reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › General Provisions › Section 84.1 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of these rules is to ensure equitable
						treatment of persons employed in positions the principal duty of which is the
						teaching or instruction of patients, or the direct supervision of such teaching
						or instruction, and to provide uniformity in matters of attendance and leave
						for such persons, insofar as practicable and consistent with the efficient
						conduct of the department's business, who are employed on the basis of an
						annual school calendar year adopted by the department which shall be consistent
						with the school calendar year of public school teachers in New York
						State.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › General Provisions › Section 84.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except as
					 otherwise expressly provided in any rule or rules, these attendance rules shall
					 apply to the following employees in the department who are employed in
					 positions the principal duty of which is the teaching or instruction of
					 patients or the direct supervision of such teaching or instruction, who are
					 employed on the basis of a calendar year similar to the school calendar year of
					 public school teachers in New York State, and who are compensated in accordance
					 with section 136 of the New York State Civil Service Law.
(1) Institution Teachers, G-12
(2) Institution Teachers (T.B.S.),
					 G-13
(3) Senior Institution
					 Teachers, G-15
(4) Senior
					 Institution Teachers (T.B.S.), G-16
(5) Institution Education Supervisors (group
					 of classes), G-17
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › General Provisions › Section 84.3 - Suspension of rules

Current through Register Vol. 46, No. 28, July 10, 2024
These rules may be suspended in whole or in part, in an
						emergency, for the duration of same and to the extent made necessary by the
						nature of the emergency, on approval by the New York State Civil Service
						Commission of a written request by the department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › General Provisions › Section 84.4 - Amendment of rules

Current through Register Vol. 46, No. 28, July 10, 2024
These rules may not be amended except on approval by the
						New York State Civil Service Commission of a written request by the
						department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › General Provisions › Section 84.5 - Agreement between state and employee organization

Current through Register Vol. 46, No. 28, July 10, 2024
The provisions of these attendance rules, insofar as they
						apply to employees in the negotiating units, established pursuant to article 14
						of the Civil Service Law, shall be continued; provided, however, that during
						periods of time when there is in effect an agreement between the State and an
						employee organization reached pursuant to the provisions of said article 14,
						the provisions of such agreement and the provisions of such rules shall both be
						applicable. In the event the provisions of the agreement are different from the
						provisions of the attendance rules, the provisions of the agreement shall be
						controlling.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Attendance › Section 84.10 - Basic workweek

Current through Register Vol. 46, No. 28, July 10, 2024
The basic workweek for annual salaried employees of State
						departments, agencies and institutions, other than those employed on a
						part-time basis only and other than employees excluded from the application of
						overtime compensation under the rules of the Director of the Budget adopted
						pursuant to section 134  of the Civil Service Law, shall be 40
						hours; provided, however, that where a shorter workweek would not interfere
						with the proper performance of government functions an appointing authority may
						establish a basic workweek of not less than 37<< hours and five days for
						any employees under its appointive jurisdiction as may be designated by it with
						the approval of the Division of the Budget; provided, however, that this
						section shall not be construed to increase the workweek of any employee for
						whom a workweek of less than 40 hours was prescribed by law, rule or
						administrative regulation as of January 2, 1957.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Attendance › Section 84.11 - Record of attendance

Current through Register Vol. 46, No. 28, July 10, 2024
All employees are required to maintain a daily record of
						absences and time and leave credits earned and used in accordance with these
						rules. A daily record of attendance shall be maintained during the period
						covered by the school calendar and for any periods during which an employee may
						receive compensation which is in addition to his regular
						salary.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Attendance › Section 84.12 - Overtime

Current through Register Vol. 46, No. 28, July 10, 2024
Overtime shall not be earned for time worked in excess of
						the basic workweek during the 10-month period an employee is paid his regular
						salary. An employee who is required to work in his position or in any other
						position allocated to a salary grade in section 130  of the Civil Service Law for the
						two-month period during which his regular salary is not paid shall receive
						additional compensation for such service.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.15 - Saturdays, sundays and holidays

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All Saturdays, Sundays and legal holidays
					 shall, so far as practicable, be allowed as days off. Employees required to
					 work on any of these days shall not be entitled to compensatory time off in
					 lieu thereof.
(b) The days
					 prescribed as holidays by the department's annual calendar for the school year
					 shall be observed as holidays.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.16 - Absences during school year

Current through Register Vol. 46, No. 28, July 10, 2024
Except as provided by these rules and except as provided
						by the department's annual calendar for the school year, employees shall not be
						entitled to any leave of absence with pay during the school year; provided,
						however, that the department may grant time off with pay for religious
						observance, teacher conferences and other appropriate professional meetings,
						and for extraordinary or emergency absences. Employees may be required to make
						up such time off by appropriate adjustments in their daily or weekly work
						schedules.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.18 - Extended sick leave

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 department may, in its discretion, advance sick leave credits to an employee
					 absent due to personal illness who has exhausted his accumulated sick leave
					 credits. Such advanced sick leave credits shall be repaid, as soon as
					 practicable after the employee's return to duty, from subsequent accumulations
					 of time credits. The outstanding unrepaid sick leave credits advanced to any
					 employee under the provisions of this section shall not at any time exceed a
					 total of five days.
(b) Upon
					 termination of the employee's services any such advance of sick leave not
					 offset by subsequent accumulations of sick leave credits, shall be deducted
					 from salary or wages due the employee.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.19 - Sick leave at half pay

Current through Register Vol. 46, No. 28, July 10, 2024
The department may, in its discretion, grant sick leave
						at half pay for personal illness to a permanent employee having not less than a
						year of service after all of his sick leave credits have been used; provided
						however, that the cumulative total of all sick leave at half pay granted to any
						employee after January 2, 1957, shall not exceed one pay period for each
						complete six months of his State service.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.20 - Workmen's compensation leave

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Leave for absence necessitated by
					 occupational injury or disease. Except as otherwise provided in subdivision (b)
					 and (c) hereof, an employee necessarily absent from duty because of
					 occupational injury or disease as defined in the Workmen's Compensation Law,
					 upon giving notice to the department that he is absent on account of such
					 injury or disease and that he claims benefits under such law, shall be allowed
					 leave from his position for the period of absence necessitated by such injury
					 or disease, up to cumulatively one year including any periods of such absence
					 during which the employee draws sick leave credits. Such leave may be extended
					 for further periods in the discretion of the appointing authority.
(b) Controverted cases. If the employee's
					 claim for benefits under the Workmen's Compensation Law is controverted by the
					 State Insurance Fund (at the request of the department or on its own
					 initiative) and the department is so notified, the employee shall not be
					 entitled to leave under this section. This shall not, however, adversely affect
					 the employee's eligibility for leave under other provisions of these rules. If
					 final determination of the controverted claim is in favor of the employee, he
					 shall be entitled to leave under this section, and all absences before such
					 final determination, to the extent that the same were necessitated by his
					 occupational injury or disease, shall be deemed to have been pursuant to leave
					 under this section.
(c) Permanent
					 incapacity. Leave under this section may be withheld or terminated if the
					 department determines that the occupational injury or disease suffered by the
					 employee is of such a nature as to permanently incapacitate him for the
					 performance of the duties of his position.
(d) Pay during leave. An employee on leave
					 under this section may receive pay, as follows:
(1) The department upon finding that the
					 employee is in fact disabled from the performance of his duties, may grant the
					 employee full pay during such leave not exceeding cumulatively six months. Such
					 full pay may be granted irrespective of the employee's accrued credits under
					 these rules.
(2) Except when on
					 full pay status under paragraph (1) of this subdivision, the employee may draw
					 accrued sick leave credits, subject to the provisions of these rules pertaining
					 thereto.
(3) If not drawing full
					 pay under paragraph (1) or paragraph (2) of this subdivision, an employee may,
					 in the discretion of the department, be allowed to draw sick leave at half pay
					 for which he may be eligible under these rules.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.21 - Leave for subpoenaed appearance and jury attendance

Current through Register Vol. 46, No. 28, July 10, 2024
On proof of the necessity of jury service or appearance
						as a witness pursuant to subpoena or other order of a court or body, an
						employee shall be granted a leave of absence with pay with no charge against
						leave credits; provided, however, that this section shall not apply to any
						absence by an employee occasioned by such an appearance if he is a
						party.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.22 - Leave for civil service examinations

Current through Register Vol. 46, No. 28, July 10, 2024
Employees shall be allowed leave with pay to take New
						York State Civil Service examinations at the appropriate center provided that
						due notice is given by the employee to the department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.23 - Leave for quarantine

Current through Register Vol. 46, No. 28, July 10, 2024
If an employee who is not ill himself is required to
						remain absent because of quarantine and presents a written statement of the
						attending physician or local health officer proving the necessity of such
						absence, he shall be granted leave with pay for the period of his required
						absence, without charge against accumulated sick leave credits. Prior to return
						to duty, such employee may be required to submit a written statement from the
						local health officer having jurisdiction that his return to duty will not
						jeopardize the health of other employees.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.24 - Leaves required by law

Current through Register Vol. 46, No. 28, July 10, 2024
The department shall grant any leave of absence, with
						pay, required by law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Absence with Pay › Section 84.25 - Leave for civil defense duties

Current through Register Vol. 46, No. 28, July 10, 2024
Upon certification by the State Director of Civil Defense
						of the necessity for the participation in State or local civil defense drills
						of an employee enrolled as a civil defense volunteer and required to perform
						civil defense duties pursuant to the State Defense Emergency Act, the
						department may allow such employee to absent himself from his position, without
						loss of pay or charge against leave credits, for such time as is necessary for
						participation in such drills, but not exceeding cumulatively five work days per
						calendar year.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Leaves Without Pay › Section 84.30 - Leave of absence; duration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A permanent employee or an employee
					 holding a position by permanent or temporary appointment who requests leave
					 because of pregnancy or childbirth may, in the discretion of the department, be
					 granted a leave of absence from his position, without pay, for a period not
					 exceeding two years. Such leave may be extended beyond two years, for periods
					 aggregating not in excess of an additional two years, only with the approval of
					 the Civil Service Commission. In an exceptional case, a further extension may
					 be permitted by the commission for good cause shown and where the interests of
					 the government would be served. For the purposes of this section, time spent in
					 active service in the military forces of the United States or of the State of
					 New York shall not be considered in computing the period of leave.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 84 - Attendance Rules For Hospital Teachers › Leaves Without Pay › Section 84.31 - Successive leaves of absence

Current through Register Vol. 46, No. 28, July 10, 2024
Where a leave of absence without pay has been granted for
						a period which aggregates two years, or more if extended pursuant to section
						84.30 
						of this Part, a further leave of absence without pay shall not be granted
						unless the employee returns to his position and serves continuously therein for
						six months immediately preceding the subsequent leave of
						absence.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitations on Hospitalization, Including Surgery › Section 85.1 - Emergency or urgent surgery

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 To be a covered benefit under medical assistance for the needy as provided in
					 section 365-1(5)(a) of the Social Services Law, any emergency or urgent surgery
					 shall be for alleviation of severe pain or for the immediate diagnosis and/or
					 treatment of conditions which threaten disability or death if not promptly
					 diagnosed or treated. No such emergency or urgent surgery requires prior
					 determination of coverability. In each case, a person designated by the
					 Commissioner of Health shall determine coverability of this benefit based upon
					 the documented existence of one or more conditions such as the following:
(1) obstetrical crises and/or
					 labor;
(2) acute trauma;
(3) reparative or reconstructive surgical
					 procedures performed within 60 days of acute trauma;
(4) malignancy, confirmed or
					 suspected;
(5) hemorrhage or threat
					 of hemorrhage;
(6) serious
					 infection;
(7) severe
					 pain;
(8) shock or impending
					 shock;
(9) decompensated vital
					 functions or threat to vital functions such as sensorium, respiration,
					 circulation, excretion and sensory organs;
(10) congenital defects or abnormalities in a
					 newborn infant best managed by prompt intervention;
(11) any condition the management of which
					 requires prompt diagnostic procedures necessarily performed on an inpatient
					 basis such as biopsy and endoscopy; or
(12) any other condition which causes severe
					 pain or threatens disability or death if not promptly diagnosed or
					 treated.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitations on Hospitalization, Including Surgery › Section 85.2 - Standards for surgical intervention

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To be covered benefit under medical
					 assistance for the needy as provided in section 365-a (a)(5)(b)  of the
					 Social Services Law, specified surgical procedures shall meet the standards for
					 intervention established in this section. The specified procedures are:
(1) cataract surgery to restore
					 vision.
(2) eye muscle surgery to
					 correct strabismus and to prevent functional loss when binocular vision still
					 exists.
(3) myringotomy, with or
					 without tube insertion to preserve hearing.
(4) tubal ligation or vasectomy to interdict
					 conception.
(5) termination of
					 pregnancy.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitations on Hospitalization, Including Surgery › Section 85.3 - Deferrable surgery

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To be
					 a covered benefit under medical assistance for the needy as provided in section 365-a (5)(c)  of the Social
					 Services Law, any surgery not coverable as emergency or urgent surgery under
					 section 365-a(5)(a) or which does not meet standards for surgical intervention
					 under section 365-a(5)(b) shall require a determination of coverability by a
					 person designated by the Commissioner of Health prior to admission. A
					 determination of coverability shall be based on the likelihood that deferral of
					 the proposed surgery for six months or more may jeopardize life or essential
					 function, or cause severe pain.
(b)
					 A determination of coverability shall be for a specified period of time not to
					 exceed the 50th percentile of length of stay norms for comparable patients
					 which have been authorized by the commissioner or the 20th day of stay,
					 whichever is less. If the stay is for rehabilitation of physical disability as
					 described in section
					 85.5(a) 
					 of this Part, such specified period of time shall not exceed the 40th day of
					 stay. Subsequent to this initial determination of coverability, extensions of
					 benefit coverability shall be subject to length of stay limitations of sections
					 85.5
					 and
					 85.7 
					 of this Part.
(c) The required
					 determination of coverability shall be initiated by written request from the
					 proposing surgeon, with information adequate for making the determination. A
					 determination of coverability shall be made by a designated physician or
					 non-physician under supervision of a designated physician. A determination of
					 non-coverability shall be made only by a physician.
(d) Prior to making a determination, the
					 designated person may require a written second opinion from a qualified
					 specialist designated by the Commissioner of Health. A written second opinion
					 shall be based upon an examination of the patient and a review of information
					 about the patient provided by the proposing surgeon. A second written opinion
					 under this section shall in every instance be required for the following
					 surgical procedures except when performed as urgent or emergency surgery as set
					 forth in this Part, or when not required under the provisions of the children
					 and youth with special health care needs support services program:
(1) tonsillectomy and/or
					 adenoidectomy.
(2)
					 herniorrhapy.
(3)
					 hemorrhoidectomy.
(4)
					 hysterectomy.
(5)
					 cholecystectomy.
(6) spinal fusion
					 or laminectomy.
(7) joint cartilage
					 surgery.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitations on Hospitalization, Including Surgery › Section 85.4 - One-day presurgical stay limitation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To be a covered benefit under medical
					 assistance for the needy, provided in section 365-a (5)(d)  of the Social
					 Services Law, any presurgical hospital stay of more than one day for surgical
					 benefits covered by sections 365- a(5)(b) and 365-a(5)(c) shall require a
					 determination of coverability prior to admission by a person designated by the
					 Commissioner of Health. Such determination of coverability shall be for a
					 specified maximum period of presurgical stay. A written request for such
					 determination shall be made by the patient's surgeon, proposing the total
					 length of presurgical stay, and citing conditions requiring such exceptional
					 stay. A determination of coverability shall be based upon existence of
					 conditions which require inpatient preparation of more than one day to improve
					 operative risk status such as:
(1) correction
					 of significant fluid or electrolyte imbalance.
(2) transfusion to correct significant
					 anemia.
(3) stabilization of
					 congestive heart failure.
(4)
					 improvement of pulmonary function or drainage.
(5) hyperalimentation to correct significant
					 malnutrition.
(6) gastro-intestinal
					 preparation before gastrointestinal surgery.
(7) stabilization of significant endocrine
					 disorder.
(8) hematologic and
					 immunologic preparation for organ transplant.
(9) management of infection.
(10) essential preliminary studies and
					 procedures performable only on an inpatient basis.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitation on Hospital Stay › Section 85.5 - Limitation on hospital stay

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 To be a covered benefit under medical assistance for the needy as provided in
					 section 365-a (2)(b)  of the Social
					 Services Law, any hospital stay beyond 20 days per spell of illness, except for
					 rehabilitation care as hereinafter provided, during which all or any part of
					 the cost of such care, services and supplies are claimed as items of medical
					 assistance shall require a prior determination of coverability by a person
					 designated by the Commissioner of Health. Any hospital stay for care under an
					 established plan for rehabilitation of physical disability in a rehabilitation
					 hospital or rehabilitation unit, beyond 40 days shall require such prior
					 determination of coverability. A written request for such determination shall
					 be made by the patient's physician. Such request shall include evidence
					 documented in the patient's medical record showing that in order to preserve
					 life or to prevent substantial risk of continuing disability, an additional
					 period of care is required of such complexity or intensity that it can be
					 provided only in a hospital. Care of such complexity or intensity shall
					 include, but not be limited to:
(1) severe
					 burns requiring continued therapy in a burns unit.
(2) continuing cardiovascular, renal or
					 pulmonary decompensation requiring care in a coronary care unit, intensive care
					 unit, pulmonary care unit or other acute care setting in the
					 hospital.
(3) central nervous
					 system damage with threatened or impaired consciousness.
(4) persistent fever or serious
					 infection.
(5) persistent
					 hemorrhage or threat of recurrent hemorrhage.
(6) life threatening conditions including
					 malignancy when chemotherapy, radiotherapy or other therapy can be provided and
					 monitored effectively only in a hospital.
(7) conditions requiring physical
					 rehabilitation under an established rehabilitation plan when such treatment can
					 be carried out only in a hospital setting.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitation on Hospital Stay › Section 85.8 - Alternate level of care placement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) During the process of making
					 determinations of coverability as specified in sections
					 85.1
					 through
					 85.7 
					 of this Part, if the person designated by the Commissioner of Health decides
					 that the patient may require placement in an alternate level of medical care
					 upon discharge from the hospital, the designated person shall refer such case
					 to the discharge planning unit of the hospital for appropriate placement
					 action.
(b) During the process of
					 making determination of coverability under sections
					 85.1
					 through
					 85.7 
					 of this Part, if the person designated by the Commissioner of Health determines
					 that the patient no longer requires inpatient hospital care but cannot be
					 discharged except to a lesser level of medical care, he shall make a
					 determination of noncoverability unless the hospital demonstrates that it has
					 made and is continuing to make every effort to place the patient but without
					 success.
(c) For all patients for
					 whom reimbursement is claimed under medical assistance for the needy who
					 require placement in a nursing home or health-related facility at time of
					 discharge from a hospital, patient review forms as required by the State
					 Department of Health must be completed by the hospital as follows:
(1)
(i) The
					 Hospital/Community Patient Review Instrument (Hospital/Community PRI), as
					 contained in section
					 400.13 
					 of this Title, shall be completed by a registered professional nurse who has
					 successfully completed a training program in patient case mix assessment
					 approved by the department to train individuals in the completion of the
					 Patient Review form (PRI) or the Hospital/Community Patient Review form
					 (Hospital/Community PRI). The SCREEN as contained in section
					 400.12  of
					 this Title shall be completed by a professional with demonstrated skills in
					 assessing psychosocial situations, including but not limited to social work and
					 discharge planning professionals, who has successfully completed a training
					 program in patient case mix screening approved by the department to train
					 individuals in the completion of the patient screening form (SCREEN);
					 or
(ii) each hospital shall have on
					 staff one trained and qualified assessor, and one trained and qualified
					 screener, each as described in subparagraph (i) of this paragraph, for every 70
					 medical surgical beds, who shall attest to the accuracy of the patient review
					 forms, except that no more than nine trained and qualified assessors and nine
					 trained and qualified screeners shall be required in a hospital.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitation on Hospital Stay › Section 85.9 - Responsibilities of persons designated by the commissioner of health

Current through Register Vol. 46, No. 28, July 10, 2024
Persons designated by the Commissioner of Health as
						specified under sections
						85.1
						through
						85.8 
						and section
						85.13 
						of this Part shall complete and forward reports of their activities as
						specified by the Commissioner of Health. The designated persons shall maintain
						copies of all notices of determinations of coverability and noncoverability and
						notifications of decisions on appeal and records which document the basis for
						all determinations of coverability and noncoverability and decisions on appeal
						and shall make such copies and records available to persons designated by the
						Commissioner of Health for review and evaluation as required.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitation on Hospital Stay › Section 85.10 - Responsibilities of hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
					 addition to their responsibilities specified under other sections of this Part,
					 hospitals shall provide such information, facilities and services as requested
					 by the persons designated by the Commissioner of Health to make determinations
					 of coverability or decisions on appeal under sections
					 85.1
					 through
					 85.9 
					 and section
					 85.13 
					 of this Part.
(b) Hospitals shall
					 designate an employee of the hospital to serve as liaison with the persons
					 designated by the Commissioner of Health to make determinations of coverability
					 or noncoverability or decisions on appeal under sections
					 85.1
					 through
					 85.9 
					 and section
					 85.13 
					 of this Part.
(c) Hospitals shall
					 maintain copies of all notices of determinations of benefit coverability and
					 noncoverability and notifications of decisions on appeal made by the
					 commissioner's designees under this Part and given to the hospital. The
					 hospital shall make such copies available for review by persons designated by
					 the Commissioner of Health, the State Department of Social Services or local
					 social services districts.
(d)
					 Hospitals shall record on each claim for reimbursement under medical assistance
					 for the needy for inpatient hospital care the period or periods of time
					 approved as covered benefits by the commissioner's designee under this Part and
					 shall certify on each claim that reimbursement is being requested only for
					 inpatient hospital care determined to be a covered benefit by the
					 commissioner's designee or that a determination is not required under this
					 Part.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitation on Hospital Stay › Section 85.11 - Determinations of commissioner of health

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The Commissioner of Health may make a
					 determination, as appropriate, that part or all of past, present or future
					 inpatient care, services and supplies in a hospital are not a covered benefit
					 under medical assistance for the needy if the hospital:
(1) has failed adequately to review, act
					 upon, and report to the department regarding discharge information provided to
					 the hospital which has been compiled and analyzed by the department from
					 information submitted to it by the hospital under paragraph (4) of subdivision
					 (e) of section
					 405.3,
					 Medical Facilities - Minimum Standards;
(2) has failed to correct the deficiencies
					 identified by the review of such discharge information;
(3) has failed to submit discharge
					 information on the forms required under paragraph (4) of subdivision (e) of
					 section
					 405.9,
					 Medical Facilities -Minimum Standards or subdivision (c) of section
					 85.8 
					 of this Part or has provided information on such forms which is not complete or
					 not accurate;
(4) has claimed
					 reimbursement for patients who did not meet benefit coverability definitions
					 under this Part during a portion of or all of their inpatient hospital
					 stay.
(5) has provided care,
					 services and supplies in a manner which results in excessive patient
					 stay;
(6) has failed fully to
					 record information justifying benefit coverability of care or services
					 provided;
(7) has failed to comply
					 with section
					 405.26,
					 Medical Facilities -Minimum Standards pertaining to utilization
					 review;
(8) has failed to fulfill
					 its responsibilities under this Part.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Limitation on Hospital Stay › Section 85.12 - Other remedies

Current through Register Vol. 46, No. 28, July 10, 2024
The remedies provided in sections
						85.1
						through
						85.11 
						of this Part shall not be exclusive but shall be cumulative and in addition to
						existing remedies or remedies hereafter provided by law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Physically Handicapped Children › Section 85.13 - Children and youth with special health care needs

Current through Register Vol. 46, No. 28, July 10, 2024
For persons under the age of 21 years having conditions
						covered under the scope of the children and youth with special health care
						needs support services program, all determinations of coverability in this Part
						shall be made by the children and youth with special health care needs support
						services program county medical director, the county commissioner of health or
						the health services administration of the City of New York as the designee of
						the Commissioner of Health. Such designee may utilize any diagnosis and
						evaluation carried out in a center approved by the children and youth with
						special health care needs support services program as the second opinion upon
						which determination of coverability is made, or may require an additional
						second opinion
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Continuing Stay Reviews in Residential Health Care Facilities › Section 85.14 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
The following definitions shall apply to sections 85.14
						through
						85.17 
						of this Part:
(a) Adverse finding
					 shall mean a determination by the utilization review agent of a residential
					 health care facility that a patient or resident who is receiving benefits under
					 the medical assistance for the needy program requires a lower level of care
					 than he is presently receiving.
(b)
					 Multi-level facility shall mean a residential health care facility which
					 provides both skilled nursing care and health-related care at its
					 premises.
(c) The patient review
					 forms and criteria for level of care shall mean the patient assessment criteria
					 and standards promulgated and published by the Office of Health Systems
					 Management (Patient Review Instrument [PRI] Patient Screening Instrument
					 [SCREEN] and Criteria for Level of Care) as contained in subdivision (i) of
					 section
					 86-2.30 
					 and section
					 400.12  of
					 this Title, except that such forms and criteria shall not apply for
					 patients/residents who are younger than 16 years of age.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Continuing Stay Reviews in Residential Health Care Facilities › Section 85.15 - Notification of adverse finding

Current through Register Vol. 46, No. 28, July 10, 2024
When an adverse finding is made, the utilization review
						agent must immediately notify the appropriate area office of the Department of
						Health, Office of Health Systems Management, Long-Term Care Unit. The
						utilization review agent must immediately forward to the area office a copy of
						the most recently completed patient review forms (PRI and SCREEN) and criteria
						for level of care as contained in subdivision (i) of section
						86-2.30 
						and section
						400.12  of
						this Title, a copy of the psychosocial evaluation completed by the facility's
						qualified social worker indicating the patient's or resident's response to
						possible transfer, the information supplied by the attending physician, if any,
						concerning the patient's or resident's current clinical status and ability to
						accept transfer, and the utilization review agent physician's statement of the
						change in the patient's or resident's medical condition or other circumstances
						justifying the adverse finding.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Continuing Stay Reviews in Residential Health Care Facilities › Section 85.16 - Review of adverse finding

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 nurse reviewer at the area office of the Office of Health Systems Management
					 shall be assigned to review the information forwarded by the utilization review
					 agent, and determine whether all relevant factors were considered in arriving
					 at the adverse finding.
(b) The
					 nurse reviewer may send the case back to the facility for appropriate
					 corrections if the information on the patient review forms (PRI and SCREEN) is
					 not internally consistent, or if the information on the forms is not legible,
					 or if the forms are not fully completed or signed by authorized individuals, or
					 if the information provided is otherwise unacceptable.
(c) If the patient's or resident's attending
					 physician has not supplied the utilization review agent with information
					 concerning the patient's or resident's current clinical status and the
					 patient's or resident's ability to accept transfer, the nurse reviewer shall
					 contact the attending physician and obtain this information.
(d) If the nurse reviewer finds that all
					 written information is acceptable, the reviewer shall contact the facility
					 administrator to schedule an onsite visit. Upon the onsite visit, the nurse
					 reviewer shall:
(1) compare the patient
					 review forms with the patient's or resident's medical record or chart to ensure
					 that the form is reflective of the patient's or resident's current medical
					 condition;
(2) discuss the
					 appropriateness of the adverse finding, including the patient's or resident's
					 physical and psychological response to transfer with the social worker,
					 attending nurse, attending physician and other facility staff directly involved
					 in providing care to the patient or resident;
(3) observe the patient's or resident's
					 physical and emotional condition; and
(4) request the patient's or resident's
					 attending physician to clinically examine the patient or resident if his
					 medical record is not up to date.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Continuing Stay Reviews in Residential Health Care Facilities › Section 85.17 - Notification of department of social services

Current through Register Vol. 46, No. 28, July 10, 2024
When a determination is made pursuant to paragraph
						(f)(1), (2) or (3) of section
						85.16 
						of this Part, the area office shall notify the appropriate social services
						district official of the determination and forward a copy of the patient review
						forms (PRI and SCREEN), and the utilization review agent physician's statement
						of the change in the patient's or resident's medical condition or other
						circumstances justifying the transfer. The social services district office
						shall notify the patient or resident, the patient's or resident's attending
						physician, the facility administrator, and the patient's or resident's next of
						kin or designated representative, of the adverse decision and the patient's or
						resident's fair hearing rights.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Nonprescription Drugs in the Medicaid Program › Section 85.20 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in the sections under the heading
						"Nonprescription Drugs in the Medicaid Program" (§
											85.20  et. seq. of this Part),
						unless the context otherwise requires:
(a) Nonprescription drug means a drug,
					 commonly referred to as a nonlegend or over the counter drug, which may be sold
					 at retail by a pharmacy to the general public. Neither Federal law nor
					 regulations of the commissioner require that such drugs be distributed or
					 dispensed on prescription. The provisions of Education Law, section
					 6810(1) and the first
					 unnumbered paragraph of section 6816 are not applicable to the sale,
					 distribution or dispensing of such nonprescription drugs.
(b) Medical assistance program means the New
					 York State medical assistance to the needy program (Medicaid) authorized by
					 article 5, title 11 of the Social Services Law.
(c) Commissioner means the Commissioner of
					 Health of the State of New York.
(d) Package size of nonprescription drug
					 means the amount of medication required to fill a request or order for such
					 drug. Under the medical assistance program, reimbursement for nonprescription
					 drugs shall not be greater than the price for the available manufacturers'
					 package or unit size which most closely corresponds to the quantity requested
					 on such written request or order.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 85 - Medical Assistance Benefits › Nonprescription Drugs in the Medicaid Program › Section 85.21 - Establishment of list of reimbursable, nonprescription drugs

Current through Register Vol. 46, No. 28, July 10, 2024
Pursuant to section 365-a  of the Social Services Law
						nonprescription drugs included in the therapeutic categories listed in this
						section may be reimbursed in the New York State Medical Assistance
						Program.
Product
(a)
					 Analgesic and Antipyretic
(1)
					 Acetaminophen
(2) Acetylsalicylic
					 Acid
(3) Ibuprofen