reglab/statecodes huggingface dataset:
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-C - Medical Advisory Committee.

§ 365-c.  Medical advisory committee. 1.  A medical advisory committee
  is  hereby  established  to  consist  of  twenty  members  who  shall be
  appointed by the governor, by and with the advice  and  consent  of  the
  senate,  for the following terms: seven shall be appointed for a term to
  expire on May thirty-first, nineteen hundred seventy-four:  seven  shall
  be  appointed for a term to expire on May thirty-first, nineteen hundred
  seventy-five: and six shall be appointed for a term  to  expire  on  May
  thirty-first,   nineteen   hundred  seventy-six.     Thereafter  members
  appointed upon expiration of a term of office shall be appointed  for  a
  term  of three years.  Vacancies caused by death, resignation or refusal
  to act or by removal from the state shall be filled  for  the  unexpired
  term  only.      At  least seven members of such committee shall be duly
  licensed physicians.  The governor shall designate a chairman from among
  the members of the medical advisory committee, to serve as such  at  the
  pleasure  of  the  governor.    In appointing the members of the medical
  advisory  committee,  the   governor   shall   give   consideration   to
  professional    qualifications   and   experience   and   to   achieving
  representation of the professions  of  medicine,  osteopathy,  podiatry,
  mental health, social work, dentistry, optometry, chiropractic, physical
  therapy,  pharmacy,  nursing,  hospital  and  health  administration and
  education for the health professions, of public and private agencies  in
  the  field  of  medical  assistance,  and of recipients and consumers of
  medical assistance for needy persons.
2.  The medical advisory committee shall advise the commissioner  with
  respect  to  health  and medical care services provided pursuant to this
  title.
3.  The medical advisory committee shall meet at least  once  a  year.
  Special  meetings  may be called by the chairman, and shall be called by
  him at the request of the governor or the commissioner.
4.  No member of the medical advisory committee shall be  disqualified
  from holding any other public office or employment, nor shall he forfeit
  any  such  office  or  employment by reason of his employment hereunder,
  notwithstanding the provisions of any general,  special  or  local  law,
  ordinance or charter.
5.    The  members  of the medical advisory committee shall receive no
  compensation for their services, but shall be allowed their  actual  and
  necessary   expenses   incurred  in  the  performance  of  their  duties
  hereunder.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-E - Optional or Continued Membership in Entities Offering Comprehensive Health Services Plans.

§  365-e.  Optional  or  continued  membership  in  entities  offering
  comprehensive health services plans. 1. In  accordance  with  applicable
  federal requirements and subject to the approval of the commissioner and
  the  director  of the budget, a district shall offer to persons eligible
  for  medical  assistance  the  option  of  membership  in   any   health
  maintenance  organization  or  other  entity  which  is  certified under
  article forty-four of the public health  law  or  licensed  pursuant  to
  article  nine-C of the insurance law or otherwise authorized by law, and
  which offers comprehensive health services  plans  to  persons  residing
  within  the  social  services  district  unless  granted a waiver by the
  commissioner on the grounds that  the  organization  or  entity  is  not
  geographically  accessible  so  as  to  provide  medical  assistance  to
  eligible recipients who reside within  the  district  or  that  the  per
  recipient  capitation  rate  is above the expected average per recipient
  fee-for-service cost within  the  local  district  or  that  the  health
  maintenance  organization  or  other  entity  refuses  to  enter  into a
  contract with the district.
2. Nothwithstanding any inconsistent provision of  law,  persons  who,
  prior  to  becoming  eligible  for medical assistance, are enrolled in a
  health maintenance organization or other entity offering a comprehensive
  health services plan shall be offered  the  option  of  continuing  that
  enrollment.
3.  The  commissioner  shall  offer  to social services districts such
  technical assistance as may be appropriate to assist in the  development
  of contracts between the districts and such entities.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-K - Provision of Prenatal Care Services.

§  365-k. Provision of prenatal care services. 1. (a) The commissioner
shall establish standards and guidelines for the provision  of  prenatal
care services under the medical assistance program. In establishing such
standards  and  guidelines,  the  commissioner  shall consider generally
accepted standards of professional practice, including, but not  limited
to,  standards  issued  by  the  American  College  of Obstetricians and
Gynecologists and the American Academy of Pediatrics, and shall  consult
with prenatal care providers and other interested parties.
(b)  The  standards  and guidelines established under this section for
providing non-invasive prenatal testing shall not limit availability and
coverage for a test based on the age of the pregnant patient, unless the
limit is explicitly called for by the generally  accepted  standards  of
professional   practice   or   is   otherwise   recommended   by  safety
communications or guidance issued by the United  States  food  and  drug
administration,  the  centers for Medicare and medicaid services, or the
United States department of health and human services.
2. For purposes of  this  title,  "prenatal  care  provider"  means  a
medical  care  facility  or  public  or private not-for-profit agency or
organization,  physician,  licensed  nurse  practitioner,  or   licensed
midwife  practicing  on  an  individual  or  group  basis  that provides
prenatal  care  or  managed  care  plan  that  contracts  with  prenatal
providers.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-O - Provision and Coverage of Services for Living Organ Donors.

§  365-o.  Provision and coverage of services for living organ donors.
  This section applies in  the  case  of  a  living  donor  under  section
  forty-three hundred seventy-one of the public health law who is enrolled
  in  medical  assistance  under  this  title.  Living  donor expenses for
  eligible individuals under section forty-three  hundred  seventy-one  of
  the  public  health  law  that are covered benefits under this title are
  excluded from reimbursement under  the  living  donor  support  program,
  defined in section forty-three hundred seventy of the public health law,
  provided federal financial participation is available.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-P - Doulas for Medicaid.

* §  365-p.  Doulas for Medicaid. 1. Definitions. (a) For the purposes
of this section, "doula" means a trained person who provides  continuous
physical,  emotional, and informational support to a pregnant person and
the family of such pregnant person during or  a  reasonable  time  after
pregnancy.
(b)  A  doula  may provide services in hospitals, birthing centers, at
home deliveries and other community settings.
2. New York state community doula directory. (a) The department  shall
establish  and  maintain  a  community doula directory for doulas on the
department's internet website for the purposes of Medicaid reimbursement
and promoting doula services to Medicaid recipients.
(b) The directory shall include the following  information  concerning
doulas such as:
(i) the name of the doula who provides doula services;
(ii)  the  address  and  location  of  where  the doula provides doula
services;
(iii) the name of each Medicaid provider  that  employs  or  contracts
with a doula to provide doula services to eligible Medicaid recipients;
(iv)   the   doula's   national  provider  identification  number,  if
applicable; and
(v) all documentation of criteria pursuant  to  subdivision  three  of
this section.
(c)  The department shall determine the method of registration and the
documentation required to verify such criteria has been met.
(d) Each doula shall be responsible for  completing  the  requirements
pursuant to subdivision three of this section.
(e)  The  department shall not impose any fee on any doula to register
for admittance into the New York state community doula directory.
(f) The community doula directory shall be publicly accessible  at  no
cost  to  the  doula or birthing person looking to hire a doula in their
community.
3. Criteria for admittance into the New  York  state  community  doula
directory.  (a) Each doula seeking Medicaid reimbursement shall apply to
be registered in the New York state community doula directory.
(b) A doula shall submit to the department a certified  copy  of  such
doula's  certification  from  a  doula  educational  organization  or by
demonstration of satisfactory proficiency pursuant to this  subdivision,
and  his, her, or their full name, address, phone number, email address,
and if applicable, their national provider identification number.
* NB Effective August 6, 2024
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 366-B - Penalties for Fraudulent Practices.

§  366-b.    Penalties  for  fraudulent practices. 1.   Any person who
  knowingly  makes  a  false  statement  or  representation,  or  who   by
  deliberate  concealment  of  any  material  fact, or by impersonation or
  other fraudulent device, obtains or attempts to obtain or aids or  abets
  any  person  to  obtain  medical assistance to which he is not entitled,
  shall be guilty of a class A misdemeanor, unless such act constitutes  a
  violation  of  a provision of the penal law of the state of New York, in
  which case he shall be punished in accordance with the  penalties  fixed
  by such law.
2.   Any person who, with intent to defraud, presents for allowance or
  payment any  false  or  fraudulent  claim  for  furnishing  services  or
  merchandise,  or  knowingly submits false information for the purpose of
  obtaining greater compensation than that to which he is legally entitled
  for furnishing services  or  merchandise,  or  knowingly  submits  false
  information  for  the  purpose of obtaining authorization for furnishing
  services or merchandise under this title, shall be guilty of a  class  A
  misdemeanor,  unless  such act constitutes a violation of a provision of
  the penal law of the state of New  York,  in  which  case  he  shall  be
  punished in accordance with the penalties fixed by such law.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 366-D - Medical Assistance Provider; Prohibited Practices.

§   366-d.  Medical  assistance  provider;  prohibited  practices.  1.
Definitions. As used in  this  section,  "medical  assistance  provider"
means  any  person,  firm,  partnership,  group, association, fiduciary,
employer or representative thereof or other  entity  who  is  furnishing
care,  services  or  supplies under title eleven of article five of this
chapter.
2.  No medical assistance provider shall:
(a)   solicit, receive, accept or  agree  to  receive  or  accept  any
payment  or  other  consideration in any form from another person to the
extent such payment  or  other  consideration  is  given:  (i)  for  the
referral  of  services  for  which payment is made under title eleven of
article five of this chapter; or (ii) to purchase, lease  or  order  any
good,  facility,  service  or item for which payment is made under title
eleven of article five of this chapter; or
(b)  offer, agree to give or give any payment or  other  consideration
in  any  form  to  another  person  to  the extent such payment or other
consideration is given: (i) for  the  referral  of  services  for  which
payment  is  made under title eleven of article five of this chapter; or
(ii) to purchase, lease or order any good, facility, service or item for
which payment is made  under  title  eleven  of  article  five  of  this
chapter;
(c)  as  used  in  this section "person"   shall have the meaning  set
forth in subdivision seven of section 10.00 of the penal law.
(d) this subdivision shall not  apply  to  any  activity  specifically
exempt by federal statute or federal regulations promulgated thereunder.
3. Any medical assistance provider who violates the provisions of this
section is guilty of a misdemeanor punishable by:
(a) a term of imprisonment in accordance with the penal law; or
(b)  a  fine  of  not less than five hundred dollars nor more than ten
thousand dollars; or
(c) if  the  defendant  has  obtained  money  or  property  through  a
violation  of the provisions of this section, a fine in an amount, fixed
by the court, not to exceed double the amount of  the  defendant's  gain
from  a  violation  of such provisions. In such event, the provisions of
subdivision three of section 80.00 of the penal law shall be  applicable
to the sentence; or
(d) both the imprisonment and the fine.
4. Any medical assistance provider who violates the provisions of this
section  and  thereby obtains money or property having a value in excess
of seven thousand five hundred dollars shall be  guilty  of  a  class  E
felony.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 366-E - Certified Home Health Agency Medicare Billing.

§  366-e. Certified home health agency medicare billing. (a) Certified
home health agencies shall bill under title XVIII of the federal  social
security  act  for  services  provided to all patients eligible for such
program who, as  defined  by  federal  law  and  regulations,  are:  (i)
homebound; (ii) receiving skilled services; and (iii) are receiving such
services  on an intermittent basis. The department, in consultation with
the department of health and representatives of  certified  home  health
agencies  with  demonstrated  ability  to maximize medicare revenue, may
promulgate regulations to implement this subdivision. Nothing  contained
herein  shall be construed to prohibit agencies from billing for medical
assistance reimbursement for eligible services provided to such patients
which are not covered under title XVIII of the federal  social  security
act meeting the standards established by the department pursuant to this
section.    Patient cases that meet the criteria established pursuant to
this subdivision, where coverage has been denied under  title  XVIII  of
the  federal  social  security  act  for  the cost of care provided by a
certified home health agency shall be referred  by  such  agency  to  an
organization pursuant to subdivision (b) of this section.
(b)  The  commissioner  shall  enter  into  agreements with persons or
entities to provide for representation of persons meeting  the  criteria
specified  in  subdivision  (a)  of  this  section  who have been denied
reimbursement, under title XVIII of the federal social security act, for
services provided by a certified home health agency.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 366-F - Persons Acting in Concert With a Medical Assistance Provider; Prohibited Practices.

§ 366-f. Persons acting in concert with a medical assistance provider;
prohibited practices.
1.  No  person  acting  in  concert with a medical assistance provider
shall, with intent to defraud:
(a) solicit, receive, accept or agree to receive or accept any payment
or other consideration in any form from another  person  to  the  extent
such  payment  or  other  consideration is given (i) for the referral of
services for which payment is made under this title or (ii) to purchase,
lease or order any good, facility, service or item for which payment  is
made under this title; or
(b) offer, agree to give or give any payment or other consideration in
any  form  to  another  person  to  the  extent  such  payment  or other
consideration is given (i)  for  the  referral  of  services  for  which
payment  is  made  under this title; or (ii) to purchase, lease or order
any good, facility, service or item for which payment is made under this
title;
(c) this subdivision shall not  apply  to  any  activity  specifically
exempt by federal statute or federal regulations promulgated thereunder.
2.  As used in this section, "person" shall have the meaning set forth
in subdivision seven of section 10.00 of the penal law.
3. A violation of the provisions of  this  section  is  a  misdemeanor
punishable by:
(a) a term of imprisonment in accordance with the penal law; or
(b) a fine of not more than ten thousand dollars; or
(c)  if  the  defendant  has  obtained  money  or  property  through a
violation of the provisions of this section, a fine in an amount,  fixed
by  the  court,  not to exceed double the amount of the defendant's gain
from a violation of such provisions. In such event,  the  provisions  of
subdivision  three of section 80.00 of the penal law shall be applicable
to the sentence; or
(d) both the imprisonment and the fine.
4. Any such person who violates the provisions  of  this  section  and
thereby  obtains  money  or  property  having a value in excess of seven
thousand five hundred dollars shall be guilty of a class E felony.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 366-G - Newborn Enrollment for Medical Assistance.

§  366-g.  Newborn enrollment for medical assistance. 1. Each hospital
licensed under article twenty-eight  of  the  public  health  law  shall
report  to  the department of health, or such other entity designated by
the department of health, in such format as  the  department  of  health
shall  provide,  each live birth of a child to a woman receiving medical
assistance on the date of the birth. Such reports shall be  made  within
five  business  days of the birth and shall include data identifying the
mother and child.
2. Each hospital licensed under article  twenty-eight  of  the  public
health  law,  upon discharge after delivery of a child, shall notify, in
plain language and in such manner as  the  department  of  health  shall
provide, each mother in receipt of medical assistance that such child is
deemed  to  be  enrolled in the medical assistance program regardless of
his or her receipt of a medical assistance identification card or client
identification number or other proof of the child's eligibility, and may
access care, services and supplies in accordance  with  this  title  and
other applicable laws.
3.  The  commissioner  of health shall establish a procedure to ensure
that every child born to a mother who is receiving medical assistance on
the date of the child's birth is automatically enrolled in  the  medical
assistance  program, assigned a client identification number, and issued
an active medical assistance identification card, as soon  as  possible,
but  in  no  event  later than ten business days from the receipt of the
report required pursuant to subdivision one of this section.
4. (a)  Consistent  with  the  provisions  of  section  three  hundred
sixty-six  of this title, a child under the age of one year whose mother
is receiving medical assistance, or whose mother was  receiving  medical
assistance  on  the  date  of  the  child's birth, who is presented to a
medical  assistance  provider,  as  defined  in  section  three  hundred
sixty-six-d  of  this title, for care, shall be deemed to be enrolled in
the medical assistance program regardless of the issuance of  a  medical
assistance  identification  card or client identification number to such
child or other proof of the child's eligibility.
(b) A medical assistance provider that furnishes medical assistance as
defined in section three hundred sixty-five-a of this title, to a  child
described  in  paragraph  (a)  of this subdivision shall be eligible for
medical assistance  reimbursement  for  such  assistance  regardless  of
whether  the  child  has been issued a medical assistance identification
card, client  identification  number  or  other  proof  of  eligibility.
Reimbursement  under  this  section  shall  be  in  accordance  with the
provisions of this title, including, as appropriate,  section  364-j  of
this  title  and  all  other  applicable  laws,  rules,  regulations and
administrative directions.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 366-H - Automated System; Established.

§   366-h.   Automated   system;   established.   Notwithstanding  any
  inconsistent provision of law or regulation, the commissioner of  health
  shall,  as  soon as practicable, establish an automated system to ensure
  that persons who meet the criteria for  receipt  of  medical  assistance
  benefits under paragraph (a) or (c) of subdivision four of section three
  hundred  sixty-six  of  this  title shall remain enrolled in the medical
  assistance program without interruption and  receive  the  benefits  set
  forth  according  to paragraph (a) or (c) of subdivision four of section
  three hundred sixty-six of this title. Pending  implementation  of  such
  automated  system,  such  commissioner  shall,  in consultation with the
  office of temporary and disability assistance,  undertake  and  continue
  efforts  to  educate  local  departments  of  social  services about the
  measures they must take to ensure that medical assistance  benefits  are
  provided to persons eligible for such benefits under subdivision four of
  section three hundred sixty-six of this title.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367 - Authorization for Hospital Care.

§  367.   Authorization for hospital care.  1.  Except as permitted by
  the regulations of the department, so far  as  practicable,  no  patient
  shall  be  admitted to a hospital as a public charge under this title or
  this chapter without the prior  authorization  of  the  social  services
  official  responsible  for  authorizing  such  care.    If  a patient is
  admitted without prior authorization of the appropriate social  services
  official and the hospital has reason to believe that the patient will be
  unable  to  pay  for  his care, and is or may be eligible for care under
  this title or this chapter, it may send a notice containing a report  of
  the  facts  of  the  case  to  such  social  services official who shall
  promptly advise the patient or his representative of his right to  apply
  for  medical  assistance  and, if eligible, to have the cost of his care
  paid for under this chapter.   If the identity of  the  social  services
  official  responsible  for  authorizing  such  care  is not known by the
  hospital, such notice shall be sent to the commissioner  of  the  social
  services  district  in  which  the hospital is located who shall make an
  investigation  to  determine  which  social  services  district  may  be
  responsible  for  authorizing  such  care  and appropriately notify such
  district, which shall advise such patient or his representative  of  his
  right  to  apply,  and if eligible to have the cost of his care paid for
  under this chapter.  The cost of care of an eligible patient shall be  a
  charge  against  a  social services district only when authorized by the
  commissioner of social services of such  district,  which  authorization
  shall  not  be withheld from any patient eligible for such care pursuant
  to this title and the regulations of the department.
2.   Notwithstanding any inconsistent provision  of  law,  the  social
  services official responsible for authorizing hospital or health related
  services shall withhold payment for such services upon the certification
  of the commissioner of health that payment for such care is unauthorized
  under the medical assistance program.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-D - Personal Care Need Determination.

* §  367-d.  Personal  care need determination. The commissioner shall
  annually determine the statewide need for personal care services for all
  recipients except for those receiving personal care services pursuant to
  section three hundred  sixty-seven-c  of  this  article  and  for  those
  recipients  who  are  receiving  personal  care services and residing in
  family care homes or community  residences  as  defined  in  subdivision
  twenty-eight-a  of  section  1.03 of the mental hygiene law certified by
  the office of mental health and the office  of  mental  retardation  and
  developmental  disabilities.  In  determining such need the commissioner
  shall consider such factors as the population  characteristics,  poverty
  levels,  the  availability  of  informal  support  and other health care
  resources,  related  demographic  data,  and  such  other  factors   the
  commissioner  deems  pertinent  for  this purpose. The need for personal
  care services, as used in this section, shall  be  expressed  in  hourly
  units  of  service  and  the total number of personal care service units
  established pursuant to this section shall be allocated to  each  social
  services district on the same basis as the statewide need is determined.
  Such  allocations  shall be in effect for the period April first through
  March thirty-first of the following year and shall be made available  to
  each  social services district prior to April first of each year, except
  that  during  calendar  year   nineteen   hundred   eighty-three,   such
  allocations  shall  be made available within thirty days after enactment
  of this section but no earlier than April first. Within thirty  days  of
  receipt  of  a  written request to the department made by a local social
  services commissioner the department  shall  provide  all  documentation
  used  as  the basis for determining aggregate statewide as well as their
  individual district allocations determined pursuant to this section.
* NB Expired March 31, 1985
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-H - Payment for Assisted Living Programs.

§  367-h.  Payment  for  assisted  living  programs. 1. Subject to the
  approval of the state director  of  the  budget,  the  commissioner  may
  authorize  the  payment  of medical assistance funds for assisted living
  programs, as  defined  in  section  four  hundred  sixty-one-l  of  this
  chapter,  in  accordance  with  capitated  rates  of payment established
  pursuant to subdivision six of section thirty-six  hundred  fourteen  of
  the public health law.
2.  No  assisted  living  program  shall cease providing services to a
  medical assistance recipient solely because the cost of his or her  care
  exceeds the amount of such capitated payments.
3.  No  medical  assistance  payments  shall  be made pursuant to this
  section while payments are also being  made  for  inpatient  care  in  a
  residential  health  care  facility or hospital with respect to the same
  person.
4. This section shall  be  effective  if,  and  as  long  as,  federal
  financial participation is available for medical assistance expenditures
  made pursuant to it.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-P - Responsibilities of Local Districts for Personal Care Services, Home Care Services and Private Duty Nursing.

* §  367-p.  Responsibilities  of  local  districts  for personal care
services, home care services and private duty nursing.  Consistent  with
the  provisions  of  section  three hundred sixty-seven-n of this title,
local  social  services  district  responsibilities  for  personal  care
services,  home care services and private duty nursing shall include the
following:
(a) local districts with programs which place  individuals  discharged
from  hospitals  solely into certified home health agencies shall ensure
that those individuals are reviewed for possible placement into personal
care services within two weeks of discharge and, if appropriate,  placed
into personal care services within four weeks thereof;
(b)  each  local  district shall, by September first, nineteen hundred
ninety-five, review that plan of  care  for  every  recipient  receiving
personal  care  on a continuous basis pursuant to sections three hundred
sixty-seven-k and three hundred sixty-seven-l of this title;
(c) each local district shall ensure access  to  a  consumer  directed
personal  assistance  program operated pursuant to section three hundred
sixty-five-f of this title is available in the district to allow persons
receiving home care pursuant to this title to directly arrange  and  pay
for such care; and
(d)  local  districts  shall not restrict, and shall not be restricted
from approving, the provision of private duty nursing as an  alternative
to  nursing  services provided by a home health agency where appropriate
and cost-effective pursuant to section three hundred sixty-seven-l.
* NB There are 2 § 367-p's
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-P*2 - Payment for Limited Home Care Services Agencies.

* §  367-p.  Payment  for  limited  home  care  services  agencies. 1.
  Notwithstanding any law to the contrary, the commissioner shall, subject
  to the approval of the  director  of  the  budget,  establish  rates  of
  payment  for  services  provided by limited home care services agencies,
  licensed by the department of  health  pursuant  to  section  thirty-six
  hundred  five  of the public health law, to eligible individuals who are
  residents of adult homes and enriched housing programs certified by  the
  department  in  accordance  with article seven of this chapter. Services
  for which reimbursement shall be available are  personal  care  services
  provided   directly  by  the  agency  and  authorized  and  provided  in
  accordance with the rules and regulations of  the  department;  and  the
  administration  of medications and application of sterile dressings by a
  registered nurse provided, however, that the services provided  by  such
  agency  are  not  services  that  must  be provided to residents of such
  facilities pursuant to article seven of this chapter.
2. Notwithstanding any law  to  the  contrary,  a  limited  home  care
  services agency licensed by the department of health shall be reimbursed
  at a rate that is significantly less than the current costs of providing
  such  services through a personal care provider or certified home health
  agency in the same service area.
3. For purposes of this  section,  an  eligible  individual  means  an
  individual  who is eligible for medical assistance, as determined by the
  appropriate social services district, which  has  also  determined  that
  such   individual  has  a  medical  need  for  services  and  that  such
  individual's needs can safely and appropriately be met  by  the  limited
  home care services agency in the adult home or enriched housing program.
4.  Prior  to authorizing payment for services provided to an eligible
  individual by a limited  home  care  services  agency,  the  appropriate
  social  services district must determine that the service proposed to be
  provided by  such  agency  is  cost-effective  in  comparison  to  other
  available  and  appropriate  service  delivery  options available in the
  district.
5. The commissioner of health shall establish  rates  of  payment  for
  services  provided  pursuant  to  this  section  by  November fifteenth,
  nineteen hundred ninety-seven.
* NB Expires June 30, 2025
* NB There are 2 § 367-p's
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-T - Payment for Emergency Physician Services.

§  367-t.  Payment  for  emergency physician services. Amounts payable
  under this title for medical assistance for items and services  provided
  to  eligible  persons  by qualified emergency physicians, provided in an
  emergency room of an entity certified pursuant to  article  twenty-eight
  of  the public health law to treat an emergency condition, as defined in
  subdivision three of section forty-nine hundred  of  the  public  health
  law, which are authorized pursuant to section three hundred sixty-five-a
  of  this  title shall be no less than twenty-five dollars per visit. For
  the purpose of this section eligible persons shall not  include  persons
  provided items and services by the medicaid managed care program.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 367-U - Payment for Home Telehealth Services.

§  367-u.  Payment  for  home  telehealth  services. 1. Subject to the
  approval of the state director  of  the  budget,  the  commissioner  may
  authorize  the  payment  of  medical  assistance funds for demonstration
  rates or fees established for home telehealth services provided pursuant
  to subdivision three-c of section thirty-six  hundred  fourteen  of  the
  public health law.
2.  Subject to federal financial participation and the approval of the
  director of the budget, the commissioner  shall  not  exclude  from  the
  payment of medical assistance funds the delivery of health care services
  through  telehealth,  as  defined  in  subdivision  four  of section two
  thousand nine hundred ninety-nine-cc of  the  public  health  law.  Such
  services   shall  meet  the  requirements  of  federal  law,  rules  and
  regulations for the provision of medical  assistance  pursuant  to  this
  title.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 368 - Quarterly Estimates.

§ 368.  Quarterly estimates. Each public welfare district shall submit
  to  the  department  quarterly estimates of its anticipated expenditures
  for medical assistance for needy persons and administrative expenses not
  less than thirty days before the first  day  of  each  of  the  quarters
  beginning  on  the first day of the months of July, October, January and
  April, in such form and together with  such  other  information  as  the
  department may require.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 368-B - State Reimbursement to Local Health Districts; Chargebacks.

§  368-b.  State reimbursement to local health districts; chargebacks.
1.  Each approved local health district which  enters  into  a  contract
with  the  department  of  health  pursuant  to  section  three  hundred
sixty-four-a of this title shall submit to the department  of  health  a
quarterly report of expenditures for administrative expenses incurred in
the performance of such contract.  The department of health shall review
such  expenditures  and,  upon  approval, shall submit the report to the
department.  Upon receipt of such approved report, there shall  be  paid
to each such district
(a)    the amount of federal funds, if any, properly received or to be
received on account of such expenditures; and
(b)  fifty per centum of the amount expended for  such  administrative
expenses,  after  first  deducting  therefrom any federal funds properly
received or to be received on account thereof.
2.  The department of health shall submit a quarterly  report  to  the
department  of expenditures for administrative expenses incurred by each
of the state health districts in  the  performance  of  the  cooperative
agreement entered into pursuant to section three hundred sixty-four-a of
this  title.    Upon receipt of such report, the department shall deduct
the amount of federal funds, if any, properly received or to be received
on account of such expenditures from the total amounts reported for each
such district   Fifty per centum of the  balance  shall  be  apportioned
among  the public welfare districts served by such district in the ratio
that the total expenditures by each such  public  welfare  district  for
medical  assistance for needy persons for the quarter bears to the total
expenditures by all such public welfare districts for such quarter.  The
proportionate share shall be deducted from the next payment due each  of
such   public  welfare  districts  pursuant  to  section  three  hundred
sixty-eight-a of this title.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 368-C - Audit of State Rates of Payment to Providers of Health Care Services.

§  368-c.  Audit of state rates of payment to providers of health care
  services. 1. The commissioner may conduct, or have conducted,  an  audit
  of   financial   and   statistical  reports  used  for  the  purpose  of
  establishing rates of payment  or  fees  made  in  accordance  with  the
  medical assistance program.
2. The commissioner shall implement audit procedures and activities to
  enable  the  identification  of  the  appropriate  rates of payment made
  through the medical assistance  program.  Furthermore  the  commissioner
  shall conduct an annual review of financial and statistical reports with
  respect  to  residential  health  care  facilities certified pursuant to
  article twenty-eight  of  the  public  health  law.  Where  such  review
  indicates  substantial  noncompliance,  as  defined in regulation by the
  commissioner, with the requirements of the  medical  assistance  program
  the  commissioner  shall  conduct  or  have  conducted an on-site audit.
  Provided further however, that at least once every four fiscal years  an
  on-site audit shall be conducted.
3.  To  allow  for  the  recomputation  of  affected  fees or rates of
  payment, the commissioner shall, as appropriate, supply  audit  findings
  to  the  governmental  agency  or corporation organized and operating in
  accordance with article forty-three of the insurance law responsible for
  the promulgation of fees or rates of reimbursement.
4. The commissioner shall enter into interagency  agreements,  subject
  to  the  approval  of  the  director  of  the  budget,  to delineate the
  respective responsibilities of the  department  and  other  governmental
  agencies with respect to this section.
5.  The  commissioner  is  authorized  to  promulgate  regulations  to
  implement the provisions of this section.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 368-F - Reimbursement of Costs Under the Early Intervention Program.

§  368-f. Reimbursement of costs under the early intervention program.
  1. The department shall review claims for expenditures  made  by  or  on
  behalf  of social services districts for the administration of the early
  intervention  program  as  established  under  title  II-A  of   article
  twenty-five  of  the  public  health law. If approved by the department,
  payment for such expenditures, which were made in accordance  with  this
  title and the regulations of the department, shall be made by payment to
  such  district,  which  incurred  the expenditure, either directly or by
  contract, of the amount of any federal funds properly received or to  be
  received on account of such expenditures.
2.  Claims  for  payment under this section shall be made in such form
  and manner, at such times, and for such periods as  the  department  may
  require.
3.  The  department's  liability  for  payment for such administrative
  expenditures made by or on behalf of districts under this section  shall
  be  limited  solely  to  payment of the federal funds received, or to be
  received,  on  account  of  such  expenditures.  In  the  event  of  any
  subsequent  disallowances  or  recoupment  of  such  funds  by a federal
  governmental  agency,  upon  notification  by  the   commissioner,   the
  comptroller  shall  withhold  or cause to be withheld the amount of such
  disallowance or recoupment from any moneys otherwise due  the  district,
  as state aid pursuant to any provision of law, and the comptroller shall
  transfer  such amount to the credit of the department of social services
  medical assistance administration program - local assistance account.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11-B - Health Insurance Continuation Program for Persons With AIDS › 369-K - Definitions.

§ 369-k. Definitions.  As used in this section:
1. "Health insurance" shall mean insurance or an employee benefit plan
  against  sickness,  ailment  or  bodily  injury  of the employee and, if
  covered, his or her dependents, other than (i) insurance or an  employee
  benefit  plan  providing disability benefits; or (ii) medical assistance
  benefits received under title eleven of this article.
2. "Health insurance costs" means the premiums or  contributions  paid
  for health insurance by or on behalf of a person with AIDS.
3.  "Household"  means  the  person  with  AIDS  and all other persons
  residing in the same dwelling for whom such person would be  responsible
  pursuant  to  section  one hundred one of this chapter, or for whom such
  person has assumed responsibility.
4. "Persons with AIDS" means  persons  who  are  diagnosed  as  having
  acquired   immune   deficiency   syndrome   (AIDS)  or  who  have  human
  immunodeficiency virus (HIV)-related illness, as defined  in  regulation
  by the state department of health.
5.  "Poverty  line" means the federal income official poverty line (as
  defined and annually revised by the federal  office  of  management  and
  budget).
6.  "Program"  means  the  health  insurance  continuation program for
  persons with AIDS established by section three hundred  sixty-nine-l  of
  this article.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11-B - Health Insurance Continuation Program for Persons With AIDS › 369-L - Establishment of Program.

§  369-l.  Establishment  of  program.  1. There is hereby established
  within  the  department  of  social  services   the   health   insurance
  continuation program for persons with AIDS.
2.   Notwithstanding   any   inconsistent   provision   of   law,  the
  commissioner, subject to the approval of the director of the budget, may
  apply for appropriate waivers under federal law and regulation  or  take
  other  actions to secure federal financial participation in the costs of
  the program; may waive or modify  any  provisions  of  this  chapter  or
  regulation  of the department to implement this title; or may promulgate
  such regulations as necessary to implement this title.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11-B - Health Insurance Continuation Program for Persons With AIDS › 369-M - Program Eligibility and Operations.

§  369-m.  Program  eligibility and operations.  1. In accordance with
regulations of the commissioner, a social services  district  shall  pay
all  or  part  of  the health insurance costs on behalf of a person with
AIDS who:
(a) is  unemployed,  or,  if  employed,  currently  is  ineligible  to
participate  in  health insurance through his or her current employer or
such employer offers no such plan; and
(b) participated in the plan of health insurance provided  by  his  or
her  prior  employer  and  is eligible to continue or convert his or her
participation in such  plan  by  assuming  the  health  insurance  costs
associated  with such plan although no longer employed by such employer;
and
(c) resides in a household whose household  income  is  less  than  or
equal to one hundred eighty-five percent of the poverty line.
2. For purposes of determining eligibility under this title, household
income  shall  be  determined  by  use  of  the same methodology used to
determine eligibility for federal supplemental security income benefits,
provided that costs incurred for medical or remedial care shall  not  be
taken  into  account  in  determining  household  income;  and, provided
further, that any resources available to such  household  shall  not  be
considered  nor  required  to  be  applied to the payment of health care
expenses.
2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11-B - Health Insurance Continuation Program for Persons With AIDS › 369-N - Relationship of Program to Medical Assistance Program.

§ 369-n. Relationship of program to medical assistance program. 1. Any
  person  eligible  for  medical assistance benefits under title eleven of
  this  article  or  who  would  be  eligible  for  such  benefits  if  an
  application  were to be made pursuant to section three hundred sixty-six
  of this article shall not be eligible for the payment of all or part  of
  such  person's health insurance costs under this program. If all members
  of a household can establish eligibility for medical assistance benefits
  under the excess income program by use of paid  or  incurred  bills,  no
  person  in  that  household  shall be eligible for the payment of all or
  part of such person's health insurance costs under this program.
2. Notwithstanding any inconsistent  provision  of  law,  expenditures
  incurred  by  social  services  districts  under  this  title related to
  program expenses shall be considered expenditures under the  program  of
  medical  assistance for needy persons under title eleven of this article
  and there shall be paid to each  such  district  fifty  percent  of  the
  amount  expended  by  such  district  under  this  title,  and  for  the
  administration thereof, after  first  deducting  therefrom  any  federal
  funds properly received or to be received on account thereof.