ACF Mental Health Evaluation Update

Linda O'Connell

The Department of Health issued a Dear Administrator Letter (DAL) #20-09, on September 23, 2020 which introduced the Adult Care Facility Mental Health Evaluation Form, DOH-5075.  NYSCAL is having active discussions with the Department of Health regarding this form and has raised several concerns with its required content. DOH has indicated to NYSCAL that given the number of providers that were not compliant with the elements required by the regulations, the Department decided to develop a form which they believed met all the requirements of the regulation.  DOH has indicated that they will discuss NYSCAL's suggestions/concerns internally and will follow up with us.  While it was the Department’s intention to make this form mandatory; because of the various comments and concerns from the industry, DOH indicated to us, at this time, that the form is not mandatory. However, the Department cautioned that facilities that do not use the form and do not meet all the elements of the regulations regarding the information that is required, will receive citations.   

Facilities may wish to review past Statements of Deficiency and Plans of Correction and, if necessary, revise what they are currently using to include all the elements of what is required for the mental health evaluation. NYSCAL will continue to keep members updated as this issue progresses. 


Linda O'Connell, Coordinator, NYSCAL Member Support
518-462-4800 x13