1. (1) An individual who appears at the service seeking treatment or evaluation shall have an initial determination made and documented in a written record by a qualified health professional, or other clinical staff under the supervision of a qualified health professional, which states the following:

   1. (i) that the individual is documented as less than 21 years of age on the date of admission and appears to be in need of chemical dependence services;
   2. (ii) that the individual appears to be free of serious communicable diseases that can be transmitted through ordinary contact; and
   3. (iii) that the individual appears not to be in need of acute hospital care, acute psychiatric care, Part 816 of this Title crisis services or other services which cannot be provided in conjunction with treatment at the facility or would prevent them from participating in substance use disorder treatment.

2. (2) The initial determinations made pursuant to the above shall be based upon provider records, reports from other providers and face-to-face contact with the individual, all of which must be documented.

   (b) Level of care determination.

   If an individual is determined to be appropriate for substance use disorder treatment services, a level of care determination utilizing the OASAS level of care determination protocol, shall be made by a clinical staff member. The level of care determination shall be made no later than one patient day after the patient's first on-site visit to the program and documented in the patient record.

   (c) Prohibition against discrimination.

   No individual shall be denied admission to the service based solely on the individual's:

3. (1) prior treatment history;
4. (2) referral source;
5. (3) pregnancy;
6. (4) history of contact with the criminal justice system;
7. (5) HIV and AIDS status;
8. (6) physical or mental disability; or

9. (7) lack of cooperation by significant others in the treatment process.

   (d) Additional requirements for the admission of Medicaid eligible individuals.

   A provider must obtain pre-admission approval as follows prior to admitting Medicaid eligible individuals to the program.

10. (1) The office shall establish a pre-admission review team (ART) that shall use the requirements of this section to review each individual candidate to determine their appropriateness for admission. If deemed appropriate for admission, the ART shall certify that the individual seeking admission is in need of this level of residential treatment for chemical dependence. The ART shall be operated in accordance with the procedures established by the office and shall at a minimum consist of a physician, a social worker licensed and currently registered as such by the New York State Education Department, and a credentialed alcoholism and substance abuse counselor.

11. (2) Except in emergency circumstances, the service provider must obtain approval from the ART prior to admitting a Medicaid eligible individual. Emergency admissions are authorized only when an individual appears for treatment meeting the admission criteria and meets one of the following conditions:

    1. (i) the individual has a history of re-occurrance outside of a structured 24-hour setting;
    2. (ii) the individual is unable to access transitional services in the community; or
    3. (iii) the individual is without appropriate housing.

12. (3) Under no circumstances should an individual be admitted on an emergency basis or otherwise if they are in medical or psychiatric crisis or if they are in need of withdrawal services and an appropriate referral for such services is made.

    (e) Admission criteria.

13. (1) To be admitted to the program it must be determined that ambulatory services in the community do not meet the needs of the individual recipient or the individual’s environment is not conducive to recovery.
14. (2) If the individual is deemed inappropriate for service, unless the individual is already receiving chemical dependence services from another provider, a referral and connection to a more appropriate service provider shall be made. The reasons for denial of admission must be provided to the individual and documented in a written record maintained by the service provider.
15. (3) The decision to admit shall be made by a staff member who is a qualified health professional authorized by the program sponsor to admit individuals. The name of the qualified health professional who made the admission decision, along with the date of admission, must be documented in the patient record.
16. (4) There must be a notation in the case record that the patient received a copy of the program’s rules and regulations, including patient rights and a summary of Federal confidentiality requirements, and a statement that notes that such rules were discussed with the patient, and that the patient indicated that they understood them.
17. (5) All prospective patients must be informed that admission to a program is on a voluntary basis and a prospective patient is free to discharge themselves from the service at any time. For prospective patients under an external mandate, the potential consequences for premature discharge must be explained, including that the external mandate does not alter the voluntary nature of admission and continued treatment.
18. (6) Individuals under the age of 18 may be admitted without the consent of a parent or legal guardian under certain circumstances in accordance with Mental Hygiene Law section 22.11.

(a) Initial determination.