Legislative Gudieline 1
Comprehensive and integrated services are provided to all individuals with diagnosed eating disorders.
Article 27-J of the Public Health Law requires Comprehensive Care Centers for Eating Disorders to provide a coordinated and comprehensive system of treatment for persons with eating disorders. Comprehensive Centers will be provider sponsored systems of care, organized by either corporate affiliation or clinical association for the purpose of providing coordinated individualized plans of care, across a continuum that includes all necessary non-institutional, institutional and practitioner services and treatments, from initial screening and evaluation to treatment, follow-up care and support.
Comprehensive Care Centers for Eating Disorders will provide or arrange a continuum of care for individuals of all ages with eating disorders. This continuum will encompass all aspects of care, from initial assessment through outpatient and follow-up services and will include medical, mental health, case management, residential and social support services.
Comprehensive Care Centers for Eating Disorders must have experience providing services to individuals with these disorders. The Center must have an organizational plan describing the capacity of and relationships between the applicant and its partners, which describes how the Center ensures effective delivery of integrated and comprehensive services. The Center's organizational plan will specify arrangements in place to manage and coordinate partial hospitalization (full-day outpatient), inpatient, residential, intensive outpatient, outpatient, follow-up care, case management, support services and other services and requirements as detailed in Guidelines 1, 2 3 and 4. The plan must describe the responsibilities of, and the structural relationships, functional relationships, and lines of communication between the applicant, the program director and all partner agencies and practitioners involved in the care of individuals with eating disorders. The plan should clearly identify the services to be provided directly by the applicant and those services that will be provided through arrangements with partner agencies The plan will also detail features of such arrangements that may impact patient care. The type of arrangement with each provider should be specified (e.g., referral agreement, contract, etc.). Prior to identification, the Comprehensive Care Center for Eating Disorders will be required to submit to the Department of Health for approval, written policies and procedures implementing the organizational plan.
Applicants will be required to demonstrate strong regional capacity for the delivery of all services. As part of the organizational plan, applicants will indicate the geographic area or areas for which they will provide services. Four service areas have been designated (see Attachment 1: map). Applicants may elect to serve more than one region or to provide services in selected areas of an additional region, however at least one of the designated regions must be fully served. All residential, outpatient and follow-up services must be provided with the individual's travel time by automobile not to exceed 60 minutes. The organizational plan should describe how outpatient and follow-up services will be provided for those individuals living in the outer areas of the designated service region.
Comprehensive Centers will employ a Program Director and staff sufficient to provide or coordinate all required services among affiliated providers. The Center must display an ability to screen individuals and accept persons with urgent needs on an expedited basis and for all individuals, must promptly conduct intakes, assessments and initiation of service plans without delay. The Center will conduct a quality assurance program which will include, but not be limited to, periodic clinical review of individual patient records, documentation of recovery rates and the methodology for determining them, and evaluation of the success of modalities of care among subgroups of the patient population. Comprehensive Care Centers for Eating Disorders will collect and maintain data for all patients, defined by the Department, allowing for evaluation of the program in cooperation with the Department of Health. Key care process and outcome indicators required of all providers will be defined by the Department.
Comprehensive Care Centers for Eating Disorders must effectively identify and access insurance benefits and other third party reimbursement. The applicant should fully describe its relationships with insurers to identify and access policy benefits, and any agreements with insurers that facilitate individualized comprehensive and integrated plans of care which Centers are required to provide. Centers must demonstrate the capacity to make HIPAA compliant commercial insurance and other third party payor claims on behalf of patients, including prior authorizations and all levels of appeals.
Centers will enter into agreements with all other identified Comprehensive Care Centers for Eating Disorders to share information and facilitate care for individuals who choose to move between Centers.