Improve quality of service by clarifying regulations to eliminate frequent waiver requests and reduce administrative burdens.
Substance of proposed rule (Full text is posted at the following State website:www.oasas.ny.gov):
The proposed amendments were identified through a process of ongoing broad-based dialogue between OASAS, OASAS certified providers, and affiliated stakeholders to define a "gold standard" for treatment and/or identify "best practices" for quality patient-centered care. Parts 815, 818 and 819 establish the requirements for patient rights, inpatient rehabilitation and residential services. Providers would be required to comply with the proposed changes as soon as the revised regulations are promulgated. The proposed amendments represent the consensus of the OASAS-provider workgroup that these changes would advance the aforementioned goals as follows:
A. Proposed Amendments to Part 815 (Patient Rights)
Sections 815.4(b) and (i), relating to notice of patient rights upon admission, and section 815.8(c), relating to documentation of breathalyzer tests, are amended as follows:
1. Section 815.4(b): A new sentence is added to require the provision of documents to a patient who wishes to express a grievance or concern so that he or she may initiate the grievance process.
2. Section 815.4(i): The provision relating to referral and written notice of status to persons who are not admitted to a program is amended to be consistent with operating regulations.
3. Section 815.8(c): This provision, relating to drug testing documentation, is repealed because it is duplicative, unduly burdensome and unnecessary.
B. Proposed Amendments to Part 818 (Inpatient Rehabilitation Services)
Section 818.2(c)(1), relating to size of counseling groups, section 818.4(a)(5), identifying services included in a comprehensive evaluation, section 818.4(f), regarding functional areas in treatment plans, section 818.4(i)(8) and (9), relating to approval of treatment plans, section 818.4(l), relating to revisions to treatment plans, section 818.4(n)(1-2), relating to documentation of treatment, section 818.8(o), relating to the definition of qualified health professionals (QHPs), and section 818.8(c), relating to staff training, are amended as follows:
1. Section 818.2(c)(1): This provision is amended to increase the maximum group counseling size from 12 to 15, which will allow for cost-effective delivery of services.
2. Section 818.4(a)(5): A new paragraph is added to identify the initial services needed to be included in the comprehensive evaluation.
3. Section 818.4(f): This subdivision regarding treatment plans is amended to extend the maximum period of time needed to identify patient needs, taking into account functional, cultural and social areas.
4. Section 818.4(i)(8) and (9): These paragraphs are amended to include new time frames for the review and signing of treatment plans and clarify the need for review and approval by the multi-disciplinary team.
5. Section 818.4(l): This subdivision regarding treatment plans is amended to allow treatment plan revisions to be achieved upon determination by a clinical staff member instead of a mandatory revision within a set period of days.
6. Section 818.4(n)(1-2): These paragraphs are amended to more clearly describe documentation requirements.
7. Section 818.8(c): This subdivision regarding staff training is amended to be consistent with training requirements for other programs and promote patient-centered treatment.
8. Section 818.8(o): This subdivision is amended to more clearly describe and define staffing requirements and promote patient-centered treatment.
C. Proposed Amendments to Part 819 (Residential Services)
Section 819.4(h)(8), relating to treatment plan signatories, section 819.4(l)(1), relating to documentation of services, section 819.7(b)(1-7), relating to staff training requirements, and section 819.2(e)(l)(i), relating to maximum size of group therapy, are amended as follows:
1. Section 819.4(h)(8): This paragraph is amended to provide administrative relief to programs by allowing any supervising QHP to sign a treatment plan.
2. Section 819.4(l)(1): This paragraph is amended to allow a progress note to be entered on a treatment plan no less than once every two weeks rather than once per week. This change recognizes current professional process.
3. Section 819.7(b)(1-7): These paragraphs on staff training are amended to be consistent with training requirements for other programs and promote patient-centered treatment.
4. Section 819.2(e)(l)(i): This paragraph is amended to increase the maximum group counseling size from 12 to 15, which is consistent with other programs and will allow for cost effective delivery of services.
Text of proposed rule and any required statements and analyses may be obtained from:
Sara Osborne, Senior Attorney, NYS Office of Alcoholism and Substance Abuse Services, 1450 Western Ave., Albany, NY 12203, (518) 485-2317, email: SaraOsborne@oasas.ny.gov
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 ensure that persons who abuse or are dependent on alcohol and/or substances and their families are provided with care and treatment which is effective and of high quality.
Section 19.09(b) of the Mental Hygiene Law authorizes the Commissioner of the Office of Alcoholism and Substance Abuse Services to adopt regulations necessary and proper to implement any matter under his or her jurisdiction.
Section 19.40 of the Mental Hygiene Law authorizes the Commissioner of the Office of Alcoholism and Substance Abuse Services to issue operating certificates for the provision of chemical dependence services.
Section 19.15(a) of the Mental Hygiene Law bestows upon the Commissioner the responsibility of promoting, establishing, coordinating, and conducting programs for the prevention, diagnosis, treatment, aftercare, rehabilitation, and control in the field of chemical abuse or dependence.
Section 32.01 of the Mental Hygiene Law authorizes the Commissioner of the Office of Alcoholism and Substance Abuse Services to adopt any regulation reasonably necessary to implement and effectively exercise the powers and perform the duties conferred by article 32 of the Mental Hygiene Law.
Section 32.07(a) of the Mental Hygiene Law gives the Commissioner of the Office of Alcoholism and Substance Abuse Services the power to adopt regulations to effectuate the provisions and purposes of article 32 of the Mental Hygiene Law.
The relevant sections of the Mental Hygiene Law cited above, authorize the Commissioner to regulate the provision of services to patients, how such chemical dependency services are delivered, establish standards for the provision of such services, and qualifications of staff.
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. Parts 815, 818 and 819 establishes the requirements for patient rights, inpatient rehab and residential services. The proposed amendments to: Part 815 Patient Rights, sections 815.4(b) and (i), 815.8(c) regarding notice of patient rights upon admission, and documentation of breathalyzer tests; Part 818 Inpatient Rehabilitation Services, sections 818.2(c)(1) regarding size of counseling groups, 818.4(a)(5) regarding identifying services included in a comprehensive evaluation, 818.4(f) regarding functional areas in treatment plans, 818.4(i)(8) and (9) regarding approval of treatment plans, 818.4(l) regarding revisions to treatment plans, 818.4(n)(1-2) regarding documentation of treatment, 818.8(o) regarding definition of qualified health professionals (QHP), and 818.8(c) regarding staff training; Part 819 Residential Services, sections 819.4(h)(8) regarding treatment plan signatories, 819.4(l)(1) regarding documentation of services, 819.7(b)(1-7) regarding staff training requirements, and 819.2(e)(l)(i) regarding maximum size of group therapy will guarantee patients the best care and treatment delivered in a manner that is also cost effective and accountable.
3. Needs and Benefits:
The proposed amendments are intended to enable clinical staff and qualified health professionals to enhance patient-centered care and more cost-effective service delivery through the reduction of paperwork and/or administrative redundancy. The need for these changes was identified through a process of on-going broad-based dialogue between OASAS, OASAS certified providers, and affiliated stakeholders to define a "gold standard" for treatment and/or identify "best practices" for quality patient-centered care. The proposed amendments represent the consensus of the OASAS-provider workgroup that these changes would advance those goals as follows:
A. 1. 815.4(b): Adding a sentence to provide a patient who wishes to express a grievance or concern, the documents to initiate the grievance process.
2. 815.4(i): REPEAL of provision relating to written notice of status to patients will provide administrative relief to providers.
B. 815.8(c): REPEAL of this provision relating to drug testing documentation is duplicative, unduly burdensome and unnecessary.
C. 818.2(c)(1): Increasing the maximum group counseling size from 12 to 15 will allow for cost effective delivery of services.
D. 818.4(a)(5): A new paragraph is added to identify the initial services needed to be included in the comprehensive evaluation.
E. 818.4(f): This section regarding treatment plans is amended to extend the maximum period of time needed to identify patient needs taking into account functional, cultural and social areas.
F. 818.4(i)(8) and (9): These paragraphs are amended to include new time frames for the review and signing of treatment plans and clarifies the need for review and approval by the multi-disciplinary team.
G. 818.4(l): This subdivison regarding treatment plans is amended to allow treatment plan revisions to be achieved upon determination by a clinical staff member instead of a mandatory revision within a set period of days.
H. 818.4(n)(1-2): This section is amended to more clearly describe documentation requirements.
I. 818.8(c): This subdivision regarding staff training is amended to be consistent with training requirements for other programs and promote patient-centered treatment.
J. 818.8(o): This section is amended to more clearly describe and define staffing requirements and promote patient-centered treatment.
K. 819.4(h)(8): This section is amended to provide administrative relief to programs by allowing any supervising QHP to sign a treatment plan.
L. 819.4(l)(1): This section is amended to allow a progress note to be entered on a treatment plan no less than once every two weeks rather than once per week. This change recognizes current professional process.
M. 819.7(b)(1-7): This section on staff training is amended to be consistent with training requirements for other programs and promote patient-centered treatment.
N. 819.2(e)(l)(i): This section is amended to increase the maximum group counseling size from 12 to 15 which is consistent with other programs and will allow for cost effective delivery of services.
4. Costs:
There are no increased costs anticipated from these proposed amendments.
a. Costs to the agency, state and local governments: There will be no additional costs to the agency, counties, cities, towns or local districts.
b. Providers will realize cost savings from more efficient delivery of services and increased productivity of a treatment staff focused more on the individual patient than on the paper-trail.
5. Local Government Mandates:
There are no new mandates or administrative requirements placed on local governments.
6. Paperwork / Reporting:
Amendments will result in a reduction in paperwork for both the OASAS and its certified providers.
7. Duplications:
There is no duplication of other state or federal requirements.
8. Alternatives:
The alternative would be to leave the existing regulations in place. These amendments will provide administrative relief to providers and overall regulatory consistency.
9. Federal Standards:
There are no specific federal standards or regulations that apply to these amendments.
10. Compliance Schedule:
Providers can comply with the proposed changes as soon as new regulations are promulgated.
Regulatory Flexibility Analysis
Types / Numbers:
The proposed amendments to Part 815 will affect all certified providers. The proposed amendments to Part 818 will impact all 65 certified providers of Inpatient Rehabilitation Services. The proposed amendments to Part 819 will impact all 88 certified providers of Intensive CD Residential Services. All providers may interact with local governments; some of these providers are also small businesses.
Reporting / Recordkeeping, Professional Services:
It is anticipated that there will be no impact on reporting, recordkeeping or engagement of professional services by local governments or small businesses. There are no new mandates or administrative requirements placed on local governments.
Costs:
Providers will realize cost savings from more efficient delivery of services and increased productivity of treatment staff because of the reduction or elimination of unnecessary or excessive administrative paperwork. There will be no impact on costs of local governments and no fiscal impact to the State.
Economic / Technological Feasibility:
The proposed amendments require no new equipment or technological improvements.
Minimizing Adverse Economic Impacts:
The need for these changes was identified through an ongoing statewide dialogue between OASAS, OASAS certified providers, and affiliated stakeholders that began in the summer of 2007. The goals of this workgroup include: defining a "gold standard" for treatment; identifying "best practices" for quality patient-centered care; and reducing the administrative burden on clinical staff while improving efficiency and productivity. Subcommittees identified and prioritized specific actions which could be readily implemented to advance quality patient-centered care and administrative relief. Potential adverse economic impact was a primary concern because the goal of the workgroup is to improve cost effectiveness and efficiency. The proposed amendments represent the consensus of the OASAS-provider workgroup that these changes would advance those goals.
The proposed amendments were presented to the Advisory Council and then distributed for comment to members of the provider/stakeholder community not already participating in the initial workgroup. Providers are supportive of these proposed changes and eager to implement them.
Participation of Affected Parties:
The need for these changes was identified through a process described above. In addition, there was additional input from the OASAS Advisory Council.
Rural Area Flexibility Analysis
Types / Numbers:
The proposed amendments to Part 815 will affect all certified providers. The proposed changes to Part 818 will impact all 65 certified providers of Inpatient Rehabilitation Services. The proposed amendments to Part 819 will impact all 88 certified providers of Intensive CD Residential Services.
Reporting / Recordkeeping, Professional Services:
Regardless of program location (rural, urban or suburban), it is anticipated that there will be no impact on reporting or recordkeeping or engagement of professional services by local governments or small businesses. There are no new mandates or administrative requirements placed on local governments.
Costs:
Regardless of program location, providers will realize cost savings from more efficient delivery of services and increased productivity of treatment staff because of reduction or elimination of unnecessary or excessive administrative paperwork. There will be no impact on costs of local governments.
Economic / Technological Feasibility:
Regardless of location (rural, urban or suburban), the proposed amendments require no new equipment or technological improvements.
Minimizing Adverse Economic Impacts:
The need for these changes was identified through an on-going statewide dialogue between OASAS, OASAS certified providers, and affiliated stakeholders that began in the summer of 2007. The goals of this workgroup include: defining a "gold standard" for treatment; identifying "best practices" for quality patient-centered care; and reducing the administrative burden on clinical staff while improving efficiency and productivity. Subcommittees identified and prioritized specific actions which could be readily implemented to advance quality patient-centered care and administrative relief. Potential adverse economic impact was a primary concern because the goal of the workgroup is to improve cost effectiveness and efficiency. The proposed amendments represent the consensus of the OASAS-provider workgroup that these changes would advance those goals.
The proposed amendments were presented to the Advisory Council and then distributed for comment to members of the provider/stakeholder community not already participating in the initial workgroup. Providers are supportive of these proposed changes and eager to implement them.
Participation of Affected Parties:
The need for these changes was identified through a process described above. In addition, there was additional input from the OASAS Advisory Council.
Job Impact Statement
No change in the number of jobs and employment opportunities is anticipated as a result of the proposed amendments to these Parts. These proposed amendments will provide administrative relief and greater staff efficiencies which should help to preserve employment.
