness of the proposed placement within the six-month transitional specialty hospital placement.

(2) For Willowbrook class members (see section 680.13 ), at the time of admission, residence shall be identified by name and address for each individual's placement subsequent to leaving the specialty hospital. The sole exception to this requirement shall be constituted when the individual's treatment at the specialty hospital may make a less restrictive placement possible than is apparent at the time of his or her admission. In this instance, the type of placement under consideration shall be described at the time of admission.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 680.5

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016