Regulations RevisitedA New Look at Article 31 Clinic Processes

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Introduction and Housekeeping

Slides will be posted at CTACNY.org

Reminders:◦ Information and timelines are current as of the date of the presentation.

◦ The actual regulations supersedes any information provided in this reference material.

◦ This presentation is not an official document. For full details please refer to the provider and billing manuals.

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Agenda

Welcome and Training Overview

Clinic Goals and Service Breakdown

Key Strategies

Access, Planning, Discharge and Re-admission

Discussion

Welcome & Training Overview

CTAC and MCTAC developed this training with NYS OMH

Tips and recommendations provided during the presentation came from best practices currently being used in the field

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Clinic Goals and Services

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Clinic Goals

Develop plan for care and treat

Engage, assess, identify and diagnose

Maximize wellness, minimize symptoms and adverse effects of illness

Promote recovery and resilience

Maintain individual in his or her natural environment

Medication Management/Psychotropic Medication Treatment

Therapy Individual/Family/Group

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Clinic Services (Required)

Assessment

Enhanced ServicesCrisis InterventionComplex Care Management

Injections (Adults Only)

Physical Health

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Clinic Services (Optional)

Testing

Enhanced ServicesSmoking CessationSBIRT

Injections (Children Only)

Psychiatric Consultation

Key Strategies Team/inter-agency

collaboration

Engagement

Timely access

Data driven decision making

Efficient and effective services

Quality and compliance

Documenting outcomes

Continuous quality improvement

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Access, Planning, Discharge and Re-admission

NAME OR LOGO

Three pre-admission sessions are not mandated. Assessment can continue

post admission

Did You Know?

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Pre-AdmissionPreadmission is just a statusAll services, including assessment and treatment, may be provided during pre-admission except for testingAll services, including assessment, treatment, and testing may be provided after admission

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Pre-AdmissionIf you have determined that the individual is eligible for services, then admission is appropriateIndividualizing the assessment process is keyHaving an individual engage in multiple appointments prior to services may erode engagement and increase no shows

Consider Make admission

individualized/person centered

Provide services prior to admission

Admit sooner when appropriate

Consider enhanced/other service needs (urgency of treatment, higher/other)

Replace “contract for treatment” with motivational interventions

NAME OR LOGO

Did You Know?

Treatment services can be provided after a need has been

assessed and before a full comprehensive Assessment is

completed

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AssessmentAssessment should be an ongoing process

Individuals receiving services may experience “assessment burnout”Individuals may be asked about sensitive areas before the therapeutic relationship is developed

Clinicians describe drowning in documentationLengthy assessments may decrease therapeutic time

Assessment process should be individualized

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Discussion

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ConsiderStreamlined and individualized assessment processConsider removing agency specific elements/questions that go beyond requirements, or are duplicativeReview assessments for potential duplication of same questions that were asked by other staffConduct assessment as a conversation

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ConsiderAccess information from other sources, like PSYCKES clinical narrative, referral sources, or other assessmentsConsider self assessment tools for some individualsIf self assessment tools are used, make sure clinicians review and utilize informationScreening Tools

NAME OR LOGO

Did You Know?

Treatment planning helps an individual participate in their

own treatment process

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Treatment PlanningPerson/Child centered, youth and family drivenOngoing process of assessing needs, goals and servicesIdentifies when goals are metA means to adjust services as necessary to assist individuals in reaching their goalsIdentifies when an individual is ready for discharge

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Treatment Planning ChallengesOften utilized less as a clinical tool and more to meet regulations

Emphasis may be put on the paperwork rather than on the collaborative process with the individual/familyThere can be a disconnect between treatment planning and treatment sessions

May be viewed as an event which intrudes upon therapeutic time rather than part of the treatment process

Consider• The treatment plan

should be theindividual’s plan

• Using treatment planning as a tool

• Document treatment planning throughout treatment

• Educate the individual about the reason and need for the plan

• Develop the plan collaboratively during the session

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NAME OR LOGO

Did You Know?

Discharge planning should start on the first visit

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DischargeDiscussion begins at admission and continues throughout treatmentInvolves discussion to determine what changes need to occur for the individual to no longer need clinic servicesLack of discharge planning can cause treatment to lose focus and take longer then needed or expected

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ConsiderShort term treatment that focuses on presenting problem with clear discharge goalsWhen there are concerns regarding client engagement, prior to discharging, try to re-engage individuals by: ◦Determining if you are still meeting the individual’s needs or whether their needs have changed?

◦Working with the individual to set up person centered scheduling◦ Provide Medication-only services if appropriate◦Utilizing other resources/approaches for engagement ◦Working with Health Home care managers (if available)

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Re-admission

DiscussionProcessAssessmentTreatment Planning

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Tips from Managed Care Organizations (MCOs)

Partnership Communicate Share information Collaborate Access to care, especially post emergency room/inpatient discharge

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Discussion

Concerns

Comments

Questions

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Resources

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14 NYCRR Part 599 RegulationsEstablishes standards for the certification, operation and reimbursement of clinic treatment programs serving adults and children.The New York State Office of Mental Health (OMH) mental health clinic regulations, 14 NYCRR Part 599 are augmented by:◦ The OMH Clinical Standards of Care◦ The OMH Standards of Care Anchors, which comprise the instrument used to measure performance for re-certification.

Both documents are found on the OMH Clinic webpage. https://omh.ny.gov/omhweb/clinic_restructuring/default.html

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599 Regulations599 Regulations:

https://govt.westlaw.com/nycrr/Browse/Home/NewYork/NewYorkCodesRulesandRegulations?guid=I9ffd0070a18311dfa00ee4a4febaeecb&originationContext=documenttoc&transitionType=Default&contextData=(sc.Default).

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Additional OMH ResourcesClinic Guidance:

https://omh.ny.gov/omhweb/clinic_restructuring/part599/part-599.pdf

Standards of Care Anchor Elements:https://www.omh.ny.gov/omhweb/clinic_standards/care_anchors.html

Clinic FAQ:https://www.omh.ny.gov/omhweb/clinic_restructuring/clinic_faq.pdf

Note: Program clinical leadership should review potential changes to all operations protocols with program administrative leadership. In many situations, billing staff should also be included in the discussion, even when at face value, the discussion is not about billing.

Contact us at ctac.info@nyu.edu