PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Proposed Action:
Amendment of Part 512 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 7.09(b), 31.04(a), 43.02(a), (b) and (c); Social Services Law, sections 364(3) and 364-a(1)
Finding of necessity for emergency rule:
Preservation of public health, public safety and general welfare.
Specific reasons underlying the finding of necessity:
The proposed rule implements a rate adjustment for PROS programs and programmatic changes. The impetus for the Emergency filing stems from the need to implement the rate changes. These adjustments have been approved by the Director of the Division of the Budget and are effective July 1, 2012. It is believed that the rate adjustments will preserve program funding and will enable PROS providers to continue to serve individuals in need of services. Since this proposed regulation has significant impact upon public health, safety and general welfare, the proposed rule warrants emergency filing.
Subject:
Personalized Recovery Oriented Services (PROS).
Purpose:
Adjust fees paid to providers as well as update and clarify existing PROS regulations.
Substance of emergency/proposed rule (Full text is posted at the following State website:www.omh.ny.gov):
This rule will amend Part 512 of Title 14 NYCRR, which establishes the certification standards for Personalized Recovery-Oriented Services (PROS) programs. The complete text of the proposed rule is available at www.omh.state.ny.us.
OVERVIEW:
The purpose of a PROS program is to partner with individuals in their recovery from mental illness through the delivery of integrated rehabilitation, treatment and support services. Such services are available within a site-based program setting as well as in off-site locations in the communities where individuals live, learn, work and socialize. PROS programs establish a therapeutic environment which fosters awareness, hopefulness and motivation for recovery and incorporates a harm reduction philosophy. The PROS regulations have been amended several times since they were adopted nearly six years ago. Over time, the Office of Mental Health has received valuable information through the evaluation of operational PROS programs and feedback from PROS providers. The changes to the PROS regulations are necessary in order to provide flexibility of the service delivery system and clarify the expectations of the Office of Mental Health with respect to PROS providers of service.
REVISIONS REGARDING ASSESSMENT PROCESS:
One issue that had been a source of confusion in the existing PROS regulation was the assessment process. The proposed rule clarifies that the assessments required are based on the individual's enrollment in a specific PROS component. For example, individuals who are enrolled in clinical treatment services at the PROS must receive a psychiatric assessment and a health assessment. Each assessment must result in a summary of findings, within the context of the specific assessment focus that addresses the individual's strengths, talents, and abilities, as well as the challenges and barriers presented by the individual's mental illness.
REVISIONS REGARDING DOCUMENTATION REQUIREMENTS:
The proposed regulation includes documentation requirements for individuals who are receiving Integrated Treatment for Dual Disorders from the PROS provider and clinical treatment services from a source other than the PROS. In this situation, there must be an exchange of information and documentation of progress and outcomes, as well as the name of the treating psychiatrist or nurse practitioner at the clinic who will collaborate with a designated member of the PROS clinical staff.
Documentation requirements associated with the Initial Service Recommendation Plan have been included in the amended regulation. The Initial Service Recommendation Plan identifies the individual's primary service needs and lists the services in which the individual will participate. After an individual is admitted to the PROS program, the Initial Service Recommendation Plan must be developed by or under the supervision of a member of the professional staff in partnership with the individual. This plan remains valid for up to 60 days or until the Individualized Recovery Plan (IRP) is completed. The Initial Service Recommendation Plan is considered to be part of the admission documentation and must be maintained in the case record as a separate document, distinct from the IRP.
REQUIRED REVIEWS:
The revised regulation includes the time table associated with the development, review and update of the IRP, as well as the review of the need for continued Intensive Rehabilitation and Ongoing Rehabilitation and Support services.
RATE ADJUSTMENTS:
The proposed rule includes Medicaid fee changes paid to PROS providers of services effective July 1, 2012. This fee modification is necessary to bring the rate structure for PROS more in line with the intention, achievements and utilization of the program. It is anticipated that the fee modifications will preserve the viability of PROS programs.
REVISED DEFINITIONS:
The amended regulation offers clarity in other areas by elaborating on the definitions of "capacity", "monthly caseload", "service frequency", "social worker", "New York Employment Support System (NYESS)" and "relapse prevention plan". Further explanation is provided for "individualized recovery planning", "integrated treatment for dual disorders", and "family psychoeducation/intensive family support". Examples of "family psychoeducation/intensive family support" have been provided.
MISCELLANEOUS:
Erroneous and outdated references within the existing regulation have been corrected by the proposed rule.
This notice is intended:
to serve as both a notice of emergency adoption and a notice of proposed rule making. The emergency rule will expire December 9, 2012.
Text of rule and any required statements and analyses may be obtained from:
Sue Watson, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, (518) 474-1331, email: Sue.Watson@omh.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: Subdivision (b) of 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 or her jurisdiction.
Subdivision (a) of Section 31.04 of the Mental Hygiene Law empowers the Commissioner to issue regulations setting standards for licensed programs for the rendition of services for persons with mental illness.
Subdivision (a) of Section 43.02 of the Mental Hygiene Law provides that payments under the Medical Assistance Program for services approved by the Office of Mental Health shall be at rates certified by the Commissioner of Mental Health and approved by the Director of the Budget. Subdivision (b) of Section 43.02 of the Mental Hygiene Law gives the Commissioner authority to request from operators of facilities licensed by the Office of Mental Health such financial, statistical and program information as the Commissioner may determine to be necessary. Subdivision (c) of Section 43.02 of the Mental Hygiene Law gives the Commissioner of Mental Health authority to adopt rules and regulations relating to methodologies used in establishment of schedules of rates for services.
Sections 364(3) and 364-a(1) of the Social Services Law give the Office of Mental Health responsibility for establishing and maintaining standards for medical care and services in facilities under its jurisdiction, in accordance with cooperative arrangements with the Department of Health.
2. Legislative objectives: Articles 7, 31 and 43 of the Mental Hygiene Law reflect the Commissioner's authority to establish regulations regarding mental health programs and establish rates of payments for services under the Medical Assistance program. Sections 364 and 364-a of the Social Services Law reflect the role of the Office of Mental Health regarding Medicaid reimbursed programs. The rule making furthers the Legislative intent under Article 7 by ensuring that the Office of Mental Health fulfills its responsibility to assure the development of comprehensive plans, programs and services in the care, treatment, rehabilitation and training of persons with mental illness.
3. Needs and benefits: The Personalized Recovery-Oriented Services (PROS) initiative created a framework to assist individuals and providers in improving both the quality of care and outcomes for people with serious mental illness in New York State. The PROS regulations have been amended several times since they were adopted nearly six years ago. Over time, the Office has received valuable information through the evaluation of operational PROS programs and feedback from PROS providers. The changes within the PROS regulations are necessary in order to provide flexibility of the service delivery system and clarify the expectations of the Office regarding PROS providers of service.
One issue that had been a source of confusion in the existing PROS regulation was the assessment process. The proposed rule clarifies the required assessments based on the individual's enrollment in a specific PROS component. For example, individuals who are enrolled in clinical treatment services at the PROS program must receive a psychiatric assessment and a health assessment.
Another change as a result of the proposed regulation is the inclusion of provisions regarding documentation requirements for individuals who are receiving Integrated Treatment for Dual Disorders from the PROS provider and clinical treatment services from a source other than the PROS program. There must be an exchange of information and documentation of progress and outcomes, as well as the name of the treating psychiatrist or nurse practitioner at the clinic who will collaborate with a designated member of the PROS clinical staff.
Documentation requirements associated with the Initial Service Recommendation Plan have been included in the amended regulation. The Initial Service Recommendation Plan identifies the individual's primary service needs and lists the services in which the individual will participate. After an individual is admitted to the PROS program, the Initial Service Recommendation Plan must be developed by or under the supervision of a member of the professional staff in partnership with the individual. This plan remains valid for up to 60 days or until the Individualized Recovery Plan (IRP) is completed. The Initial Service Recommendation Plan is considered to be part of the admission documentation and must be maintained in the case record as a separate document, distinct from the IRP. The revised regulation includes the time table associated with the development, review and update of the IRP, as well as the review of the need for continued Intensive Rehabilitation and Ongoing Rehabilitation and Support services.
The amended regulation offers clarity in other areas by elaborating on the definitions of "capacity", "monthly caseload", "service frequency", "social worker", "New York Employment Support System (NYESS)" and "relapse prevention plan". Further explanation is provided for "family psychoeducation/intensive family support", "individualized recovery planning" and "integrated treatment for dual disorders". Examples of family psychoeducation/intensive family support have been provided.
Erroneous and outdated references within the existing regulation have been corrected by the proposed rule.
Lastly, the proposed rule includes Medicaid fee changes paid to PROS providers of services effective July 1, 2012. This fee modification is necessary to bring the rate structure for PROS more in line with the intention, achievements and utilization of the program. It is anticipated that the fee modifications will preserve the viability of PROS programs.
4. Costs:
(a) Cost to state government: These regulatory amendments are not expected to result in any additional costs to State government. The impact of the fee adjustment for PROS programs would have resulted in a cost of $1.8 million to State government, but these additional costs will be offset by an adjustment in the array of outpatient services licensed by the Office.
(b) Cost to local government: These regulatory amendments are not expected to result in any additional costs to local government.
(c) Cost to regulated parties: These regulatory amendments are not expected to result in any additional costs to regulated parties.
5. Local government mandates: The regulation will not mandate any additional imposition of duties or responsibilities upon county, city, town, village, school or fire districts.
6. Paperwork: This rule making should not result in an increase in paperwork requirements. In fact, it is believed that this proposed rule will reduce the paperwork of providers.
7. Duplication: The regulatory amendment does not duplicate existing State or federal requirements.
8. Alternatives: The only alternative would have been to continue with the current PROS regulations in place. As the amendments provide clarity regarding the expectations of the Office of Mental Health, and should ultimately result in a more flexible mental health service delivery system, that alternative was necessarily rejected.
9. Federal standards: The regulatory amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.
10. Compliance schedule: The regulatory amendment will become effective upon adoption.
Regulatory Flexibility Analysis
A Regulatory Flexibility Analysis for Small Businesses and Local Governments is not being submitted with this notice because the amended rule will not have an adverse economic impact upon small businesses or local governments. The proposed rule updates and clarifies the expectations of the Office of Mental Health with respect to PROS providers of services, and includes an adjustment of fees paid to PROS providers effective July 1, 2012.
Rural Area Flexibility Analysis
The amendments to Part 512 of Title 14 NYCRR update and clarify the expectations of the Office of Mental Health with respect to PROS providers of services, and include an adjustment of fees paid to PROS providers effective July 1, 2012. The amendments will not impose any adverse economic impact on rural areas; therefore, a Rural Area Flexibility Analysis is not submitted with this notice.
Job Impact Statement
A Job Impact Statement is not submitted with this notice because the purpose of the proposed rule is to update and clarify the expectations of the Office of Mental Health with respect to PROS providers of services. In addition, the proposed rule includes an adjustment of fees paid to PROS providers effective July 1, 2012. There will be no adverse impact on jobs and employment opportunities as a result of this proposed rule.
