2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 364 - Responsibility for Standards.

§  364.  Responsibility for standards. To assure that the medical care
and services rendered pursuant to this title are of the highest  quality
and  are  available  to  all  who  are  in  need, the responsibility for
establishing and maintaining standards for medical care and  eligibility
shall be as follows:
1. The department of social services shall be responsible for
(a)  determining  eligibility  for  care and services pursuant to this
title and consistent with standards established by the  commissioner  of
the  department  of  health and, as authorized by such commissioner, for
hearing  appeals  and  making  findings  and  recommendations   relating
thereto;
(b)  auditing  payments  to  providers  of care, services and supplies
under the medical assistance program; and
(c) publishing and distributing to the public, from time to  time  and
in  consultation  with the department of health, information relating to
the medical assistance program, to promote maximum public  awareness  of
the availability of, and the procedure for obtaining, such assistance.
2. The department of health shall be responsible for
(a)  establishing  and  maintaining  standards  for  all  hospital and
related services pursuant to article twenty-eight of the  public  health
law,  and  for all medical care and services furnished in an institution
operated by the department of health pursuant to other provisions of the
public health law;
(b) establishing and maintaining standards for  all  non-institutional
health  care and services rendered pursuant to this title, including but
not  limited  to  procedural  standards  relating  to  the   revocation,
suspension,  limitation  or annulment of qualification for participation
as a provider of care and services, on a determination that the provider
is an incompetent provider of  specific  services  or  has  exhibited  a
course  of  conduct  which is either inconsistent with program standards
and  regulations  or  which  exhibits  an  unwillingness  to  meet  such
standards and regulations, or is a potential threat to the public health
or safety pursuant to section two hundred six of the public health law;
(c) reviewing and approving local social services medical plans;
(d)  establishing  by  regulation requirements for a uniform system of
reports relating to the quality of medical care and  services  furnished
pursuant to this title;
(e)  reviewing  the  quality  and  availability  of  medical  care and
services furnished under local social services medical plans, to  assure
that the quality of medical care and services is in the best interest of
the recipients;
(f)  providing consultative services to hospitals, nursing homes, home
health agencies, clinics, laboratories, and such other  institutions  as
the secretary of the federal department of health and human services may
specify  in  order  to  assist  them:  to qualify for payments under the
provisions of this title and title XIX of the  federal  social  security
act;  in  providing  information  needed  to determine such payments; in
establishing and maintaining such fiscal records as may be necessary for
the proper and efficient administration of medical assistance;
(g) establishing standards  of  eligibility  for  medical  assistance,
consistent with the provisions of this title; and
(h)  making  policy, rules and regulations for maintaining a system of
hearings for applicants and recipients of medical  assistance  adversely
affected  by  the  actions of the department or social service districts
and for making final administrative  determinations  and  issuing  final
decisions concerning such matters.
3.  Each  office  within  the  department  of  mental hygiene shall be
responsible for establishing and maintaining standards for medical  care

and  services  received in institutions operated by it or subject to its
supervision pursuant to the mental hygiene law.
4.  The public health and health planning council shall be responsible
for establishing and maintaining qualifications for persons employed  by
social services districts as professional directors.