HLT-24-16-00003-RP Specialized Programs for Residents with Neurodegenerative Diseases

8/24/16 N.Y. St. Reg. HLT-24-16-00003-RP

NEW YORK STATE REGISTER

VOLUME XXXVIII, ISSUE 34

August 24, 2016

RULE MAKING ACTIVITIES

DEPARTMENT OF HEALTH

REVISED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. HLT-24-16-00003-RP

Specialized Programs for Residents with Neurodegenerative Diseases

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

Proposed Action:

Addition of section 415.41 to Title 10 NYCRR.

Statutory authority:

Public Health Law, section 2803(2)

Subject:

Specialized Programs for Residents with Neurodegenerative Diseases.

Purpose:

To establish nursing home specialty units for residents with Huntington's Disease (HD) and Amyotrophic Lateral Sclerosis (ALS).

Substance of revised rule:

A new section for Part 415 of Title 10 (Health) of the Official Compilation of Codes, Rules and Regulations of the State of New York is proposed, to be designated as section 415.41 and entitled “Specialized Programs for Residents with Neurodegenerative Diseases”.

(a) General. For purposes of the proposed regulation, “Neurodegenerative Disease” shall mean Huntington’s disease or Amyotrophic Lateral Sclerosis. “Specialized program” means a discrete unit within a nursing home that offers services and facilities for individuals with Neurodegenerative Diseases, with the goal of helping them attain or maintain the highest practicable level of physical, affective, behavioral and cognitive functioning. The program must be located in a nursing unit which is specifically designated for this purpose and physically separate from other facility units.

The proposed regulation also provides that the facility shall make information and data available to assist the Department of Health (department) in evaluating the effectiveness of specialty units and their impact on outcomes for individuals with Neurodegenerative Diseases.

(b) Admission. The proposed regulation requires nursing homes to develop written admission criteria for specialty units for individuals with Neurodegenerative Diseases. At a minimum, the resident’s medical record must document that the resident has a Neurodegenerative Disease diagnosis, cannot appropriately be served and is not safe in a less restrictive setting, and can benefit from the care and services available in a specialty unit. The proposed regulation also provides that a facility shall evaluate the effects of its admission criteria on its success in achieving its goals and objectives for the specialty unit and requires the facility to report its findings to the department annually thereafter.

(c) Assessment and Care Planning. The proposed regulation requires a home evaluation with the future resident and his or her family, as appropriate, prior to admission to discuss care needs. The proposed regulation also requires development of a care plan for each resident, which shall include a discharge plan, by an interdisciplinary resident care team. The care plan must be reviewed and modified at least once a month for the first three months following admission and then quarterly or upon a significant change in the resident’s condition thereafter.

(d) Discharge. The proposed regulation requires that a proposed discharge plan must be developed within 30 days of admission for each resident as part of the overall care plan and shall include input from all professionals caring for the resident, the resident and his or her family, as appropriate, and any outside agency or resource anticipated to be involved with the resident following discharge. The resident must be discharged to a less restrictive setting when he or she no longer meets one or more of the admission criteria for the unit. Additionally, the proposed regulation provides that a facility shall evaluate the effects of its discharge criteria on its success in achieving the goals and objectives for the specialty unit and requires the facility to report its findings to the department annually thereafter.

Nursing homes with specialty units shall have a written agreement with a general hospital or hospitals providing for the transfer of residents in need of emergency or acute inpatient care services. Such hospital(s) shall have expertise in caring for individuals with Neurodegenerative Diseases, except in cases where a general hospital with such expertise is not available within a distance and time considered reasonable by accepted emergency medical standards. In the event of a transfer to any general hospital, the facility must require a member of the specialty unit’s staff to accompany the resident, if feasible, and must communicate with the hospital and provide any relevant information about the resident at the time of transfer. The resident shall be given priority readmission status to the unit as warranted by his or her condition.

(e) Program/Unit Staffing Requirements. The facility must maintain consistent assignment of direct care staff to residents in the specialty unit. In addition, the proposed regulation requires that a specialty unit shall be managed by a program coordinator and that a physician must be responsible for medical direction of the unit. The proposed regulation also identifies other specific categories of personnel who must be assigned or available to the specialty unit, including a psychiatrist, a clinical psychologist or licensed clinical social worker, at least one registered professional nurse on each shift, a respiratory therapist, and a therapeutic recreation specialist.

Revised rule compared with proposed rule:

Substantial revisions were made in section 415.41(e)(9).

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

Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

30 days after publication of this notice.

Revised Regulatory Impact Statement, Revised Regulatory Flexibility Analysis, Revised Rural Area Flexibility Analysis and Revised Job Impact Statement

Changes made to the last published rule do not necessitate revision to the previously published Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement.

Assessment of Public Comment

The Department received one comment during the public comment period.

Comment:

Sitrin Medical Rehabilitation Center, located in New Hartford, New York, expressed concern about the ability to secure Registered Nurses in their geographical area. They suggested that the staffing requirement for RNs should be to have an RN in the building where the Neurodegenerative Disease unit is located who will be readily available to the unit.

Response:

The Department believes that this is a valid concern, and the regulatory language in section 415.41(e)(9) has been revised accordingly.