Forensic Assertive Community Treatment (ACT)

The Adult Assertive Community Treatment (ACT) program is a high-intensity, evidence-based service model operated under the auspices of the New York State Office of Mental Health (NYS OMH). The ACT model is designed to deliver person-centered, recovery-oriented care to adults over the age of 18 diagnosed with serious mental illness (SMI) who have not benefited from traditional site-based behavioral health services. These individuals frequently have complex service needs, such as repeated hospitalizations, homelessness, co-occurring substance use disorders, or criminal justice involvement. The ACT model responds to these needs with a mobile, multidisciplinary team that includes clinical professionals, peer specialists, and support staff who provide integrated care within the community setting. Services are rooted in principles of trauma-informed care, cultural responsiveness, and shared decision-making to support wellness, independence, and social integration. The core mission of ACT is to provide comprehensive, community-based behavioral health treatment, rehabilitation, and support to individuals who require frequent and flexible contact. Services include assessment, person-centered planning, crisis intervention, medication management, psychoeducation, substance use treatment, counseling, vocational and housing support, health monitoring, and peer support. The ACT model emphasizes continuity of care and is designed to serve individuals over an extended period—potentially indefinitely—depending on need. Contacts are conducted in the individual’s preferred setting and occur as often as clinically necessary, with most interactions occurring outside traditional office settings. ACT services are available 24/7, with after-hours crisis intervention as a core element. Each ACT team is responsible for maintaining an individual-to-staff ratio no greater than 10:1 to ensure the quality and intensity of service delivery. Eligibility for ACT services is determined through the county’s Single Point of Access (SPOA) process. Eligible individuals must be 18 or older with a mental illness as listed in the current DSM that seriously impairs community functioning. Priority populations include those with schizophrenia, schizoaffective disorder, bipolar disorder, and chronic major depression. High-need indicators may include frequent psychiatric hospitalizations, homelessness or housing instability, justice system involvement, co-occurring substance use, or inability to engage with traditional treatment models. Exclusions include individuals whose primary diagnosis is a personality disorder, intellectual/developmental disability, or sole substance use disorder. Individuals with Medicaid are prioritized for billing purposes, but lack of active Medicaid does not disqualify eligibility. Applications for the establishment of ACT teams are managed by NYS OMH, which may release Requests for Proposals (RFPs) when there is a demonstrated need in specific counties or regions. Interested providers must submit a comprehensive Prior Approval Review (PAR) application that details how the proposed team will meet state fidelity standards. The application must outline staffing, geographic coverage, service delivery models, and budget justifications. Team structures are defined by size—either a 48- or 68-capacity model—with staffing mandates including clinical professionals, a psychiatrist or psychiatric nurse practitioner, vocational and substance use specialists, and a program assistant. Programs are expected to maintain fidelity to state operational requirements including service hours, crisis responsiveness, documentation, and quality assurance protocols. Program evaluation is based on multiple outcomes, including reduced psychiatric hospitalizations and emergency room visits, improved medication adherence, reduced substance use, improved housing stability, and increased vocational and educational engagement. ACT teams are required to submit data through the Child and Adult Integrated Reporting System (CAIRS) and engage in continuous quality improvement using OMH tools such as Tableau and ACT Team Profiles. Reimbursement for services is provided via Medicaid under a three-tiered payment system based on service intensity, with additional state funding for service dollars and non-Medicaid net deficit support. While ACT services are delivered year-round and do not operate under standard grant cycles, NYS OMH may issue new RFPs based on regional need assessments. Providers are advised to monitor the OMH website and SPOA portals for opportunities and to maintain readiness for future application windows. Teams must maintain certification and comply with annual utilization reviews, incident reporting, fidelity assessments, and workforce development benchmarks to remain in good standing with the state.

Ensure adherence to required staffing ratios, fidelity to the ACT service model, and consistent CAIRS reporting.