N.Y. Comp. Codes R. & Regs. tit. 14 § 590.8

Current through Register Vol. 46, No. 45, November 2, 2024

Section 590.8 - Admission and discharge procedures

(a) Each comprehensive psychiatric emergency program shall maintain admission and discharge criteria which are consistent with its goals and objectives, and which are subject to the approval of the Office of Mental Health. Each admission shall be in accordance with the provisions of section 9.40 of the Mental Hygiene Law and on the forms prescribed therefor.

(b) Admission and retention of individuals.

(1) Any person admitted into the emergency room of the comprehensive psychiatric emergency program must be examined by a staff physician as soon as practicable and in any event within six hours after being received into the emergency room.

(2) The director of the comprehensive psychiatric emergency program may, in accordance with section 9.40 of the Mental Hygiene Law, involuntarily receive and retain in an extended observation bed any person alleged to have a mental illness which is likely to result in serious harm to the person or others and for whom immediate observation, care and treatment in the comprehensive psychiatric emergency program is appropriate. Retention in an extended observation bed shall not exceed 72 hours, which shall be calculated from the time such person is initially received into the emergency room of the comprehensive psychiatric emergency program.

(3) No person may be involuntarily retained in a comprehensive psychiatric emergency program for more than 24 hours unless the person is admitted to an extended observation bed in accordance with section 9.40 of the Mental Hygiene Law.

(4) Any person with a need of medical or surgical care or treatment which cannot be provided in the comprehensive psychiatric emergency program, shall not remain in the comprehensive psychiatric emergency program for a period exceeding eight hours. Within eight hours such person shall be accepted by the host hospital or a hospital with an affiliation agreement pursuant to section 590.7(b)(3) of this Part for appropriate observation or treatment in accordance with applicable regulations of the Department of Health (10 NYCRR section 405.19 ).

(c) Information gathering

(1) The program shall access the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) or other available electronic health records or database(s) to identify the patient's treatment providers and prior medication use and/or treatment engagement history.

(2) The program shall document efforts to identify and contact with the individual's consent, the individual's treatment team and other relevant providers (e.g., housing providers, care coordination, managed care organizations), and collaterals.

(d) Screening and assessment

(1) all presenting individuals shall be screened for risk of harm to self and others;

(2) staff shall collaborate with collaterals as appropriate and available;

(3) for individuals determined to be of moderate to high risk, efforts shall be made to obtain or develop a safety plan;

(4) all presenting individuals shall be screened for alcohol and substance use, high risk use and substance use disorder;

(5) screening tools should be evidence based and validated where possible; and

(6) assessments shall be strength-based and person-centered.

(e) The commissioner or his or her designee may prevent new admissions to the comprehensive psychiatric emergency program emanating from emergency medical services, ambulance services and law enforcement if a conclusion is reached that the ability of the program to deliver quality service would be jeopardized.

(1) The commissioner or his or her designee shall review the continued necessity for such prevention at least once every 24 hours according to a mutually developed plan.

(2) The comprehensive psychiatric emergency program shall develop a contingency plan with other local affiliated hospitals, emergency medical services and law enforcement for the prevention of new admissions during periods of high demand and overcrowding.

(3) Where a comprehensive psychiatric emergency program prevents new admissions pursuant to this paragraph, the comprehensive psychiatric emergency program must notify the appropriate OMH Field Office according to a mutually developed plan.

(f) Discharge criteria.

The provisions of section 29.15 of the Mental Hygiene Law shall not apply to the discharge of an individual from a comprehensive psychiatric emergency program, however:

(1) Discharge planning shall be conducted for all persons discharged from a comprehensive psychiatric emergency program who have been determined to require additional mental health services after triage and referral or full emergency visit and for those persons admitted to extended observation beds who require additional mental health services.

(2) Discharge planning criteria shall include at least the following activities prior to discharge from the comprehensive psychiatric emergency program:

(i) a review of the person's psychiatric and physical needs;

(ii) completion of referrals to community services providers, in collaboration with the individual receiving services and comprehensive psychiatric emergency program staff, to address the person's identified needs;

(iii) in collaboration with the individual receiving services, the comprehensive psychiatric emergency program shall arrange for appointments with community providers which shall be made as soon as possible after discharge from the emergency room of the comprehensive psychiatric emergency program. When an appointment for mental health services cannot be made within a reasonable period of time, crisis outreach teams or other available comprehensive psychiatric emergency program staff may provide crisis outreach until the initial appointment occurs and such services shall be reimbursed pursuant to section 591.4(f); and

(iv) each individual shall be given the opportunity to participate in the development of his or her discharge plan. Absent the objection of the person and when clinically appropriate, reasonable attempts shall be made to contact family members for their participation in the discharge planning program. However, no person or family member shall be required to agree to the person's discharge. A notation shall be made in the person's record if such person objects to the discharge plan or any part thereof.

(3) The comprehensive psychiatric emergency program shall verify that after-care appointment(s) occurred and follow up with individuals to ensure satisfactory linkage to care. Until linkage to care is completed, or for other clinically-indicated reasons, comprehensive psychiatric emergency program staff should provide crisis outreach services to ensure individuals are safe and stable in the community and continue to provide support, care and assistance with linkage to follow up care. Such services shall be reimbursed pursuant to section 591.4(f)

N.Y. Comp. Codes R. & Regs. Tit. 14 § 590.8

Amended New York State Register May 19, 2021/Volume XLIII, Issue 20, eff. 5/5/2021