Title: Section 487.4 - Admission standards
487.4 Admission standards. (a) An operator shall admit, retain and care for only those individuals who do not require services beyond those the operator is permitted by law and regulation to provide.
(b) An operator shall not exclude an individual on the basis of an individual’s mobility impairment, and shall make reasonable accommodations to the extent necessary to admit such individuals, consistent with federal, state, and local laws.
(c) An operator shall not accept nor retain any person who:
(1) is in need of continual medical or nursing care or supervision as provided by facilities licensed pursuant to article 28 of the Public Health Law, or licensed or operated pursuant to articles 19, 23, 29 and 31 of the Mental Hygiene Law;
(2) suffers from a serious and persistent mental disability sufficient to warrant placement in a residential facility licensed pursuant to article 19, 23, 29 or 31 of the Mental Hygiene Law;
(3) requires health or mental health services which are not available or cannot be provided safely and effectively by local service agencies or providers;
(4) causes, or is likely to cause, danger to himself or others;
(5) repeatedly behaves in a manner which directly impairs the well-being, care or safety of the resident or other residents, or which substantially interferes with the orderly operation of the facility;
(6) has a medical condition which is unstable and which requires continual skilled observation of symptoms and reactions or accurate recording of such skilled observations for the purposes of reporting to the resident's physician;
(7) refuses or is unable to comply with a prescribed treatment program, including but not limited to a prescribed medications regimen when such failure causes, or is likely to cause, in the judgment of a physician, life-threatening danger to the resident or others;
(8) is chronically bedfast;
(9) has chronic unmanaged urinary or bowel incontinence;
(10) suffers from a communicable disease or health condition which constitutes a danger to other residents and staff;
(11) is dependent on medical equipment, unless it has been demonstrated that:
(i) the equipment presents no safety hazard;
(ii) use of the equipment does not restrict the individual to his room, impede the individual in the event of evacuation, or inhibit participation in the routine activities of the home;
(iii) use of the equipment does not restrict or impede the activities of other residents;
(iv) the individual is able to use and maintain the equipment with only intermittent or occasional assistance from medical personnel;
(v) such assistance, if needed, is available from approved community resources; and
(vi) each required medical evaluation attests to the individual's ability to use and maintain the equipment;
(12) engages in alcohol or drug use which results in aggressive or destructive behavior; or
(13) is under 18 years of age; or, in a public adult home, under 16 years of age.
(d) An operator shall not admit or retain a number of persons in excess of the capacity specified on the operating certificate. No operator of an adult home with a certified capacity of eighty or more and a mental health census, as defined in section 487.13(b)(4) of this Part, of 25 percent or more of the resident population shall admit any person whose admission will increase the mental health census of the facility.
(e) Prior to any prospective resident’s admission to a transitional adult home, as defined in subdivision (b) of section 487.13 of this Part, the operator shall contact the Department, in a manner prescribed by the Department, to obtain a pre-admission screening as to whether the prospective resident may be a person with serious mental illness, as defined in subdivision (c) of section 487.2 of this Part.
(1) To obtain such pre-admission screening, the operator shall, in a manner prescribed by the Department, provide the Department with the prospective resident’s full name, date of birth, guardianship information if applicable, and Medicaid identification number if applicable. For individuals who are not currently enrolled in Medicaid, the operator shall state whether an interview and/or medical evaluation indicate the need for a mental health evaluation pursuant to paragraph (3) of subdivision (g) of this section. The results of the Department’s pre-admission screening shall be provided to the operator within three business days of receipt of a complete request. A complete request is one that contains all of the information required by this paragraph.
(2) The Department shall conduct its pre-admission screening in consultation with the Office of Mental Health by reviewing the prospective resident’s Medicaid claims data for relevant Health and Recovery Plan eligibility criteria, which may indicate that the prospective resident is a person with serious mental illness.
(3) Possible pre-admission screening results:
(i) Where the Department’s pre-admission screening of the prospective resident does not indicate that the prospective resident may be a person with serious mental illness or, in the case of a prospective resident for whom recent Medicaid claims data is not available, the operator has advised that an interview and/or medical evaluation do not indicate the need for a mental health evaluation pursuant to paragraph (3) of subdivision (g) of this section, the Department shall advise the operator that it may admit the prospective resident within 30 days of receipt of the results, provided that all other relevant admission criteria are met. In the event an operator does not admit the prospective resident within 30 days of receipt of the results of the Department’s pre-admission screening, the operator must obtain a new pre-admission screening pursuant to this subdivision.
(ii) Where the Department’s pre-admission screening indicates that the prospective resident may be a person with serious mental illness or, in the case of a prospective resident for whom recent Medicaid claims data is not available, the operator has advised that an interview and/or medical evaluation indicate the need for a mental health evaluation pursuant to paragraph (3) of subdivision (g) of this section, the operator shall not admit the prospective resident without conducting or obtaining a mental health evaluation, documented on a form prescribed by the Department and developed in consultation with the Office of Mental Health, within 30 days prior to the date of admission, pursuant to paragraph (1) of subdivision (k) of this section. The operator may admit the prospective resident only when the mental health evaluation concludes the individual: (a) is not a person with serious mental illness; or (b) is a person with serious mental illness, but the individual is a former resident of a transitional adult home and the operator obtains a waiver approved by the Department pursuant to subdivision (g) of section 487.3 of this Part.
(f) An operator shall not admit an individual before a determination has been made that the facility program can support the physical, psychologicaland social needs of the resident.
(g) Such a determination shall be based upon:
(1) receipt and consideration of a medical evaluation;
(2) conduct of an interview between the administrator, or a designee responsible for admission and retention decisions, and the resident and the resident's representative(s), if any; and
(3) in the event that a proposed resident has a known history of chronic mental disability, or the medical evaluation or resident interview suggests such disability, then a mental health evaluation must be conducted.
(h) Each medical evaluation (DSS-3122 or an approved substitute) shall be a written and signed report from a physician, physician assistant or nurse practitioner which includes:
(1) the date of examination, significant medical history and current conditions, known allergies, the prescribed medication regimen, including information on the applicant's ability to self-administer medications, recommendations for diet, exercise, recreation, frequency of medical examinations and assistance needed in the activities of daily living;
(2) a statement that the resident is not medically or mentally unsuited for care in the facility;
(3) a statement that the resident does not require placement in a hospital or residential health care facility; and
(4) a statement that the physician, physician assistant or nurse practitioner has physically examined the resident within 30 days prior to the date of admission or, for required annual evaluations, within 30 days prior to the date of the report.
(i) Each mental health evaluation shall be a written and signed report, from a psychiatrist, physician, registered nurse, certified psychologist or certified social worker who is approved by the department in consultation with the Office of Mental Health, and who has experience in the assessment and treatment of mental illness. Such report shall be documented on a form prescribed by the Department and developed in consultation with the Office of Mental Health and shall include:
(1) the date of examination;
(2) significant mental health history and current conditions, including whether the resident or prospective resident is a person with serious mental illness as defined in Section 487.2(c) of this Part;
(3) a statement that the resident's or prospective resident's mental health needs can be adequately met in the facility and a statement that the resident does not evidence need for placement in a residential treatment facility licensed or operated pursuant to article 19, 23, 29 or 31 of the Mental Hygiene Law; and
(4) a statement that the person signing the report has conducted a face-to-face examination of the resident or prospective resident within 30 days prior to the date of admission or, for required annual evaluations or evaluations conducted due a change in condition, within 30 days of the date of the report.
(j) Each resident interview shall:
(1) include explanation of the conditions of residency, including but not limited to the admission agreement, resident rights and responsibilities, facility rules and regulations and the personal allowance protections available to Supplemental Security Income or HR recipients;
(2) ascertain that the facility program can:
(i) meet the physical needs and personal care needs of the resident, including dietary needs occasioned by cultural or religious practice or preference or medical prescription; and
(ii) meet the social needs of the resident through facility programs and the fostering and maintenance of family and community ties and associations; and
(3) be summarized in writing, including the date of the interview and identification of those present.
(k) Medical and mental health evaluations, if required, shall be conducted:
(1) within 30 days prior to the date of admission; and
(2) whenever a change in the resident's condition warrants, but no less than once in every 12 months.
(l) The operator shall assist a resident in obtaining any required evaluations.
(m) For any residents who cannot be retained under the conditions set forth in subdivision (c) of this section:
(1) the operator shall make persistent efforts to secure appropriate alternative placement and shall document such efforts;
(2) persistent efforts shall be defined as:
(i) assisting the resident or resident's representative with filing five applications for each such resident with appropriate facilities;
(ii) following up by telephone every two weeks on the status of the applications;
(iii) if an application is rejected, the operator shall assist the resident or resident's representative in filing an application to another facility within five working days of the date of rejection; and
(iv) if the resident is not placed, the operator must notify the regional office in writing, every 90 days from the filing of the first application, of the name of the resident and any pending and rejected applications.
(n) Notwithstanding subdivision (k) of this section, medical evaluations shall not be required of a competent adult who relies upon or is being furnished treatment by spiritual means through prayer, in lieu of medical treatment, in accordance with the tenets and practices of a recognized church or religious denomination of which the resident is a member or bona fide adherent. In such cases the operator shall:
(1) require documentation of the resident's standing as a member; and
(2) adhere to the admission and retention standards set forth in subdivision (c) of this section.
(o) The operator shall not admit nor accept for return an individual directly from a general or special hospital, psychiatric center, developmental center, skilled nursing or health-related facility, without a statement from the referral source which details significant medical conditions, prescribed health or mental health regimens and such psychosocial information as may be available to help the operator plan an adequate level of care for the resident. This statement may substitute for the medical or mental health evaluations if the requirements of subdivision (h) or (i) of this section are met.
(p) In facilities with a significant number of mentally disabled persons, the mental health organization or agency with which the operator has executed the agreement required by section 487.7(b) of this Part shall be afforded reasonable opportunity to participate in the admission or retention assessment of persons who require a mental health evaluation or who would be eligible for the mental health organization's services by reason of residency in the adult home. Such participation shall be solely for the purpose of assisting the operator to determine if the operator and available mental health services can meet the needs of the resident.
(q) An applicant shall receive at or prior to the admissions interview:
(1) a copy of the admission agreement;
(2) a copy of the statement of resident rights;
(3) a copy of any facility regulations relating to resident activities, office and visiting hours and like information; and
(4) if made available to the operator by the Long-Term Care Ombudsman Program, a fact sheet about the program and the listing of legal services or advocacy agencies made available by the department.
(r) Each applicant for admission shall have the opportunity to review a copy of the most recent report of inspection issued by the department to the facility.
(s) If the applicant/resident is sight-impaired or hearing-impaired or otherwise unable to comprehend English or printed matter, the operator shall arrange for conduct of the interview and transmission of the contents of the admission agreement, the statement of rights and responsibilities and facility information in a manner comprehensible to the applicant.
VOLUME B-1 (Title 18)