PDD-43-11-00016-A Provisions for Medical Director Coverage in Article 16 Clinics

3/14/12 N.Y. St. Reg. PDD-43-11-00016-A

NEW YORK STATE REGISTER

VOLUME XXXIV, ISSUE 11

March 14, 2012

RULE MAKING ACTIVITIES

OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

NOTICE OF ADOPTION

 

I.D No. PDD-43-11-00016-A

Filing No. 171

Filing Date. Feb. 28, 2012

Effective Date. Mar. 14, 2012

Provisions for Medical Director Coverage in Article 16 Clinics

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Action taken:

Amendment of section 679.3 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 13.07, 13.09(b) and 16.00

Subject:

Provisions for medical director coverage in Article 16 clinics.

Purpose:

To scale medical director coverage to the size of the clinic.

Text or summary was published

in the October 26, 2011 issue of the Register, I.D. No. PDD-43-11-00016-P.

Final rule as compared with last published rule:

No changes.

Text of rule and any required statements and analyses may be obtained from:

Barbara Brundage, Director, Regulatory Affairs Unit, OPWDD, 44 Holland Avenue, Albany, NY 12229, [phone], email: [e-mail]

Additional matter required by statute:

Pursuant to the requirements of the State Environmental Quality Review Act, OPWDD, as lead agency, has determined that the action described herein will have no effect on the environment, and an E.I.S. is not needed.

Assessment of Public Comment

OPWDD received three comments from three not-for-profit providers in its system.

Comment: A provider submitted a comment in support of the proposed rule which reduces the minimum medical director coverage required and scales coverage to the size of the clinic. The provider indicated that the current requirement for.34 FTE "far exceeded" the provider's needs and that the proposed rule "allows sufficient time" for its medical director to provide the proper clinic services to individuals. The provider also added that "while the medical director's insight has proven valuable in making clinical decisions" for individuals in its clinics, "oversight beyond a base level seems excessive and unnecessary." The provider stated, "Best practice would dictate that the individual's primary medical provider be given the task of addressing any needs that lie beyond the base level."

Response: OPWDD appreciates the provider's support for the regulations.

Comment: A provider commended OPWDD "for providing greater flexibility to providers in how they staff their Article 16 Clinics." The provider agrees with OPWDD's approach to scale coverage to the size of the clinic and recognized that this is a "regulatory modernization that makes sense." The provider requested that OPWDD consider calculating the medical director full time equivalent by the number of "patient" visits, rather than the number of assessments conducted. The provider expressed that this might be easier to monitor and that it "better comports with how productivity and staffing metrics are measured in health care."

Response: In developing the regulation, OPWDD evaluated various indicators which could be used to correlate with the workload of the medical director. Among the measures that it considered was the use of total number of patient visits. However, OPWDD selected an indicator which approximates the number of individuals served (number of annual physician assessments), rather than the number of patient visits. OPWDD considers that the oversight of the clinic medical director is more closely correlated with the number of patients than with the number of patient visits. This is because of the wide variation in the number of services received by individuals in a given year. Some individual receive a large number of similar services (e.g. physical therapy twice a week) and others receive a small number (e.g. routine dentistry a few times a year). OPWDD considers that the oversight provided by the medical director is generally related to a review of each individual's treatment plan rather than related to a review of each specific instance of service delivery. The level of oversight provided by the medical director may be modestly greater for an individual receiving more patient visits, but the amount of time needed to provide this oversight is not in proportion to the difference in the number of services. Because of the variation in the average number of patient visits per patient per year between clinics, the use of the suggested indicator of patient visits might result in the minimum being too high for some clinics and too low for others. OPWDD is therefore finalizing the regulation using the indicator used in the proposed regulation (annual physician assessments).

Comment: A provider commented that the proposed regulation would be an improvement over existing regulations. However, the provider asserts that the best solution would be to mirror the regulations in place for Article 28 clinics. The Article 28 regulations do not prescribe the amount of time necessary for the medical director to be employed by the clinic and therefore, this ensures that there is clinical oversight while allowing the clinics to manage a medical director's time based on the needs of the patients.

Response: OPWDD considers that it is important to specify the minimum requirements for adequate medical director coverage for clinics to make sure that the necessary oversight is provided and to safeguard the quality of services. OPWDD has therefore historically included such minimum requirements in its regulations for Article 16 clinics and intends to continue to specify the minimum FTE for the clinic medical director. OPWDD considers that the proposed regulations continue to provide for adequate oversight by a medical director while "right-sizing" the minimum FTE and is therefore finalizing the regulations as proposed.

Request for clarification: OPWDD received a question about whether the proposed rule would change required duties of the clinic medical director.

Response: OPWDD notes that the new regulations only changes requirements for medical director coverage. The new regulations do not add any new requirements or change any requirements pertaining to the duties of the clinic medical director.