N.Y. Mental Hygiene Law § 41.47: Community support services program

§ 41.47 Community support services program.

(a) As used in this section:

(1) "Approved reimbursable rate" means the maximum rate of payment per

unit of service established by the commissioner of mental health

pursuant to subdivision (e) of this section, or the actual unit cost of

providing community support services, whichever is less, minus revenue.

(2) "Core services" means the daily managing and monitoring of the

implementation of the community support services program within a

defined geographical area.

(3) "Designated adult home" means an adult care facility which is

licensed by the commissioner of social services pursuant to article

seven of the social services law, and which has been designated by the

commissioner of mental health as containing a significant number of

mentally ill persons who are in need of community support services.

(4) "Designated shelter for the homeless" means a shelter for the

homeless which is licensed by the commissioner of social services

pursuant to article seven of the social services law, and which has been

designated by the commissioner of mental health as containing a

significant number of mentally ill persons who are in need of community

support services.

(5) "Designated single room occupancy residence" means a single room

occupancy, as such term is defined in the multiple dwelling law or

multiple residence law, whichever is applicable, which has been

designated by the commissioner of mental health as containing a

significant number of mentally ill persons who are in need of community

support services.

(6) "Functionally disabled as a result of mental illness" means a

person who has a severe, chronic disability which:

(i) is caused by a medically determined mental illness, as evidenced

by a primary psychiatric diagnosis;

(ii) is likely to continue for a prolonged period; and

(iii) results in substantial functional limitations in three or more

of the following areas: (A) self-care, (B) social functioning, (C)

activities of daily living, (D) economic self-sufficiency, (E)

self-direction, and (F) ability to concentrate.

(7) "Provider of services" means the local governmental unit,

voluntary agency, proprietary agency, association, or corporation which

provides the community support services.

(8) "Qualified residence" means a community residence, residential

care center for adults, family care home, or residential treatment

facility for children and youth which is licensed or operated by the

office of mental health.

(9) "Revenue" shall include:

(i) reimbursement for operating costs for community support services

received from other local governmental units or from state agencies

other than the office of mental health, provided that revenue shall not

include money received from any source, in the form of grants, awards or

contracts, for purposes other than the support of such operating costs;

(ii) federal aid received for such operating costs;

(iii) fees received from patients, or on their behalf, from public and

private health insurance and medical aid programs;

(iv) other income received from the operation of the community support

services program; and

(v) interest and dividends accruing from funds received pursuant to

this section.

(b) The community support services program shall include services and

programs such as: case management services, advocacy services, clinic

services, day treatment, day training, continuing treatment, homemaker

services, housekeeping services, on-site rehabilitation services,

sheltered workshop and other vocational programs, psychosocial clubs,

neighborhood drop-in centers, transportation services, non-residential

crisis services, outreach services, and other services approved by the

commissioner.

(c) (1) The commissioner may, upon the application of a local

governmental unit, and within the limits of appropriation therefore,

grant state aid to such local governmental unit for one hundred percent

of the approved costs of providing community support services to

eligible persons, which shall not exceed the approved reimbursable rate,

and the approved costs of providing core services. Local governmental

units which receive state aid pursuant to this subdivision either shall

directly provide community support services or shall enter into

contracts with providers of services for the provision of such services.

Such local governmental units may also provide core services or contract

with voluntary agencies for the provision of such core services.

(2) Persons who are otherwise ineligible to receive community support

services pursuant to subdivision (d) of this section, shall be

considered to be eligible to receive such services for purposes of

paragraph one of this subdivision, if they are certified pursuant to

subdivision (d) of this section to be eighteen years of age or older, to

be functionally disabled as a result of mental illness and to have an

ability to remain in the community which would be seriously jeopardized

without the provision of community support services, but who do not meet

the eligibility criteria of paragraph two or three of subdivision (d) of

this section, provided however, that the provider of services shall make

a reasonable effort to determine such persons' eligibility and, provided

further, that no more than ten percent of the persons served by a local

governmental unit or a provider of services which directly contracts

with the office of mental health shall be otherwise ineligible persons.

(d) (1) Persons who shall be eligible for community support services

shall include individuals who are eighteen years of age and older, who

are functionally disabled as a result of mental illness, whose ability

to remain in the community would be seriously jeopardized without the

provision of community support services, and who satisfy the criteria in

either paragraph two or three of this subdivision. Such eligibility

shall be certified by a licensed psychiatrist, nurse, psychologist,

licensed clinical social worker or a licensed master social worker under

the supervision of a physician, psychologist or licensed clinical social

worker who is approved by a local governmental unit, a core service

agency, or the commissioner to certify individuals as being eligible for

community support services.

(2) Persons who may be certified as permanently eligible to receive

community support services pursuant to paragraph one of this subdivision

shall include individuals who are determined to be eligible pursuant to

regulations promulgated by the commissioner of mental health and shall

include but not be limited to: (i) persons who have received inpatient

psychiatric services in a hospital, or who have resided in a qualified

residence or a designated adult home for a period or periods of time as

established in such regulations of the commissioner; (ii) persons who

are in receipt of supplemental security income benefits or social

security disability insurance benefits pursuant to the federal social

security act, provided that individuals who are in receipt of

supplemental security income benefits must have been determined to be

eligible for such benefits prior to reaching sixty-five years of age;

(iii) persons who are receiving community support services on the

effective date of this act pursuant to the regulations of the

commissioner in effect on such date, who were determined to be eligible

for such services based upon a prior history of inpatient

hospitalization; and (iv) other persons who have received specified

psychiatric services, as established pursuant to the regulations of the

commissioner.

(3) Persons who may be certified as eligible to receive community

support services pursuant to paragraph one of this subdivision shall

include individuals who are residing in a designated adult home, a

designated shelter for the homeless, a designated single room occupancy

residence, a qualified residence, or who are homeless mentally ill

persons. Such persons shall be considered eligible for community support

services for the duration of their participation in such community

support services, and such persons who need such services shall continue

to be eligible to receive such services for a period of one year after

receiving any such services.

(4) Notwithstanding the provisions of paragraph three of this

subdivision, persons who are residing in designated adult homes or in

designated shelters for the homeless, or who are homeless persons, may

receive on-site rehabilitation services or outreach services provided

under this section without a determination of eligibility as otherwise

required under this subdivision.

(e) (1) The commissioner shall annually establish a schedule of

maximum rates of payment per unit of service for reimbursable community

support services. In establishing such maximum rates of payment per unit

of service the commissioner may consider geographical variations and

other relevant considerations. Such rates shall equal the medical

assistance rates established pursuant to section 43.02 of this chapter,

when applicable. Upon the application of the local governmental unit or

a provider of services which directly contracts with the office of

mental health to provide community support services, the commissioner

may authorize additional reimbursement for a period of three local

fiscal years after the effective date of this act, upon a showing of

extraordinarily high costs of providing community support services and

extraordinarily high revenue receipts, which have been demonstrated to

be appropriate.

(2) The commissioner shall establish revenue goals for services,

provided, however, the commissioner may approve local services plans or

may enter into direct contracts with providers of services which

substitute alternative revenue goals for individual providers of

services based upon appropriate documentation and justification, as

required by the commissioner.

(f) Prior to entering into contracts for the provision of community

support services, the office of mental health and local governmental

units shall consider the following:

(1) the service needs of mentally ill persons in the geographical area

in which the community support services program operates;

(2) the capacity of the program to meet identified service needs;

(3) the current availability of services for mentally ill persons in

the area, including the special needs of ethnic minorities and

non-English speaking mentally ill persons;

(4) the extent to which community support services authorized by the

contract will be integrated with other available services in the area to

more effectively maintain mentally ill persons in the community;

(5) the availability of resources for such services;

(6) the extent to which the community support services authorized by

the contract are consistent and integrated with the applicable local

services plan of the area to be served; and

(7) the extent to which such contracts conform with the minimum

contractual requirements as established by the commissioner.

(g) The commissioner may enter into a direct contract for the

provision of community support services when the commissioner

determines, after the approval of the local services plan and the

allocation of state aid therefore, that such direct contract is

necessary to assure that additional community support services are

available to persons who are functionally disabled as a result of mental

illness and are eligible for community support services. Before entering

into a direct contract with a provider located within the geographic

area of a local governmental unit which receives state aid for community

support services pursuant to this section, the commissioner shall notify

the local governmental unit and give the director of the local

governmental unit an opportunity to appeal the need for such direct

contract. Such appeals shall be informal in nature and the rules of

evidence shall not apply.

(h) In order to qualify for one hundred percent state aid pursuant to

this section in any local fiscal year local governmental units shall

assure that the local tax levy share of expenditures for net operating

costs pursuant to an approved local services plan for services provided

to mentally ill persons pursuant to section 41.18 of this article shall

be equal to or greater than the local tax levy share of such

expenditures under an approved local services plan in the last complete

local fiscal year preceding the effective date of this section,

provided, however, any such required maintenance of expenditures under

this subdivision for local governmental units may be reduced to reflect

the local governmental share of revenue applicable to increased payments

made by governmental agencies pursuant to title eleven of article five

of the social services law, which are a result of increased efficiencies

in the collection of such revenue and which represent an increased

proportion of the total local services operating costs from the prior

local fiscal year. The commissioner shall be authorized to reduce

payments made to local governmental units pursuant to this article, in

the following local fiscal year, for failure to maintain expenditures in

accordance with this subdivision.

(i) The provisions of subdivision (h) of this section shall not apply

to a local governmental unit in any local fiscal year in which the total

amount of state aid granted to the local governmental unit for net

operating costs under section 41.18 of the article is less than such

amount of state aid granted in the local fiscal year preceding the

effective date of this section, or in any local fiscal year in which the

total amount of state aid granted to the local governmental unit under

this section, plus the total amount of direct contracts entered into

between the commissioner and providers of services for the provision of

community support services to eligible residents of such local

governmental unit, shall be less than the total amount of such aid and

direct contracts in the first local fiscal year following the effective

date of this section.

(j) The commissioner is authorized and empowered to make inspections

and examine records of a local governmental unit receiving state aid

under this section or a provider of services which directly contracts

with the office of mental health for the provision of community support

services. Such examination shall include all medical service and

financial records, receipts, disbursements, contracts, loans and any

other moneys relating to the financial operation of the community

support services program.

(k) A local governmental unit in receipt of a grant for the provision

of community support services pursuant to subdivision (c) of this

section, which is a unit of a local government with a population of less

than one hundred thousand or which has total program expenditures for

mentally ill persons under this article equal to five hundred thousand

dollars or less in a local fiscal year, shall be permitted to commingle

such funds and the clients receiving community support services with

other local mental health program funds or clients, including local

mental health program funds and clients of other local governmental

units. Such local governmental unit shall be required to submit a plan

to the commissioner which shall describe how the goals and objectives of

the community support services program shall be maintained under such an

arrangement, and such plan must be approved by the commissioner prior to

its implementation.

(l) No provision of this section shall be interpreted to create an

entitlement for any individual to receive community support services.

(m) The commissioner is authorized to promulgate regulations to

implement the provisions of this section.