OMH-22-09-00012-P Prior Approval Review for Quality and Appropriateness

6/3/09 N.Y. St. Reg. OMH-22-09-00012-P

NEW YORK STATE REGISTER

VOLUME XXXI, ISSUE 22

June 03, 2009

RULE MAKING ACTIVITIES

OFFICE OF MENTAL HEALTH

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. OMH-22-09-00012-P

Prior Approval Review for Quality and Appropriateness

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

Proposed Action:

Amendment of Part 551 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 7.09, 31.04, 31.05 and 31.23

Subject:

Prior Approval Review for Quality and Appropriateness.

Purpose:

To streamline the process for agencies to obtain OMH project approval.

Substance of proposed rule (Full text is posted at the following State website:www.omh.state.ny.us):

Summary

This rule will amend 14 NYCRR Part 551, Prior Approval Review for Quality and Appropriateness, by streamlining the process for agencies to obtain project approval from the Office of Mental Health.

Overview

All programs requiring licensure (e.g., inpatient, community residences, outpatient) by the Office of Mental Health are required to obtain prior approval from the Office before a program can be developed or modified. The current regulatory requirements involve a comprehensive review process that does not necessarily reflect the scope of the proposed action; thus, changes that are relatively ministerial in nature require the same level of review as a more substantial project. The amendments will make better use of agency resources by categorizing projects requiring review into three distinct categories: “Administrative Action”, “Comprehensive PAR” and “E-Z PAR”. The amendments will ultimately result in a reduction in the amount of time it takes for the Office of Mental Health to render a decision, as well as a reduction in the amount of paperwork necessary to be completed by providers. Ultimately, the streamlined process will allow the agency to more appropriately focus its resources on substantial projects and eliminate or reduce such focus on ministerial projects.

Requirements

Projects categorized as “Administrative Action” will not be subject to the prior approval review specified in Part 551 of Title 14 NYCRR; however, certain projects will require the submission of OMH-prescribed forms prior to the implementation of a proposed action.

Projects in the category of “Comprehensive PAR” review would include those that establish a new program which is not currently licensed by OMH or which has been licensed for less than six months; establishment of licensed psychiatric inpatient beds or expansion or reduction of licensed psychiatric inpatient beds by at least 15 percent of the licensed capacity of that site or by more than 10 beds, whichever is less; a change in sponsor of a program licensed by OMH where the new sponsor does not currently operate a program licensed by OMH or has been licensed for less than six months; closure of a licensed psychiatric inpatient program; capital projects that exceed $600,000 (or a dollar amount determined by the Commissioner based upon average construction cost increases subsequent to 2010), and projects otherwise eligible for E-Z PAR review that are reclassified to Comprehensive PAR review pursuant to the regulation.

Projects classified as E-Z Par review would consist of outpatient program projects submitted by an applicant which currently operates an outpatient program that is currently licensed by OMH including: establishment of a new outpatient program; establishment of a new satellite, relocation of a licensed outpatient program or satellite to a location outside of the program’s current county; expansion or reduction of caseload or annual volume of services in a clinic treatment program over any contiguous 12-month period by more than 25 percent; expansion or reduction of the approved caseload or capacity of an outpatient program, excluding clinic treatment programs, over any contiguous 12-month period by more than 10 percent; closing an outpatient program; a substantial change in population served, services provided, or program type; and other projects that may have a substantial impact on outpatient mental health services. Other E-Z PAR projects would include licensed housing projects submitted by an applicant which currently operates a program which has been licensed by OMH including: expansion or reduction of licensed capacity; relocation of licensed housing, including community residences, crisis residences, single room occupancy residences; establishment of licensed housing operated by a business entity; establishment of licensed housing not selected through OMH’s request for proposal process; and closure of licensed housing programs. E-Z PAR projects also include inpatient projects that involve expansion or reduction of licensed inpatient beds by more than 5 percent up to 15 percent, or by a maximum of 10 beds, whichever is less; and requests for a waiver of the requirement that the program admit individuals in emergencies. A change of sponsor of a program currently licensed by OMH, when the new sponsor currently operates a program which has been licensed by OMH for at least six months and is in good standing would warrant an E-Z PAR process, as would a significant change in the terms and conditions of an operating certificate and capital projects falling within a prescribed dollar range.

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

Joyce Donohue, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, [phone], email: [e-mail]

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 7.09 of the Mental Hygiene Law grants the Commissioner of the Office of Mental Health the authority and responsibility to adopt regulations that are necessary and proper to implement matters under his/her jurisdiction.

Section 31.04 of the Mental Hygiene Law provides that the Commissioner has the power to adopt regulations and to establish procedures for the issuance and amendment of operating certificates.

Section 31.05 of the Mental Hygiene Law establishes the criteria for the issuance of an operating certificate.

Section 31.23 of the Mental Hygiene Law establishes criteria for the approval of facility programs, services and sites.

2. Legislative Objectives: Article 7 of the Mental Hygiene Law reflects the Commissioner’s authority to establish regulations regarding mental health programs. Furthermore, the Legislature intended, through passage of Mental Hygiene Law Article 31, to grant the Commissioner of the New York State Office of Mental Health (OMH) the authority to issue operating certificates, and to prescribe a process to determine appropriate criteria for quality, safety and fiscal viability of the program.

3. Needs and Benefits: The amendments to Part 551 of Title 14 NYCRR will streamline the process for agencies to obtain OMH project approval. All programs requiring licensure (e.g., inpatient, community residences, outpatient) by OMH are required to obtain prior approval from OMH before a program can be developed or modified. The current regulatory requirements involve a comprehensive review process that does not necessarily reflect the scope of the proposed action. Therefore, changes that are relatively ministerial in nature require the same level of review as a more substantial project. The amendments will better use of agency resources by categorizing projects requiring review into three distinct categories: “Administrative Action, “Comprehensive PAR” and “E-Z PAR”.

Projects categorized as “Administrative Action” will not be subject to the prior approval review specified in Part 551 of Title 14 NYCRR; however, certain projects will require the submission of OMH-prescribed forms prior to the implementation of a proposed action.

Projects in the category of “Comprehensive PAR” review would include those that establish a new program which is not currently licensed by OMH or which has been licensed for less than six months; establishment of licensed psychiatric inpatient beds or expansion or reduction of licensed psychiatric inpatient beds by at least 15 percent of the licensed capacity of that site or by more than 10 beds, whichever is less; a change in sponsor of a program licensed by OMH where the new sponsor does not currently operate a program licensed by OMH or has been licensed for less than six months; closure of a licensed psychiatric inpatient program; capital projects that exceed $600,000 (or a dollar amount determined by the Commissioner based upon average construction cost increases subsequent to 2010), and projects otherwise eligible for E-Z PAR review that are reclassified to Comprehensive PAR review pursuant to the regulation.

Projects classified as E-Z Par review would consist of outpatient program projects submitted by an applicant which currently operates an outpatient program that is currently licensed by OMH including: establishment of a new outpatient program; establishment of a new satellite, relocation of a licensed outpatient program or satellite to a location outside of the program’s current county; expansion or reduction of caseload or annual volume of services in a clinic treatment program over any contiguous 12-month period by more than 25 percent; expansion or reduction of the approved caseload or capacity of an outpatient program, excluding clinic treatment programs, over any contiguous 12-month period by more than 10 percent; closing an outpatient program; a substantial change in population served, services provided, or program type; and other projects that may have a substantial impact on outpatient mental health services. Other E-Z PAR projects would include licensed housing projects submitted by an applicant which currently operates a program which has been licensed by OMH including: expansion or reduction of licensed capacity; relocation of licensed housing, including community residences, crisis residences, single room occupancy residences; establishment of licensed housing operated by a business entity; establishment of licensed housing not selected through OMH’s request for proposal process; and closure of licensed housing programs. E-Z PAR projects also include inpatient projects that involve expansion or reduction of licensed inpatient beds by more than 5 percent up to 15 percent, or by a maximum of 10 beds, whichever is less; and requests for a waiver of the requirement that the program admit individuals in emergencies. A change of sponsor of a program currently licensed by OMH, when the new sponsor currently operates a program which has been licensed by OMH for at least six months and is in good standing would warrant an E-Z PAR process, as would a significant change in the terms and conditions of an operating certificate and capital projects falling within a prescribed dollar range.

The amendments will result in a reduction in the amount of time it takes for OMH to render a decision, a reduction in the amount of paperwork necessary to be completed by providers, and will ultimately allow OMH to focus agency resources on substantial projects and eliminate or reduce the focus on ministerial projects. The above-noted benefits are expected to assist agencies in adjusting to the needs of individuals receiving mental health services in a timely manner without undue delays.

4. Costs:

(a) cost to State government: These regulatory amendments will not result in any additional costs to State government.

(b) cost to local government: These regulatory amendments will not result in any additional costs to local government.

(c) cost to regulated parties: These regulatory amendments will not result in any additional costs to regulated parties.

5. Local Government Mandates: These regulatory amendments will not result in any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.

6. Paperwork: By streamlining the Prior Approval Review process, this rule will result in reduced paperwork for certain providers.

7. Duplication: These regulatory amendments do not duplicate existing State or federal requirements.

8. Alternatives: The only alternative to the regulatory amendment which was considered was inaction. Since the amendment will provide a more streamlined and quicker approval process for providers, which will ultimately result in an improved mental health delivery system, that alternative was necessarily rejected.

9. Federal Standards: The regulatory amendments do not exceed any minimum standards of the federal government for the same or similar subject areas.

10. Compliance Schedule: The regulatory amendments will become effective immediately upon adoption.

Regulatory Flexibility Analysis

The amendments to Part 551 serve to streamline the process for agencies to obtain OMH project approval. This will result in a reduction in the amount of time it takes for OMH to render a decision in the approval process, as well as a reduction in the amount of paperwork necessary to be completed by providers. Therefore, as it is evident from the nature of the proposed rule that there will be no adverse economic impact on small businesses or local governments, a regulatory flexibility analysis is not submitted with this notice.

Rural Area Flexibility Analysis

A Rural Area Flexibility Analysis is not submitted with this notice because the proposed rule will not impose any adverse economic impact on rural areas. The amendment merely streamlines the process for agencies to obtain project approval from the Office of Mental Health.

Job Impact Statement

A Job Impact Statement is not submitted with this notice because the amendments merely serve to streamline the Prior Approval Review process. It is obvious from this rulemaking that there will be no adverse impact on jobs and employment opportunities.