To require chemical dependency programs to establish, explain, and post patient rights and responsibilities.
Substance of proposed rule (Full text is posted at the following State website: www.oasas.state.ny.us):
The Patient Rights regulation establishes criteria for communicating the rights and responsibilities of patients and staff members in alcoholism and substance abuse treatment facilities. The purpose of the regulation is to establish guidelines for providers to create a patient handbook and bill of rights that sets out all of the expectations of treatment. Each facility will create a document that sets forth all of the information relevant to their program which will tell patients what is expected of them and what they can expect from treatment.
Part 815 Patient Rights establishes the standards for communicating the rights and responsibilities of providers and patients in relation to alcohol and substance abuse treatment. All treatment providers shall establish and post a patient bill of rights. This patient bill of rights shall be communicated to the patient in a language or form that will ensure understanding, and shall include information about how to file a complaint or grievance. The document and posting shall include information on how the patient can contact the Office of Alcoholism and Substance Abuse Services.
The patient bill of rights established by treatment providers shall address confidentiality, handling of personal property, and handling of communications with the judicial system and the child welfare system. It shall also include information about treatment planning, services, referrals, and medical planning/ treatment, expectations of behavior while a patient, expectations of staff behavior, discharge criteria, and discharge planning. The patient rights document shall also address issues of religious practice, communication, visiting, payment, drug testing, and policies on restraint and seclusion. The patient rights document shall be created by each provider to include all of the areas required by this regulation, and shall be posted in their facility as well as given to each patient upon admission to their program.
Text of proposed rule and any required statements and analyses may be obtained from:
Patricia Flaherty, Office of Alcoholism and Substance Abuse, 1450 Western Ave., Albany, NY 12203, (518) 485-2317, e-mail: Patricia.Flaherty@oasas.state.ny.us
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
45 days after publication of this notice.
Regulatory Impact Statement
1. Statutory Authority:
Section 19.07(e) of the Mental Hygiene Law authorizes the Commissioner of the Office of Alcoholism and Substance Abuse Services (“the Commissioner”) to adopt standards including necessary rules and regulations pertaining to chemical dependence services.
Section 19.09(b) of the Mental Hygiene Law authorizes the Commissioner to adopt regulations necessary and proper to implement any matter under his or her jurisdiction.
Section 19.21(b) of the Mental Hygiene Law requires the Commissioner to establish and enforce certification, inspection, licensing and treatment standards for alcoholism, substance abuse, and chemical dependence facilities.
Section 19.21(d) of the Mental Hygiene Law requires the commissioner to promulgate regulations which establish criteria to assess alcoholism, substance abuse, and chemical dependence treatment effectiveness and to establish a procedure for reviewing and evaluating the performance of providers of services in a consistent and objective manner.
Section 22.03 of the Mental Hygiene Law requires the Director of any chemical dependency program to establish, communicate and post patient rights, to include information about how to communicate with the Office and the Commissioner.
Section 22.07 of the Mental Hygiene Law authorizes the Commissioner to adopt rules and regulations and take any other necessary action to insure that the rights of individuals who have received or are receiving chemical dependence services are protected.
Section 32.01 of the Mental Hygiene Law authorizes the Commissioner to adopt any regulation reasonably necessary to implement and effectively exercise the powers and perform the duties conferred by Article 32.
Section 32.07(a) of the Mental Hygiene Law gives the Commissioner the power to adopt regulations to effectuate the provisions and purposes of Article 32.
The relevant sections of the Mental Hygiene Law cited above, allow the Commissioner to regulate how alcoholism and chemical dependency services are administered. This regulation will alter the way those services are administered, in that, each provider will be required to establish policy and procedures in regard to patients rights. The objective is in line with the legislative intent behind the enactment of Sections 19, 22 and 32 of the Mental Hygiene Law, allowing the Commissioner to certify, inspect, license and establish treatment standards for all facilities that treat alcoholism and chemical dependency. The enactment of section 22.03 of the Mental Hygiene in 1999 established that the Office was required to notify patients of their rights in a specific way, i.e.: posting them, giving them a written copy, and making sure they are communicated to patients in a form understandable by the patient. Establishing policy and procedures with regard to patient rights, will be a rule that establishes a standard for all facilities which is in the best interest of the client providing better health care and a stronger basis of recovery from addiction.
2. Legislative Objectives:
Chapter 558 of the Laws of 1999 requires the promulgation of rules and regulations to regulate and assure the consistent high quality of services provided within the state to persons suffering from chemical abuse or dependence, their families and significant others, as well as those who are at risk of becoming chemical abusers. The legislature enacted section 19 enabling the Commissioner to establish best practices for treating chemical dependency. Additionally section 22.03 enables the Office to require treatment providers to establish a patient rights document including information about communicating with the Commissioner and the director. Establishing a rule which requires treatment providers to create a policy and procedure for patient rights and clearly delineates the patient's rights and responsibilities in the treatment environment is a best clinical practice which will only enhance the treatment experience.
3. Needs and Benefits:
Best clinical practice for chemically dependent people indicates that clearly defined rights and responsibilities aid in treatment in that patients will know what to expect from treatment providers. Patient rights documents are already being used by treatment providers and are promoted within our treatment community. Mental Hygiene Law section 22.03 requires the Director of any chemical dependency program to establish, communicate and post patient rights, to include information about how to communicate with the Office and the Commissioner. This regulation will mandate that all providers of chemical dependency services become compliant with the statutory requirement. The purpose of the regulation is to establish guidelines for providers to create a patient handbook and bill of rights that sets out all of the expectations of treatment, information relevant to their program, and what is expected of their clients. Each facility/provider shall post notice of the patient bill of rights and a summary of the rights to include information about how to contact the Office of Alcoholism and Substance Abuse Services (OASAS) and the Director of the service in order to assure that every patient is informed of their rights. The patient bill of rights established by treatment providers shall address confidentiality, handling of personal property, and handling of communications with the judicial system and the child welfare system. It shall also include information about treatment planning, services, referrals, and medical planning/ treatment, expectations of behavior while a patient, expectations of staff behavior, discharge criteria, and discharge planning. The patient rights document shall also address issues of religious practice, communication, visiting, payment, drug testing, and policies on restraint and seclusion.
4. Costs:
Any costs incurred by providers will be minimal, consisting of additional paper and printing materials, and are necessary to establish clear treatment boundaries between providers and patients.
a. Costs to regulated parties: Costs for materials will be minimal.
b. Costs to the agency, state and local governments: There will be no additional costs to counties, cities, towns or local districts.
5. Local Government Mandates:
There are no new mandates or administrative requirements placed on local governments.
6. Paperwork:
Part 815 will require some paperwork for certified and or funded providers in order to ensure that utilization review requirements are met. However, since utilization control is presently required and providers are already familiar with utilization control record keeping, it is not expected that new record keeping requirements will be excessive.
7. Duplication:
There is no duplication of other state or federal requirements.
8. Alternatives:
The only alternative is to establish a set policy and procedure at the agency level and impose this on the providers. This alternative was explored and it was decided that each provider is in a unique situation and should establish policy and procedure that are in tune with the special needs and environment for which their patients are situated to. The Alcoholism and Substance Abuse Providers (ASAP) of NYS distributed this proposed regulation to all of its members and requested comment. The comments received were addressed and some changes were made. For example, the section on drug testing was changed to reflect each providers right to require, or not, “supervised” drug testing. Additionally, these regulations were also sent to the Council of Local Mental Hygiene Directors, Greater New York Hospital Association, the Committee on Methadone Program Administrators, Inc., and Outreach Development Corp., for comment.
9. Federal Standards:
There are no specific federal standards or regulations that apply to this amendment.
10. Compliance Schedule:
It is expected that full implementation of Part 815 will be completed within nine months of the adoption of the regulation.
Regulatory Flexibility Analysis
Effect of the Rule: The proposed amendments to Part 815 will impact certified and or funded providers. It is expected that the development of a Patient Rights policy and procedure manual will not only result in better patient care but more effective programs. Most providers already have some form of policy and procedure regarding patient rights. This rule will require uniform compliance by all certified or funded providers.
Compliance Requirements: It is not expected that there will be significant changes in compliance requirements. Since providers are already required to provide utilization review, it is not expected that this regulation, will have significant additional costs.
Professional Services: it is not expected that programs will need to utilize additional professional services.
Compliance Costs: Minimal costs for printed material are expected.
Economic and Technological Feasibility: Compliance with Part 815 is not expected to have an economic impact or require any changes to technology for small businesses and government.
Minimizing Adverse Impact: Part 815 has been carefully reviewed to ensure minimum adverse impact to providers. The Alcoholism and Substance Abuse Providers of NYS, Inc., were briefed on this proposal, and they were provided with the ability to comment as a part of the process of developing this rule. Any impact this rule may have on small businesses and the administration of State or local governments, will either be a positive impact or the minimal costs for materials and compliance are so small that they will be absorbed into the already existing economic structure.
Small Business and Local Government Participation: These amendments were shared with New York's treatment provider community including, Alcoholism and Substance Abuse Providers of NYS, Inc. In addition the Council of Local Mental Hygiene Directors, the Greater New York Hospital Association, The Healthcare Association of New York, and the Committee on Methadone Program Administrators, Inc, as well as the Legal Action Center.
Rural Area Flexibility Analysis
1. Types and estimated number of rural areas: Certified providers of services that will be impacted by the amendments to Part 815 are located in rural as well as suburban and metropolitan areas of the State.
2. Reporting, recordkeeping and other compliance requirements; and professional services: There will be no new reporting requirements that will impact rural providers.
3. Costs: There will be minimum impact for rural providers. Any additional costs for print materials will be minimal.
4. Minimizing adverse impact: It is not expected that there will be any adverse impact to rural areas.
5. Rural area participation: These amendments were shared with New York's treatment provider community and included a cross-section of upstate and downstate, as well as urban and rural programs.
Job Impact Statement
The expectations contained in Part 815 are being accomplished by the majority of treatment providers pursuant to their own internal policy and procedures and will not have a significant impact on the job duties of treatment providers. The requirement relating to drug testing may require additional staff, however existing funding reimburses staffing ratios at a sufficient level to reimburse any additional staffing costs.
