09 Dec New York ACEP Raises Concerns: Public Health and Health Planning Council Committee Approves Section 405.19

Posted at 15:31h in Advocacy Update, Member Update by
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UPDATE December 19, 2024: 

OMH has amended 14NYCRR Part 580 to define an individual with complex needs.

(e)Individual with Complex Needs shall mean individuals who have one or more of the following:

(1)Demonstrates high utilization of inpatient, crisis, or emergency services, as indicated by:

(i) three or more mental health inpatient hospitalizations in the past year; or

(ii) four or more mental health presentations to an emergency department (ED) or comprehensive psychiatric emergency program (CPEP) in the past year; or

(iii) three or more medical/surgical hospitalizations in the last year and carrying a diagnosis of schizophrenia or bipolar disorder.

(2) Discharge from an office-licensed residential treatment facility (RTF) in the past year.

(3) Discharge from inpatient level of care where the length of stay was greater than 60 days at an office-operated psychiatric center in the past year.

(4) Current enrollment in, or discharge from in the past year, Assertive Community Treatment(ACT), including but not limited to Adult ACT, Youth ACT, Young Adult ACT, Shelter-partnered ACT, Forensic ACT.

(5) Currently receiving services from Critical Time Intervention (CTI), Safe Options Supports(SOS), Pathway Home, Intensive Mobile Treatment (IMT), Home Based Crisis Intervention, or other high-intensity ambulatory services. 

(6) Eligible for or current enrollment in Health Home Plus Care Management Services.

(7) Eligible for or current enrollment in High Fidelity Wraparound Care Management in Health Homes Serving Children; eligible for or current enrollment in Children’s Home and Community Based Services Waiver for children with Serious Emotional Disturbance (SED)

(8) An active Assertive Outpatient Treatment order or an order that expired in the past year.

(9) Experiencing high-risk social needs, including, but not limited to, current homelessness, criminal or juvenile justice involvement, and child welfare involvement in the past year.

(10) Clinical determination by staff in the licensed program that on presentation the individual has an elevated risk of suicide, violence and/or overdose.

(11) Has a current complexity clinical flag in the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES).

(12) Experiencing other factors that the licensed program determines would significantly interfere with the individual’s ability to maintain stability in the community after discharge.

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On December 5, 2024 the New York State Department of Health Codes Committee recommended the amendment of Section 405.19 of Title 10 NYCRR (General Hospital Emergency Services Behavioral Health) to the full Public Health and Health Planning Council and in the full council meeting the Public Health and Health Planning Council voted to approve this regulation.

New York ACEP submitted public comment for this council’s consideration, raising concerns related to the impact of this unfunded mandate on the Emergency Department. These comments were used as reference throughout the council discussion.

Concerns raised within the council discussion included items such as:

  • The requirement of multiple information sources for medical records, and the need for an integration of PSYCKES.
  • The requirement for a definition of the term “individual with complex needs” to properly review and implement these regulations.
  • The impact these expanded discharge requirements will have on the already extensive Emergency Room Boarding issue across the state.
  • The impact on rural and safety net emergency rooms, where mental health resources are already limited.

Despite these concerns, this regulation was approved.

The significance of closely monitoring the impact of these regulations was noted following the vote. New York ACEP is working to establish a process to track and communicate the impact of these regulations on Emergency Rooms across New York State.

If you have any questions on this issue, please contact New York ACEP at nyacep@nyacep.org.

Link to December 5, 2024 Public Health and Health Planning Council Committee regarding this decision.