N.Y. Comp. Codes R. & Regs. tit. 14 § 595.13 - Quality Assurance at Residental Programs for Adults with Mental Illness

This regulation requires that each provider of service at residential programs for adults with mental illness have a quality assurance plan in place.  The regulation further states that the plan must:

• Have a written utilization review procedure including the review of appropriateness for admission and continued stay at the program, appropriateness of services provided by the program, and readiness for referral and transfer of youth no longer in need of the program’s services
• Have the utilization review carried out by staff without primary responsibility for the resident under review
• Have an internal incident reporting, investigation and management process, which is detailed in the quality assurance plan
• Have procedures for internal monitoring of program performance with the goal of identifying and addressing problems in care and treatment of clients

The regulation tasks the Office of Mental Health with the responsibility for monitoring the quality of these programs, and sets forth certain requirements for this monitoring:

• Office of Mental Health or its authorized agents shall carry out this external program monitoring and will review program operations, quality assurance activities and the individual records of residents periodically
• Office of Mental Health or its agents will carry out external utilization review according to the provider’s plan
• Office of Mental health will carry out external review as necessary based on patterns of reported incidents or occurrence of an individual incident of extreme gravity

 
In the event that the Office of Mental Health determines that a provider of service is not complying with the requirements stated here, the Office of Mental Health is required to give notice of the issue to the provider, and the regulation further allows the Office to request that the provider prepare a plan to correct the issue or provide necessary technical assistance to help the provider rectify the issue.  Further, if the provider fails to prepare an acceptable plan of correction, refuses the Office's technical assistance, or fails to promptly implement a plan of correction, the regulation states that the provider will be in violation of this part. The regulation states that any provider who fails to comply with the requirements may face fines or lose its operating certificate.  The regulation permits the commissioner to step in and take any immediate steps necessary to protect a resident whose health or safety is in imminent danger or to curb any practice that poses danger to the health and safety of any resident or the public.
 
The regulation further requires that each program have a consumer evaluation process approved by the Office of Mental Health, through which the residents have an opportunity to give their feedback about the program confidentially.  The regulation states that the information received through this process should be summarized and presented to the Office of Mental Health, the resident, and all the staff in the program while protecting the confidentiality of the residents.