New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-5 - Eligibility Based On Disability › Section 360-5.10 - Medically determined drug addicts and alcoholics

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purposes of MA disability, an
			   individual will be medically determined to be a drug addict or alcoholic only
			   if he/she is under a disability in accordance with section
			   360-5.3 
			   of this Subpart, and drug addiction and alcoholism is a contributing factor to
			   a finding of disability. An individual who is under a disability independent of
			   his/her drug addiction or alcoholism will not be medically determined to be a
			   drug addict or alcoholic, for the purpose of MA disability.
(b) Treatment required for medically
			   determined drug addicts and alcoholics. No disabled person will be
			   categorically eligible for MA if he/she is medically determined to be a drug
			   addict or alcoholic, unless he/she is undergoing treatment that is appropriate
			   for his/her condition as a drug addict or alcoholic at an approved institution
			   or facility, so long as such treatment is available and the person demonstrates
			   that he/she is complying with the terms, conditions and requirements of such
			   treatment.
(c) What constitutes
			   appropriate treatment. Appropriate treatment is a recognized medical or other
			   professional procedure for the individual's condition as a drug addict or
			   alcoholic and carried out at, or under the supervision of, an approved
			   treatment facility. This treatment may include medical examination and
			   treatment, psychiatric, psychological and vocational counselling, or other
			   appropriate services. It may be furnished through one or more facilities as
			   part of an individualized treatment plan intended to insure that the individual
			   is receiving treatment appropriate to his/her specific needs.
(d) Institutions or facilities which can
			   provide this treatment. An institution or facility that furnished medically
			   recognized treatment for drug addiction or alcoholism, and is licensed to
			   operate such a program by the State, is approved to provide treatment. This
			   definition includes, but is not limited to, Division of Substance Abuse
			   Services facilities and alcoholic services from the Department of Mental
			   Hygiene.
(e) Availability of
			   treatment. Whether treatment is available to a particular individual depends on
			   the existence of an obtainable treatment vacancy in an approved institution or
			   facility; the condition and circumstances of the individual; the treatment
			   required and the location of the treatment institution or facility, or the
			   services or resources provided by the institution or facility. In determining
			   the availability of treatment, consideration will also be given to the
			   individual's general health, including his/her mobility and capacity to
			   comprehend the essential specification of appropriate treatment, and also the
			   availability and cost of public and private transportation. If an individual is
			   not undergoing treatment for drug addiction or alcoholism because he/she is
			   required to pay therefor at the time of his/her application, and no appropriate
			   facility providing appropriate treatment is available to him/her without
			   charge, such individual will not be categorically ineligible for MA only for
			   the reasons of his/her failure to undergo appropriate treatment. If it is the
			   agency's opinion, based on the above criteria, that treatment is not feasible
			   for a particular individual, this individual would be exempt from required
			   treatment in order to maintain his/her disability status.