Section 404.9 - Integrated Care Services

404.9 Integrated Care Services

(a) Primary Care Services

(1)
General Principles.Integrated services providers of primary care services shall effectively meet patient physical health needs by:

(i) providing patient care in a continuous manner by the same health care practitioner, whenever possible;

(ii) appropriately referring to other health care facilities or health care practitioners for services not available;

(iii) identifying, assessing, reporting and referring cases of suspected or confirmed child abuse or maltreatment;

(iv) identifying, assessing, reporting and referring cases of suspected or confirmed domestic violence;

(v) ensuring that all staff receive education in the identification, assessment, reporting and referral of cases of suspected child abuse or maltreatment or domestic violence; and

(vi) developing a written plan of treatment which shall be periodically revised, as necessary, in consultation with other health care professionals.

(2)
Provision of Primary Care Services

(i) All primary care services shall be provided in a manner that safely and effectively meets the needs of the patients served in the integrated care services program.

(ii) Integrated care services programs delivering primary care services must have sufficient staff and appropriate equipment to deliver primary care services.

(iii) Integrated services providers delivering primary care services shall conduct periodic reviews of its integration of primary care services with behavioral health services as part of its overall quality assurance program.

(iv) Integrated services providers delivering primary care services shall assign a medical director to be responsible for the primary care services.

(v) Primary care services provided within the specialty of OB/GYN are limited to routine gynecologic care and family planning provided pursuant to 10 NYCRR Part 753.

(vi) Primary care services shall not include prenatal care, dental services or ambulatory surgery which includes any procedure that requires more than minimal sedation or local anesthesia, unless specifically authorized by the Department of Health.

(vii) For integrated services providers providing primary care, practitioners, or their delegate, shall provide their patient complete and current information concerning his or her diagnosis, treatment and prognosis in terms the patient can be reasonably expected to understand, and necessary for the patient to give informed consent prior to the start of any nonemergency procedure or treatment or both. An informed consent shall include, at a minimum, the provision of information concerning the specific procedure or treatment or both, the reasonably foreseeable risks involved, and alternatives for care or treatment, if any, as a reasonable medical practitioner under similar circumstances would disclose in a manner permitting the patient to make a knowledgeable decision. A patient also may refuse treatment to the extent permitted by law, and if so, shall be fully informed of the medical consequences of his/her action.

(b) Mental Health Services

(1)
General principles.

(a) For adult patients, integrated services providers of mental health care shall effectively meet patient mental health care needs by diagnosing and treating an individual’s mental illness, working with the individual in developing a plan of care designed to minimize symptoms and adverse effects of illness, maximize wellness, and promote recovery toward the achievement of life goals such as, but not limited to, education and employment.

(b) For integrated services providers of mental health care that serve children, effective care includes early assessment and identification of childhood emotional disturbances, and engagement of the child and family in the development of a plan of care designed to minimize the symptoms and adverse effects of illness, maximize wellness, assist the child in developing a resilient and hopeful approach to school, family, and community, and maintain the child in his or her natural environment.

(2)
Provision of Mental Health Services

Integrated services providers of mental health care shall offer each of the following mental health services, to be provided consistent with patients’ conditions and needs, and which include:

(i) Outreach;

(ii) Crisis Intervention:

(a) mental health crisis intervention services must be available 24 hours a day/7 days per week.

(b) after hours coverage may be provided directly by the integrated services provider or pursuant to a clinical services contract, as defined in 14 NYCRR § 599(f), which must require, at a minimum, that in the event of a crisis, the nature of the crisis and any measures taken to address such crisis are communicated to the primary care clinician or other designated clinician involved in the individual’s treatment in the primary care component of the integrated services provider on the next business day.

(iii) Psychotropic medication treatment, including injectable psychotropic medication administration for adult patients;

(iv) Psychotherapy services, including but not limited to:

(a) Individual psychotherapy;

(b) Family/Collateral psychotherapy;

(c) Group psychotherapy; and

(d) Complex Care Management.

(3) The following optional services may be offered:

(i) Developmental testing (for children and adolescents);

(ii) Psychological testing;

(iii) Psychiatric consultation; or

(iv) Injectable Psychotropic medication administration for patients who are minors.

(4) Integrated services providers delivering mental health services shall conduct periodic reviews of the integration of primary care and/or substance use disorder services as part of its overall quality assurance program.

(c) Substance Use Disorder Services

(1)
General Principles.

Integrated services providers of substance use disorder treatment shall effectively meet patient substance use disorders needs by diagnosing and treating an individual’s substance use disorders, working with the individual in developing a plan of care to achieve goals identified in the individual’s treatment plan and promote recovery.

(2)
Provision of Substance Use Disorder Services.

For purposes of this subdivision, the term “clinical staff” shall mean staff who provide services directly to patients as prescribed in the treatment plan; including licensed medical staff, credentialed or licensed staff, non-credentialed staff, non-licensed staff and student interns.

(3) Integrated services providers of substance use disorder services shall offer, at a minimum, each of the following services, to be provided consistent with patients’ conditions and needs:

(i) Assessments;

(ii) Counseling, which can be delivered via two distinct methods:

(a) Individual counseling, which is a face-to-face service between a clinical staff member and a patient focused on the needs of the patient to be delivered consistent with the treatment/recovery plan, its development, or emergent issues. Individual counseling must be provided with a frequency and intensity consistent with the individual needs of each unique patient, as prescribed by the responsible clinical staff member; and

(b) Group counseling, which is a face-to-face service between one or more clinical staff member and multiple patients at the same time, to be delivered consistent with patient treatment/recovery plans, their development, or emergent issues. Group counseling must contain no more than 15 patients in each group counseling session.

(iii) Education about, orientation to, and the opportunity for participation in, available and relevant peer support and mutual assistance groups; and

(iv) Chemical abuse and dependence awareness and relapse prevention.

(4) An integrated services provider of substance use disorder services shall:

(i) promote the achievement and maintenance of recovery from substance use disorder and abuse;

(ii) improve functioning and development of necessary recovery management skills so the patient can be treated in the least intensive environment; and

(iii) develop individualized treatment/recovery plans to support the achievement and maintenance of recovery from substance use disorder and abuse, the attainment of economic self-sufficiency (including, where appropriate, the ability to sustain long-term productive employment), and improvement of the patient's quality of life.

(5) Integrated services providers of substance use disorder services may offer:

(i) Collateral services;

(ii) Complex care coordination;

(iii) Medication administration and management;

(iv) Outreach; and

(v) Peer support services.

(6) Integrated services providers delivering substance use disorder services shall conduct periodic reviews of the integration of primary care and/or mental services as part of its overall quality assurance program.

Effective Date: 
Thursday, January 1, 2015
Doc Status: 
Complete