New NYS Regulations Require Adult Homes to Lower MH Census to 25%

NYAPRS Note: The Cuomo Administration has released proposed regulations requiring adult homes with a percentage of residents diagnosed with serious psychiatric disabilities to lower the number to 25%. The regulations indicated that 61 adult homes currently exceed that total and will be required to submit a compliance plan as to how they will best prepare adult home residents with psychiatric disabilities to prepare to leave the homes and to be transitioned to an array of supported housing, supported single room occupancy units, community residences, apartment treatment, senior housing and enriched housing programs. Homes that fail to do so will have a compliance home imposed on them by the Department of Health. Simultaneously, OMH has proposed a regulation to prohibit psychiatric units within general hospitals from discharging people to ‘transitional adult homes,’ defined as homes with a certified capacity of 80 beds or more in which 25% of the residents have a psychiatric disability.

These actions represent a major commitment to advancing the rights, choices and hopes of potentially thousands of adult home residents with psychiatric disabilities from across the state (not just NYC) to live a full life in the community, in respect for their ADA rights under the Supreme Court’s Olmstead decision.

This is an historic commitment by New York that will likely set a national trend across our nation. Great thanks are due to the Administration for their groundbreaking action.


New NYS Regulations Require Adult Homes to Lower MH Census to 25%

Excerpts by NYAPRS


Today, new regulations issued by the NYS Department of Health propose limiting the percentage of residents with serious mental illness in adult homes with a certified capacity of eighty or more to less than 25 percent of the resident population.


The regulations arise from the New York State Office of Mental Health’s  clinical determination that while mixed use, larger scale congregate housing is an important and viable form of community living, certain housing settings in which there are a significant number of individuals with serious mental illness are not conducive to the recovery or rehabilitation of the residents. This is particularly so when the settings: are not specifically designed to serve people with serious mental illness; are not under the license and control of OMH; do not foster independent living due to institutional practices such as of congregate meals or ritualized medication administration; and do not provide specifically designed rehabilitation programs linked to community work settings.


OMH will be issuing regulations applicable to all OMH licensed psychiatric hospitals and units that prohibit the discharge of a patient to a transitional adult home, as defined in the regulations of the Department of Health, unless the patient was a resident of the home immediately prior to his or her current period of hospitalization.


These regulations require the operator of every adult home with a certified capacity of 80 or more in which the number of residents with serious mental illness is already 25 percent or more of the resident population ("transitional adult homes") to create and implement a compliance plan that is acceptable to the Department of Health to reduce that number to a level that is less than 25 percent of the resident population, over a reasonable period of time, through the lawful discharge of residents to alternative community settings with appropriate community services.


"An alternative community setting is any setting other than a transitional adult home that is designed to promote independence and economic self-sufficiency. Alternative community settings include, but are not limited to (i) supported housing, including scattered site apartments and single site apartments; (ii) supported single room occupancy; (iii) supportive housing, including community residence single room occupancy; (iv) community residences; (v) apartment treatment, (vi) senior housing; (vii) enriched housing programs; and (viii) such other housing alternatives as are clinically appropriate."


Community services are defined as "services and supports provided in New York State that assist individuals with mental illness to live in the community. Such services and supports include, but are not limited to, assertive community treatment, intensive case management, case management, personalized recovery oriented services, continuing day treatment and Medicaid benefits for which a resident is eligible, including home and community based services waivers, clinic services, certified home health care, personal care assistance, and rehabilitative services."


The compliance plan must also specify how the operator of a transitional adult home will serve the needs of its mental health population while the reduction in population is being achieved, particularly with regard to ensuring the development of independent living skills, ensuring access to and quality of mental health services, encouraging community involvement and integration, and fostering a homelike atmosphere.

Operators of transitional adult homes who do not submit a compliance plan, or who submit a compliance plan that is not acceptable to the Department, will have a compliance plan imposed on them by the Department.


As a result of the Compliance Plans required by these regulations, many adult home residents with serious mental illness are expected to transition to alternative community settings, including but not limited to OMH-funded Supported Housing. The annual cost of one Supported Housing unit is approximately $20,000 per person.


However, while OMH is engaged in a multi-year effort to expand development of Supported Housing units to serve individuals with serious mental illness, including adult home residents, it is not possible to project the precise number of Supported Housing units that will be needed for this population, which will depend on factors including resident assessments and the need to target units throughout the state.


Moreover, it is expected that when adult home residents with behavioral health needs transition to appropriate community housing, coupled with appropriate supportive services, their overall utilization of Medicaid-funded services will decrease.


Several local governments operate adult homes on a not-for-profit basis. These local governments will incur the same costs as any other adult home or transitional adult home operator.