reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 721 - Perinatal Regionalization System › Section 721.3 - Perinatal designation of hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Perinatal services will be designated by
					 the commissioner based on the following:
(1)
					 each hospital designated as a Level I, Level II or Level III hospital shall
					 enter a written perinatal affiliation agreement with an RPC;
(2) the level of care currently provided by
					 the hospital shall meet the definition, standards and criterion set forth in
					 this Part for a Level I, Level II, Level III perinatal service or
					 RPC;
(3) for Level II, Level III
					 and RPCs, the number of births and intensity of neonatal care at the hospital
					 during the previous full calendar year must meet the following minimum volume
					 standards:
(i) a Level II perinatal care
					 hospital shall provide no fewer than 1,200 high-risk newborn patient days
					 annually, and no fewer than 150 high-risk maternal patient days
					 annually;
(ii) a Level III
					 perinatal care hospital shall provide no fewer than 2,000 high-risk newborn
					 patient days annually, and no fewer than 250 high-risk maternal patient days
					 annually;
(iii) RPCs shall provide
					 no fewer than 4,000 high-risk newborn patient days annually, and no fewer than
					 400 high-risk maternal patient days annually. An RPC shall provide quality
					 improvement services to a group of perinatal affiliates with a minimum total of
					 8,000 births each year;
(4) the availability of appropriate medical,
					 nursing, and other staffing as described in this Part supportive of the
					 perinatal service at the hospital;
(5) surface travel time for transfers. The
					 surface travel time to reach a Level II hospital, a Level III hospital, or an
					 RPC within the geographic area or affiliative perinatal network, under usual
					 travel conditions shall be no more than two hours. Transfer decisions must be
					 based on the appropriate level of perinatal care required, and care shall be
					 provided at a hospital offering the appropriate level of care which is
					 accessible and convenient to the mother's place of residence whenever
					 feasible;
(6) the geographic
					 distribution of designated hospitals throughout the state to ensure access to
					 appropriate levels of care throughout the state; and
(7) such other additional information as the
					 commissioner may require to make the designation.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 721 - Perinatal Regionalization System › Section 721.4 - Patient care and patient transfers

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Each hospital providing perinatal care services shall provide patient care
					 based on the individual needs of the patient and in accordance with the
					 following criteria.
(1) A Level I perinatal
					 care service hospital shall evaluate and stabilize all women and neonates.
(i) For patients needing a higher level of
					 care, it shall consult with a higher level hospital and arrange for timely
					 transfer to a Level III perinatal care service hospital or an RPC that provides
					 the appropriate level of perinatal care.
(ii) For healthy women with an anticipated
					 delivery at 36 weeks gestation or later and for healthy newborns with a
					 birthweight of 2,500 grams or more, it shall provide continuing care until
					 their discharge.
(iii) Except in
					 unusual circumstances, smaller and more premature infants shall be delivered at
					 higher level hospitals; if such an infant is born at a Level I perinatal care
					 hospital, he/she shall be transferred promptly after birth.
(iv) Women and neonates who have relatively
					 minor problems that do not require advanced laboratory, radiologic, or
					 consultation services may remain in the Level I perinatal care
					 hospital.
(v) When it is known that
					 the newborn may require immediate complex care, it shall be delivered at a
					 Level III perinatal care hospital or an RPC whenever possible.
(vi) Level I perinatal care hospitals shall
					 also provide care for convalescing babies who have been transferred from Level
					 II, Level III and RPC perinatal care hospitals.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 721 - Perinatal Regionalization System › Section 721.7 - Nursing care

Current through Register Vol. 46, No. 28, July 10, 2024
In addition to providing nursing care that meets
						generally accepted professional standards, hospitals shall meet the following
						additional nursing requirements at each designated level of care.
(a) Level I perinatal care service hospital.
					 Maternal and newborn nursing care shall be provided under the direct
					 supervision of a registered nurse. All obstetric nursing personnel shall be
					 qualified in interpretation of fetal heart rate monitoring and understand the
					 physiology of labor. All newborn nursing personnel shall be qualified in
					 assessment of the newborn and all aspects of routine monitoring and care,
					 including education and support related to breastfeeding.
(b) Level II care hospital. In addition to
					 the qualifications described in subdivision (a) of this section, direct patient
					 care shall be provided by registered nurses who have education and experience
					 in the care of moderately high-risk women and/or newborns. All nurses caring
					 for ill women or newborns shall demonstrate competence in the observation and
					 treatment of such patients, including cardiorespiratory monitoring. Registered
					 nurses in a Level II perinatal care hospital shall be able to: monitor and
					 support the stability of cardiopulmonary, neurologic, metabolic, and thermal
					 functions; assist with special procedures such as lumbar puncture, endotracheal
					 intubation, and umbilical catheterization; and perform emergency
					 resuscitation.
(c) Level III
					 perinatal care hospital. Responsibilities of registered nurses shall include
					 those defined in subdivisions (a) and (b) of this section. In addition,
					 registered nurses in the Level III perinatal care hospital shall have specialty
					 certification or advanced training and experience in the nursing management of
					 high-risk women, neonates and their families. They shall also be experienced in
					 caring for unstable women and neonates with multi-organ system problems and in
					 specialized care technology. An advanced practice nurse shall be available to
					 the staff for consultation and support on nursing care issues. Assessment and
					 monitoring activities shall remain the responsibility of a registered nurse or
					 advanced practice nurse in obstetric-neonatal nursing, even when personnel with
					 a mixture of skills are used.
(d)
					 RPC. Responsibilities of registered nurses shall include those defined in
					 subdivisions (a), (b) and (c) of this section. In addition, nurses with special
					 training shall participate in regional perinatal center responsibilities such
					 as outreach, training, education and support.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 721 - Perinatal Regionalization System › Section 721.8 - Ancillary personnel

Current through Register Vol. 46, No. 28, July 10, 2024
The ancillary personnel requirements for each designated
						level are as follows:
(a) All
					 designated Level I, II, III perinatal care services and RPCs shall have:
(1) an organized plan of action that includes
					 personnel and equipment for identification and immediate resuscitation of
					 newborns and mothers requiring cardiorespiratory assistance;
(2) personnel who are capable of determining
					 blood type, cross-matching blood, and performing antibody testing and who are
					 available on a 24-hour basis;
(3)
					 infection control personnel responsible for surveillance of infections in women
					 and neonates, as well as for the development of an appropriate environmental
					 control program;
(4) a radiologic
					 technician available 24 hours a day to perform imaging;
(5) at least one staff member with expertise
					 in lactation and breastfeeding management responsible for the hospital's
					 breastfeeding support program, as described in section
					 405.21(f)(3)(i)
					 of this Title;
(6) at least one
					 staff member with expertise in bereavement responsible for the hospital's
					 bereavement activities, including a systematic approach to ensuring that
					 individuals in need receive such services;
(7) at least one qualified social worker
					 available who has experience with the socioeconomic and psychosocial problems
					 of pregnant women, ill neonates, and their families assigned to the perinatal
					 service. Additional qualified social workers sufficient to meet the needs of
					 women and newborns are required when there is a high volume of medical activity
					 or psychosocial need;
(8) licensed
					 practical nurses and other licensed patient care staff with demonstrated
					 knowledge and clinical competence in the nursing care of women, fetuses, and
					 newborns during labor, delivery, and the postpartum and neonatal periods;
					 and
(9) the need for other support
					 personnel shall depend on the intensity and level of sophistication of the
					 other support services provided and shall be sufficient to meet the needs of
					 the patients.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 721 - Perinatal Regionalization System › Section 721.9 - Regional quality improvement activities

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Quality of care reviews of affiliates.
					 Each hospital with a Level I, Level II or Level III perinatal care service
					 shall enter into and comply with a perinatal affiliation agreement as defined
					 in this Part with an RPC in its geographic area or network of perinatal
					 affiliates. RPC representatives shall participate in the affiliate hospital's
					 quality assurance committee and other reviews of the quality of perinatal care
					 provided by the affiliate and in the provision of recommendations for quality
					 improvement of perinatal services. Each RPC and each affiliate hospital shall
					 take actions necessary, including but not limited to entering into a perinatal
					 affiliation agreement, to authorize such participation by the RPC's
					 representatives in the affiliate hospital's quality assurance committee and for
					 purposes of such participation, the RPC representative or representatives shall
					 be deemed members of the affiliate's quality assurance committee. RPC
					 representatives may only access confidential patient information for quality
					 improvement purposes through their roles on the affiliate hospitals' quality
					 assurance committees as set forth in the affiliation agreements and these
					 regulations. Members of hospitals' quality assurance committees must maintain
					 the confidentiality of patient information and are subject to the
					 confidentiality restrictions of Public Health Law section 2805-m.
(1) The RPC representative(s) shall
					 participate in the review of information and data for quality improvement
					 purposes as described in the affiliation agreement which may include:
(i) statistical data from the statewide
					 perinatal data system or equivalent data available from other
					 sources;
(ii) the affiliate
					 hospital's quality improvement program, policies, and procedures;
(iii) care provided by medical, nursing, and
					 other health care practitioners associated with the perinatal
					 service;
(iv) appropriateness and
					 timeliness of maternal and newborn referrals and transfers and of patients
					 retained at the affiliate hospital who met criteria for transfer to a higher
					 level of care; and
(v) maternal and
					 newborn serious adverse events or occurrences that may include the following:
(a) maternal and newborn
					 fatalities;
(b) maternal and
					 newborn morbidity in circumstances other than those related to the natural
					 course of disease or illness;
(c)
					 maternal and newborn nosocomial infections;
(d) maternal and newborn high-risk
					 procedures; or
(vi)
					 pathology related to all deaths and significant surgical specimens.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 721 - Perinatal Regionalization System › Section 721.10 - Perinatal affiliation agreements and transfer agreements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each hospital
					 with a Level I, II or III perinatal care service shall enter into and comply
					 with a perinatal affiliation agreement with an RPC. Each hospital with a Level
					 I or II perinatal care service may also enter into a transfer agreement with a
					 hospital with a Level III perinatal care service if such an agreement would
					 result in an acceptable level of care and provide a more convenient alternative
					 than transfer to an RPC. All such agreements and amendments to such agreements
					 shall be made available to the department, upon request. The terms of such
					 agreements shall be mutually agreed upon by the affiliating
					 hospitals.
(b) Changes in the
					 identity of the RPC with which a hospital has a perinatal affiliation agreement
					 may not be made more frequently than once annually. Such changes shall require
					 30 days prior notice to the department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.1 - Definition

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon the
					 request of a qualifying hospital, i.e., hospitals licensed under article 28 of
					 the Public Health Law that have an emergency department and meet the
					 qualification specified herein, the department may designate that hospital as
					 having an approved Sexual Assault Forensic Examiner (SAFE) Program. Such
					 hospital program shall meet the standards for treatment of sexual assault
					 victims and maintenance of sexual offense evidence established in section
					 405.9(c) of this
					 Title and shall also make available to survivors, on a 24-hour per day basis,
					 specially trained sexual assault forensic examiners. Such programs:
(1) may also be referred to as Sexual Assault
					 Nurse Examiner (SANE) and Sexual Assault Examiner (SAE) Programs;
(2) are comprehensive and designed to meet
					 the needs of survivors of sexual assault by providing not only medical care but
					 also forensic examinations in a private setting conducted by specially trained
					 sexual assault forensic examiners;
(3) are designed to provide specialized
					 standards of medical care and evidence collection that support recovery and
					 prevent further injury or illness arising from the trauma for all survivors and
					 may increase the successful prosecution of sex offenders for survivors who
					 choose to report the crime to law enforcement; and
(4) coordinate an interdisciplinary
					 collaborative effort involving a hospital-based SAFE Program, a rape crisis
					 center, law enforcement, the prosecutor's office and other appropriate service
					 agencies. These organizations provide a coordinated response that not only
					 effectively meets the needs of the sexual assault survivor but also can improve
					 the overall community response to sexual assault.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.2 - Applications for designation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General
					 hospitals may choose to seek designation from the department as SAFE hospitals.
					 Such hospitals shall complete an application form developed by the department,
					 which includes but is not limited to, the following information:
(1) the location of the hospital;
(2) the hospital's capacity to provide
					 on-site, comprehensive medical services to survivors of sexual
					 offenses;
(3) the capacity of the
					 hospital to coordinate services for survivors of sexual offenses, including
					 medical treatment, rape crisis counseling, psychological support, law
					 enforcement assistance and forensic evidence collection;
(4) the hospital's capacity to provide access
					 to the sexual assault forensic examination site for individuals with
					 disabilities;
(5) the hospital's
					 existing services for survivors of sexual offenses;
(6) the capacity of the hospital site to
					 collect uniform data and ensure the confidentiality of such data; and
(7) the hospital's commitment to compliance
					 with all applicable State and Federal laws, regulations and generally accepted
					 standards of care, including the standards of care and services established in
					 this Part and the approved provider agreement between the hospital and the
					 department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.3 - Review and approval of applications for designation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The department shall review applications
					 for designation to ensure that the information supplied is consistent with
					 statutory requirements as well as regulatory program standards and
					 requirements.
(b) The department or
					 its designee may conduct site visits to resolve any concerns and/or to ensure
					 that the proposed SAFE Program is consistent with program
					 requirements.
(c) The department
					 shall notify applicants of its decision, including reasons for any denial of
					 designation.
(d) Approved
					 designations shall be reflected on the hospital's operating
					 certificate.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.4 - Withdrawal of designation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 department may withdraw designation from an approved program if:
(1) it finds and documents a material failure
					 to comply with relevant statutes, regulations, or generally accepted standards
					 of care and services, a failure to provide the department with accurate and
					 timely reporting, including program data, a failure to permit appropriate
					 department personnel access to perform program and patient record reviews, or a
					 failure to provide the provider agreement; and
(2) the hospital has been provided ample and
					 reasonable notice and an opportunity to address any deficiencies identified
					 regarding its SAFE Program but has not done so. Reasonable notice and an
					 opportunity to respond will consist of written notice to the program by the
					 department and an opportunity for the hospital to respond no later than 30 days
					 from the date on which the notice was sent to the hospital by the
					 department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.5 - Provider agreements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 hospital with a designated SAFE Program shall enter into a provider agreement
					 with the department. Such agreement shall address at least the following:
(1) A description of the proposed SAFE
					 Program model that is acceptable to the department, including adequate
					 availability of appropriately trained and certified SAFE examiners.
(2) Participation by the program in an
					 interdisciplinary/community task force, including:
(i) hospital administration and emergency
					 service representatives;
(ii) the
					 local rape crisis center;
(iii) law
					 enforcement entities; and
(iv) a
					 representative of the district attorney's office of the county or city in which
					 the hospital is located, including the special sex crimes unit, where
					 available.
(3) The
					 program's organization, including administrative and clinical oversight,
					 designed to provide care to survivors that is consistent with generally
					 accepted standards of care.
(4) A
					 listing of facilities/equipment required of the program, including a private,
					 designated room for the performance of exams, access to a shower and access for
					 individuals with disabilities.
(5)
					 A listing of data required to be maintained by the program and provided to the
					 department on a quarterly and/or annual basis.
(6) Other such terms and conditions that may
					 be required by the department to ensure that the program will comply with
					 relevant statutes, regulations, generally accepted standards of care and the
					 goals of the SAFE Programs.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.7 - Responsibilities of hospital emergency staff

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Hospital emergency staff shall
					 immediately implement the following protocol upon arrival of a putative sexual
					 assault victim:
(1) provide triage and
					 assessment in a timely manner;
(2)
					 contact the sexual assault forensic examiner when the patient discloses that
					 she or he has been sexually assaulted;
(3) contact a rape crisis advocate at the
					 same time that contact is made with the sexual assault forensic
					 examiner;
(4) be available for
					 consultation and support of the SAFE Program and the sexual assault forensic
					 examiner;
(5) assist in obtaining
					 necessary tests and medications;
(6) assist in arranging referrals and
					 follow-up services; and
(7) ensure
					 the availability of medical/surgical back up as may be needed including, but
					 not limited to: general surgery, obstetrics/gynecology, pediatrics, urology and
					 psychiatry.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.8 - Staffing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) At a minimum,
					 SAFE Programs shall maintain the following staff:
(1) a program director who:
(i) reports directly to the emergency service
					 director or the director of nursing;
(ii) if he or she is a clinician, also may
					 provide clinical services to the program, provided administrative
					 responsibilities remain his or her primary duties;
(iii) is responsible for integrating the SAFE
					 Program within the hospital's overall administrative structure;
(iv) acts as the liaison with the
					 interdisciplinary/community task force;
(v) has relevant training and experience
					 sufficient to perform his or her duties;
(vi) oversees recruitment, education and
					 continuing education, preceptorships, certification and re-certification of
					 program staff; and
(vii)
					 participates with the interdisciplinary/community task force in development of
					 a community outreach and education plan;
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.9 - Treatment of patients

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Absent
					 exigent circumstances or unless the patient does not disclose a sexual assault
					 at the time of triage, the sexual assault forensic examiner shall meet the
					 patient within 60 minutes of the patient's arrival at the hospital. Should
					 circumstances beyond the hospital's control prevent the hospital from meeting
					 this standard, the hospital shall ensure that the patient receives the same
					 care and services that are provided to all such patients in accordance with all
					 applicable State and Federal laws, regulations and generally accepted
					 standards, including but not limited to:
(1)
					 Public Health Law, section 2805-i. T reatment of sexual offense patients and
					 maintenance of evidence in a sexual offense;
(2) section
					 405.9(c) of this
					 Title. Establishment of hospital protocols and maintenance of sexual offense
					 evidence;
(3) the Sexual Assault
					 Reform Act (SARA), chapter 1 of the Laws of 2000; and
(4) generally accepted standards for the
					 treatment of sexual assault victims such as:
(i) the DOH guidance, HIV Prophylaxis
					 Following Sexual Assault: Guidelines for Adults and Adolescents; and
(ii) The DOH Protocol for the Acute Care of
					 the Adult Patient Reporting Sexual Assault (as currently posted on the DOH
					 website at www.health.state.ny.us/nysdoh/sexual_assault/index.htm).
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 3 - Hospital Operation › Part 722 - Sexual Assault Forensic Examiner (safe) Programs › Section 722.10 - Continuous quality improvement

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The SAFE Program shall develop and implement written policies and procedures
					 establishing an internal quality improvement program to identify, evaluate,
					 resolve and monitor actual and potential problems in patient care. The internal
					 program shall be integrated with the hospital's overall quality improvement
					 plan and shall include, but not be limited to, the following components:
(1) chart audits performed periodically on a
					 statistically significant number of sexual assault patient records. The
					 hospital must designate one or more individuals to review sexual assault
					 patient records periodically, along with other appropriate information, to
					 determine the following:
(i) length of time
					 the patient waited from arrival to exam commencement;
(ii) availability of appropriately trained
					 staff to examine the patient;
(iii)
					 availability of all of the necessary equipment for the examination;
(iv) if a rape crisis program advocate was
					 contacted to accompany the patient;
(v) if consent was appropriately obtained
					 from the patient or the person authorized to give consent on behalf of the
					 patient;
(vi) if the patient
					 received appropriate medical treatment;
(vii) if HIV prophylaxis was recommended in
					 all cases, when appropriate, pursuant to this DOH protocol (for the most recent
					 version of the HIV guidelines, visit www.hivguidelines.org);
(viii) If HIV prophylaxis was made available
					 on-site to all clients requesting this preventive measure;
(ix) for female patients, whether the patient
					 received appropriate counseling relating to pregnancy prophylaxis and whether
					 the patient received on-site pregnancy prophylaxis if the patient requested
					 it;
(x) if the patient received
					 treatment for STDs, including prophylaxis;
(xi) if forensic evidence was collected in a
					 manner consistent with law, regulations and standards, including maintenance of
					 the chain of custody;
(xii) if an
					 appropriate medical and psychosocial referral and follow-up plan were developed
					 for the patient;
(xiii) if safe
					 discharge was assured for the patient; and
(ix) if confidentiality was
					 maintained;
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-1 - Provider Certification › Section 732-1.3 - Change in ownership or control of preferred provider organization

Current through Register Vol. 46, No. 28, July 10, 2024
The governing body shall provide the commissioner with
						  written notice of any proposed change in the ownership or control of the entity
						  certified to operate as a PPO. If such change requires the prior approval of
						  any other agency, board or officer of this State, or any other State or
						  jurisdiction, the governing body shall provide the commissioner with
						  documentation of such other entity's determination to approve or disapprove
						  such proposed change. No change shall be implemented prior to approval thereof
						  by the commissioner pursuant to the applicable provisions of this Subpart for
						  initial certification and the commissioner shall not issue such approval if the
						  change in ownership results in the insurer or employer having a financial
						  interest in the PPO.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-1 - Provider Certification › Section 732-1.4 - Preferred provider organization decertification

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The commissioner may revoke, suspend or
						amend the certification of any PPO if the commissioner finds that:
(1) the PPO fails to meet any of the
						requirements of this Part or article 10-A of the Workers' Compensation Law, or
						fails to maintain compliance with the standards set forth in the application
						for certification:
(i) if the commissioner
						has reason to believe that such lack of compliance was unintentional and did
						not have a negative impact on any claimant, he or she may request from the PPO
						a plan of correction; and
(ii) if
						such plan of correction is accepted by the commissioner and implemented,
						decertification shall not be required; or
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-2 - Operations › Section 732-2.1 - Organization and administration

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
						The PPO shall have a governing body functioning in accordance with the
						provisions of section
						732-1.2(d) of
						this Part.
(b) The PPO shall employ
						an administrator who shall be responsible for overseeing all facets of the
						operation.
(c) The PPO shall employ
						a medical director responsible for oversight of all aspects of medical care
						including the quality and appropriate utilization of services and the
						development, updating and assurance of compliance with medical standards.
						Individuals providing medical direction shall have training and experience
						necessary for effective performance and any such individuals who practice
						medicine in New York State shall comply with licensing, registration and scope
						of practice requirements of the State Education Department. Medical direction
						shall also be provided consistent with the requirement that the insurer or
						employer shall not have a financial interest in the PPO.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-2 - Operations › Section 732-2.2 - General operating requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The PPO shall develop, implement, require
						provider adherence to and make available for inspection by the commissioner
						quality and treatment standards and protocols, consistent with generally
						accepted standards of care, which will ensure the coordination, quality and
						continuity of care for claimants.
(b) The PPO shall ensure that emergency and
						urgent care are available and accessible to claimants 24 hours a day, seven
						days a week. However, a claimant may access any medical facility during an
						emergency or urgent care situation.
(c) The PPO shall ensure that first access to
						initial treatment for all non-emergency care is available to injured employees
						within 48 hours of a request by a claimant for treatment for any accidental
						injury arising out of and in the course of employment or for occupational
						disease and that subsequent referrals are made on a timely basis.
(d) If the PPO cannot provide access to
						necessary services within the approved provider network within 48 hours of a
						claimant's request, it shall secure such services from appropriate
						practitioners outside the approved network within 48 hours of a claimant's
						request and bear the cost of such services.
(e) The PPO shall develop and implement a
						system under which employees may obtain information on a 24 hour-a-day basis
						regarding the availability of necessary medical services including emergency
						services and other urgently needed medical care.
(f) The PPO shall submit to the commissioner
						and ensure the conduct of a service utilization review process which indicates
						what reports are to be produced, the frequency of review, the standards used
						and the types of corrective action to be taken when problems are identified.
						Such process shall:
(1) be consistent with
						the utilization review requirements of article 49 of the State Insurance Law,
						article 49 of the Public Health Law or a generally accepted and nationally
						recognized utilization review accrediting entity acceptable to the
						commissioner; or
(2) be produced by
						an entity currently certified by the Utilization Review Accreditation
						Commission.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-2 - Operations › Section 732-2.3 - Quality assurance and improvement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A PPO shall develop and implement on a
						continuous basis a quality assurance and improvement program that includes
						organizational arrangements and ongoing procedures for the identification,
						evaluation and resolution of potential and actual problems in health care
						administration and delivery to claimants. These organizational arrangements and
						ongoing procedures shall be fully described in written form, provided to all
						members of the governing authority, providers and staff, and made available to
						eligible employees of an affected employer.
(b) The organizational arrangements for the
						quality assurance and improvement program must be clearly defined and should
						include, but need not be limited to, the following:
(1) a quality assurance and improvement
						committee, responsible for quality assurance activities, consisting of the
						medical director, the administrator, at least one member of the governing body
						and provider representatives including physicians;
(2) accountability of the committee to the
						governing body, with requirements for periodic written and oral reports to the
						governing body;
(3) participation
						from an appropriate base of providers and support staff;
(4) supervision by the medical
						director;
(5) regularly scheduled
						meetings at appropriate intervals but at least quarterly; and
(6) written minutes of the meetings of the
						quality assurance and improvement committee describing in detail the actions
						taken by the committee, the medical charts reviewed, problems discussed,
						recommendations made, and any other pertinent discussions and
						activities.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-2 - Operations › Section 732-2.4 - Reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A PPO shall not
						be required to reimburse for provider services in accordance with the provider
						fee schedules authorized pursuant to the Workers' Compensation Law.
(b) PPOs shall be eligible for reimbursement
						on a fee-for-service basis.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-2 - Operations › Section 732-2.5 - Contracts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) PPOs shall have
						written contracts with all providers in the network.
(1) Such contracts shall be made available
						for review by the commissioner upon request.
(2) The PPO shall develop and, upon request,
						make available to prospective providers, written application procedures and
						minimum qualification requirements which the provider must meet in order to be
						considered by the PPO.
(3) Unless
						otherwise specified in contract, a PPO shall not terminate a contract with a
						provider unless it gives the provider a written explanation of the reasons for
						the proposed termination and an opportunity for a review or hearing. Either
						party to a contract, however, may, on 60-day notice, exercise a right of
						non-renewal at the expiration of the contract period or, for a contract without
						a specific expiration date, on each January first occurring after the contract
						has been in effect for at least one year. Such non-renewal shall not constitute
						a termination.
(4) Unless otherwise
						specified in contract, a provider may not terminate a contract with a PPO
						except upon a material breach of contract by the PPO. Such terminations shall
						be reported to the chair and shall take effect only after arrangements for the
						continuing care of affected claimants, acceptable to the commissioner and such
						claimants, are effected.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 4 - Managed Care › Part 732 - Workers' Compensation Preferred Provider Organizations › Subpart 732-2 - Operations › Section 732-2.7 - Notice and approval required to discontinue operation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No PPO shall voluntarily discontinue
						operation unless at least 90 days written notice of its intention to do so is
						sent to each participating carrier or self-insured employer, the commissioner
						and the chair. Such entities shall communicate this information to other
						affected employers.
(1) Operations shall not
						be discontinued until approval to do so is obtained from the
						commissioner.
(2) The commissioner
						shall grant such approval when the conditions of subdivision (b) of this
						section have been met.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 6 - Treatment Center and Diagnostic Center Operation › Part 750 - General Provisions › Section 750.1 - General requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) As a
					 minimum, all diagnostic and treatment centers shall comply with the rules and
					 regulations as set forth in Part 751 of this Title.
(b) Diagnostic and treatment centers shall
					 comply with the rules and regulations as set forth in Parts 752 through 756 of
					 this Title for each service that is provided at the center.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 6 - Treatment Center and Diagnostic Center Operation › Part 751 - Organization And Administration › Section 751.1 - Definition

Current through Register Vol. 46, No. 28, July 10, 2024
The terms diagnostic center and treatment center, also
						referred to in this Article as a center, shall mean a medical facility with one
						or more organized health services not part of an inpatient hospital facility or
						vocational rehabilitation center primarily engaged in providing services and
						facilities to out-of-hospital or ambulatory patients by or under the
						supervision of a physician or, in the case of a dental service or dispensary,
						of a dentist, for the prevention, diagnosis and, in the case of a treatment
						center, treatment of human disease, pain, injury, deformity or physical
						condition, not including the individual or group private practice of
						medicine.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 6 - Treatment Center and Diagnostic Center Operation › Part 751 - Organization And Administration › Section 751.3 - Administrator

Current through Register Vol. 46, No. 28, July 10, 2024
The operator shall appoint an administrator whose
						training and experience is related to the services provided at the center, and
						who shall have executive authority and responsibility for the operation of the
						center.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 6 - Treatment Center and Diagnostic Center Operation › Part 751 - Organization And Administration › Section 751.4 - Medical director

Current through Register Vol. 46, No. 28, July 10, 2024
The operator shall appoint a medical director who:
(a) is qualified by training, experience and
					 administrative ability to assume responsibility for the position;
(b) is delegated the authority and is
					 responsible to the operator for the professional, organizational and
					 administrative aspects of the adequacy and quality of care provided to patients
					 in the center;
(c) is a physician
					 licensed by and currently registered with the New York State Education
					 Department. In dental centers, the director shall be a dentist who is licensed
					 by and currently registered with the New York State Education
					 Department;
(d) develops and
					 recommends to the operator policies and procedures governing patient care in
					 accordance with generally accepted standards of professional
					 practice;
(e) develops and
					 recommends to the operator policies and procedures concerning the appointment
					 of medical and dental staff, the assignment of their clinical privileges and
					 reviews of such appointments; and
(f) is responsible for the supervision of the
					 quality assurance program and for reporting the activities of the program to
					 the operator.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 6 - Treatment Center and Diagnostic Center Operation › Part 751 - Organization And Administration › Section 751.6 - Personnel

Current through Register Vol. 46, No. 28, July 10, 2024
The operator shall ensure:
(a) the development and implementation of
					 written policies and procedures, which are reviewed annually and revised as
					 necessary;
(b) the employment of
					 personnel without regard to age, race, color, sexual orientation, religion, sex
					 or national origin;
(c) that the
					 health status of each employee is examined prior to the beginning of
					 employment, which is sufficient in scope to ensure that the employee is free
					 from a health impairment which is of potential risk to patients or which may
					 interfere with the performance of his/her duties;
(d) that a record of the following tests,
					 procedures and examinations is maintained for all employees:
(1) a certificate of immunization against
					 rubella which means:
(i) a document prepared
					 by a physician, physician's assistant, specialist's assistant, nurse
					 practitioner, licensed midwife or a laboratory possessing a laboratory permit
					 issued pursuant to Part 58 of this Title, demonstrating serologic evidence of
					 rubella antibodies;
(ii) a document
					 indicating one dose of live virus rubella vaccine was administered on or after
					 the age of 12 months, showing the product administered and the date of
					 administration, and prepared by the health practitioner who administered the
					 immunization; or
(iii) a copy of a
					 document described in subparagraph (i) or (ii) of this paragraph which comes
					 from a previous employer or the school which the employee attended as a
					 student; and
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 6 - Treatment Center and Diagnostic Center Operation › Part 751 - Organization And Administration › Section 751.7 - Medical record system

Current through Register Vol. 46, No. 28, July 10, 2024
The operator shall:
(a) maintain a medical record
					 system;
(b) designate a staff
					 member who has overall supervisory responsibility for the medical record
					 system;
(c) ensure that the medical
					 record supervisor receives consultation from a qualified medical record
					 practitioner when such supervisor is not a qualified medical record
					 practitioner;
(d) ensure that the
					 medical record for each patient contains and centralizes all pertinent
					 information which identifies the patient, justifies the treatment and documents
					 the results of such treatment;
(e)
					 ensure that the following are included in the patient's record as appropriate:
(1) patient identification
					 information;
(2) consent
					 forms;
(3) medical
					 history;
(4) immunization and drug
					 history with special notation of allergic or adverse reactions to
					 medications;
(5) physical
					 examination reports;
(6) diagnostic
					 procedures/tests reports;
(7)
					 consultative findings;
(8)
					 diagnosis or medical impression;
(9) medical orders;
(10) psychosocial assessment;
(11) documentation of the services provided
					 and referrals made;
(12) anesthesia
					 record;
(13) progress
					 note(s);
(14) follow-up plans;
					 and
(15) discharge summaries, when
					 applicable;