Regulations Revisited A New Look at Article 31 Clinic Processes - - PowerPoint PPT Presentation

Regulations Revisited

A 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 Services Crisis Intervention Complex Care Management

Injections (Adults Only)

Physical Health

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Clinic Services (Optional)

Testing

Enhanced Services Smoking Cessation SBIRT

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-Admission

• Preadmission is just a status
• All services, including assessment and treatment,

may be provided during pre-admission except for testing

• All services, including assessment, treatment, and

testing may be provided after admission

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Pre-Admission

• If you have determined that the individual is

eligible for services, then admission is appropriate

• Individualizing the assessment process is key
• Having 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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Assessment

• Assessment 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 documentation
• Lengthy assessments may decrease therapeutic time
• Assessment process should be individualized

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Discussion

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Consider

• Streamlined and individualized assessment

process

• Consider removing agency specific

elements/questions that go beyond requirements, or are duplicative

• Review assessments for potential duplication of

same questions that were asked by other staff

• Conduct assessment as a conversation

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Consider

• Access information from other sources, like PSYCKES

clinical narrative, referral sources, or other assessments

• Consider self assessment tools for some individuals
• If self assessment tools are used, make sure

clinicians review and utilize information

• Screening Tools

NAME OR LOGO

Did You Know?

Treatment planning helps an individual participate in their

• wn treatment process

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Treatment Planning

• Person/Child centered, youth and family driven
• Ongoing process of assessing needs, goals and

services

• Identifies when goals are met
• A means to adjust services as necessary to assist

individuals in reaching their goals

• Identifies when an individual is ready for discharge

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Treatment Planning Challenges

• Often 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/family

• There 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 the individual’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

• n the first visit

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Discharge

• Discussion begins at admission and continues

throughout treatment

• Involves discussion to determine what changes need

to occur for the individual to no longer need clinic services

• Lack of discharge planning can cause treatment to

lose focus and take longer then needed or expected

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Consider

• Short term treatment that focuses on presenting problem with clear

discharge goals

• When 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

• Discussion
• Process
• Assessment
• Treatment 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 Regulations

Establishes standards for the certification, operation and reimbursement

• f 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 Regulations

599 Regulations:

https://govt.westlaw.com/nycrr/Browse/Home/NewY

• rk/NewYorkCodesRulesandRegulations?guid=I9ffd00

70a18311dfa00ee4a4febaeecb&originationContext= documenttoc&transitionType=Default&contextData=( sc.Default).

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Additional OMH Resources

Clinic 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