(b) No application for the issuance of an operating certificate of a psychiatric inpatient unit of a hospital licensed pursuant to article 28 of the Public Health Law, which is applying for an operating certificate pursuant to Part 580 of this Title, shall be granted unless the applicant hospital is, or will be, approved to admit individuals in emergencies pursuant to section 9.39 of the Mental Hygiene Law, except as or provided pursuant to the authority granted in section 31.04(a)(4) of the Mental Hygiene Law and as outlined below.

1. (1) The commissioner shall waive this requirement for a period of two years upon determination that:

   1. (i) there is no public need for additional beds for emergency psychiatric admission in the service area. In determining such need, the factors which the commissioner shall consider include, but shall not be limited to:

      1. (a) the current and projected population characteristics of the service area, including the prevalence of mental illness in the population;
      2. (b) the current patterns of utilization of psychiatric services and the service demands of the service area; and
      3. (c) the existence and availability of psychiatric resources available in the community;
   2. (ii) the hospital lacks the physical capacity to reasonably accommodate such emergency admissions without extensive structural changes. For the purpose of this section, extensive structural changes shall consist of any project for which the costs of accommodating emergency admissions will unreasonably increase the psychiatric inpatient rate of the hospital;
   3. (iii) the hospital does not and reasonably could not provide the scope of services necessary to assure adequate and appropriate psychiatric care and treatment for patients in emergency situations; or

   4. (iv) the hospital has agreed to accept referrals of involuntary psychiatric patients under an emergency admissions system which has been approved by the commissioner. In determining whether such a proposed system should be approved, the commissioner, in consultation with the local governmental unit, shall consider whether such proposal:

      1. (a) defines the specific area to be served;
      2. (b) provides for sufficient beds for emergency psychiatric admissions to meet the public needs identified for the service area pursuant to subparagraph (i) of this paragraph;
      3. (c) describes the manner in which the patterns of admission in the service areas will be altered;
      4. (d) projects the number of admissions that will occur at the hospital covered under the proposal; and
      5. (e) effectively addresses the availability of emergency psychiatric admissions to meet the projected public needs.
2. (2) No hospital without an on-site emergency room shall be required to accept patients in need of emergency observation, care and treatment. No application for the issuance of an operating certificate for a psychiatric inpatient unit of such hospital shall be accepted until the hospital has agreed to accept referrals of involuntary psychiatric patients under an emergency admission system which has been approved by the commissioner, except the commissioner may waive this requirement for a period of two years pursuant to paragraph (1) of this subdivision.
3. (3) Nothing in this Part shall prevent the commissioner from requiring a hospital to admit patients under section 9.39 of the Mental Hygiene Law on an emergency basis if the health or welfare of the public so requires.
4. (4) Prior to granting a waiver to a hospital, the commissioner shall consider the comments of the director of the local governmental unit of the specific service area.

(c) In reviewing projects for inpatient beds, the Office of Mental Health shall consider:

1. (1) the advice and recommendations of the local governmental unit;
2. (2) current or anticipated psychiatric treatment alternatives to acute psychiatric inpatient care which lessen the need for inpatient care;
3. (3) whether the project improves the network of services available to patients in the service area;

4. (4) for projects serving children and adolescents:

   1. (i) conformance with admission and utilization review practices which emphasize the shortest lengths of stay clinically appropriate in order to prevent the child's or adolescent's estrangement from family and community;
   2. (ii) conformance with discharge practices which emphasize planning for discharge from the time of admission, prevention of family or community estrangement, and post discharge follow-up responsibility for all patients; and
   3. (iii) conformance with the policy of developing smaller, specialized children/adolescents units that serve children and adolescents as close to their own communities as possible. Specifically, the Office of Mental Health will consider location of beds, number of beds, travel distances to obtain service in the proposed service area, public transportation, other access factors, and service area plans for children and adolescent beds.