reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Section 43-1.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A tuberculosis
					 case shall mean a person diagnosed as having disease caused by M. tuberculosis
					 determined by bacteriological evidence of tuberculous disease or a significant
					 reaction to a mantoux tuberculin test and clinical or roentgenographic evidence
					 of current disease.
(b) A person
					 with tuberculosis infection shall mean a person diagnosed as having a
					 significant reaction to the mantoux tuberculin test in the absence of clinical,
					 roentgenographic or bacteriological evidence of tuberculous disease.
(c) A suspect shall mean a person suspected
					 of having either tuberculosis infection or disease, (including a person who has
					 been in close contact with a tuberculosis case) for whom diagnostic procedures
					 have not been completed and who may or may not be receiving treatment. A person
					 shall not be classified as a tuberculosis suspect for longer than 60
					 days.
(d) A tuberculosis contact
					 shall mean a person who has been in close association with a suspect or
					 tuberculosis case for a length of time sufficient to become infected with M.
					 tuberculosis by breathing contaminated droplets.
(e) A provider shall mean any facility,
					 agency or organization authorized to furnish tuberculosis health care services
					 under article 3, 28, 36 or 44 of the Public Health Law or a licensed and
					 registered physician.
(f) A
					 tuberculosis patient shall mean a person who is a tuberculosis case; a
					 tuberculosis suspect; or has a tuberculosis infection; and who has been
					 accepted or admitted into care by a provider.
(g) Tuberculosis health care services shall
					 mean diagnostic procedures, care, and treatment for tuberculosis patients
					 furnished by a provider.
(h) Local
					 health official shall mean the Commissioner of Health or public health
					 administrator of a county or part county health district, the Commissioner of
					 Health of the City of New York, the county health director or other appropriate
					 health officer designated by the legislative body of each county or the
					 corresponding authority of the City of New York to be responsible for providing
					 or securing tuberculosis care and treatment, pursuant to section 2202 (1)  of the Public
					 Health Law.
(i) A State or local
					 charge shall mean those persons defined as such in section 2200 (4) and (5)  of the
					 Public Health Law.
(j) Third-party
					 payer shall mean Medicare, workers' compensation, medical assistance in
					 accordance with the Social Services Law, the Veterans Administration, health
					 and other insurers and indemnitors or other third parties by whom diagnosis,
					 care and treatment hereunder is payable.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Section 43-1.2 - Responsibility for tuberculosis care and treatment

Current through Register Vol. 46, No. 28, July 10, 2024
The local health official, where a tuberculosis patient
						or contact resides or is found, shall provide or secure tuberculosis health
						care services needed by such person. Upon notification of a tuberculosis case
						or suspect, the appropriate local health official shall be responsible for
						immediately determining if other persons may have become infected with
						tuberculosis by the case or suspect, and shall perform those duties and
						responsibilities identified in Part 2 of the State Sanitary Code. The local
						health official shall provide or secure health care services needed for all
						cases or suspects found. The local health official shall initiate preventive
						measures, to prevent the spread of infection or development of disease. If a
						case or contact resides outside of the geographic jurisdiction of the local
						health official to which he or she has been reported, the local health official
						shall transfer copies of all materials concerning that case or contract to the
						local health official with jurisdiction.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Section 43-1.3 - Nonresidents, aliens, refugees and staff members of legations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) There shall be
					 no discrimination against tuberculosis patients or contacts because of lack of
					 United States citizenship or lack of New York State or local
					 residence.
(b) Tuberculosis health
					 care services for the following aliens are not eligible for payment by local
					 health officials or the State or for payment of State aid reimbursement:
(1) officials, representatives or employees
					 of foreign governments;
(2)
					 officers and employees of international organizations;
(3) attendants, servants, personal employees
					 of those listed in paragraphs (1) and (2) of this subdivision; or
(4) members of immediate families of those
					 listed in paragraphs (1) through (3) of this subdivision.
Payments for tuberculosis health care services for these
						persons is the responsibility of the individual or foreign country through its
						appropriate representative in the United States.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Providers as a Condition to Being Entitled to Payment for Tuberculosis Health Care Services › Section 43-1.4 - Standards for tuberculosis care and services

Current through Register Vol. 46, No. 28, July 10, 2024
The care and treatment by providers of tuberculosis
						  patients shall include health care services which meet prevailing standards of
						  professional practice, including the following:
(a) a licensed and currently registered
						physician shall be responsible for the tuberculosis health care services
						furnished to a patient;
(b)
						tuberculosis suspects shall be confirmed as being or not being tuberculosis
						cases within 60 days from the date accepted into care by a provider. On or
						before the 60th day, the provider shall report findings in writing to the local
						health officials where the patient resides and where the provider is located;
						and
(c) providers shall comply with
						applicable utilization review requirements.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Providers as a Condition to Being Entitled to Payment for Tuberculosis Health Care Services › Section 43-1.5 - Hospital inpatient admissions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Tuberculosis health care services
						provided in a hospital shall be based on prevailing standards of professional
						practice for the care of tuberculosis.
(b) An inpatient admission of a tuberculosis
						patient to a hospital for treatment of tuberculosis may be made when a person
						has severe symptoms attributed to tuberculosis, presents diagnostic problems or
						presents difficulties in drug treatment selection.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Providers as a Condition to Being Entitled to Payment for Tuberculosis Health Care Services › Section 43-1.6 - Reporting by providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When
						a tuberculosis case or suspect is accepted for care by a provider, the provider
						shall notify by telephone within 24 hours the local health official where the
						provider is located, and also the local health official where the person
						resides. The provider shall then submit a written case report within five
						working days to the same local health official or officials. The written report
						shall include the person's name, date accepted for care, age, address,
						telephone number, name and address of employer, county of residence, diagnosis,
						clinical evidence of disease and diagnostic procedures completed. If the person
						has been admitted as an inpatient, a written statement shall also be submitted
						by the hospital indicating the reasons for inpatient admission, rather than
						ambulatory care.
(b) When a
						tuberculosis case or suspect accepted into care by a provider is or may be a
						local charge, as defined by article 22, section 2200  of the Public Health Law, the provider
						shall, within five working days, notify the local health official where the
						person resides of the person's name, address, potential status as a local
						charge, and the names and addresses of any third-party payers, along with all
						other information stated in subdivision (a) of this section.
(c) When a tuberculosis case or suspect
						accepted for care by a provider is or may be a State charge, as defined by
						article 22, section 2200  of the Public Health Law, the provider
						shall, within five working days, notify the local health official where the
						provider is located of the person's name, address, potential status as a State
						charge, and the names and addresses of any third-party payers, along with all
						information stated in subdivision (a) of this section. The health official will
						immediately inform the person designated by the State Health Commissioner for
						such purpose.
(d) A monthly patient
						status report on each person with tuberculosis disease shall be submitted by
						each provider to the local health officials where the person resides and where
						the provider is located, which shall include a medical and social history and,
						if applicable, a discharge summary. Reports shall be submitted within two weeks
						of the end of each month.
(e)
						Providers shall submit to such health official additional reports as the State
						Commissioner of Health may provide.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Authorization › Section 43-1.7 - Authorization of reimbursement for tuberculosis health care and services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Tuberculosis
						health care services shall be paid by the local health official with
						jurisdiction or the State only as authorized. Authorization for local charges
						shall be made by the local health official where the patient resides.
						Authorization for State charges shall be made by the designee of the State
						Health Commissioner.
(b) Providers
						shall be deemed authorized to collect reimbursement for tuberculosis health
						care services when they are so notified by the local health official or
						designee of the State Health Commissioner, if they comply with the requirements
						of this Subpart.
(c) Reimbursement
						for inpatient hospital services for a patient hospitalized for a period in
						excess of six weeks during a calendar year are not authorized unless approved
						in writing before expiration of the six weeks. Authorization for local charges
						may only be made by the local health official where the patient resides. If the
						patient is a potential State charge, the provider shall request authorization
						for care beyond six weeks by writing to the local health official where the
						patient resides. Such health official shall recommend whether such care is
						justified or not to the designee of the State Health Commissioner.
						Authorization for State charges may only be made by the designee of the State
						Health Commissioner.
(d) In
						determining which tuberculosis health care services to authorize for a
						tuberculosis patient, the local health official or designee of the State Health
						Commissioner shall consider available alternative tuberculosis health care
						services and determine the most appropriate source to meet the patient's
						needs.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Provider Claim for Payment and Efforts to Determine Availability of Third-Party Payers › Section 43-1.8 - Provider claim

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Providers
						of tuberculosis health care services may not claim payment from local health
						officials or the State for amounts which are eligible for payment from any
						other third-party payer or payers.
(b) For a tuberculosis patient who is a local
						charge, a provider shall submit to the local health official where the patient
						resides an itemized claim form for payment for tuberculosis health care
						services furnished to the patient who does not have full third-party coverage
						of the claim.
(c) For a State
						charge who does not have full third-party coverage, a provider shall submit an
						itemized claim form to the local health official where the patient resides. The
						health official shall verify the information on the claim form and shall
						forward the claim to the designee of the State Health Commissioner.
(d) The claim form shall show the charges for
						each of the services provided and shall deduct all amounts eligible for
						reimbursement or indemnification by the third-party payers.
(e) The claim form shall include the names of
						third-party payers or indemnitors who have paid, or are or may be responsible
						for making payments for part or all of the claim, and the amounts each has paid
						or is or may be responsible for paying.
(f) A form shall be submitted with a copy
						maintained by the provider, together with the claim form stating in detail the
						efforts made to determine whether there is third-party coverage or
						indemnification available for the claim. The form shall also state the efforts
						made to claim such reimbursements. If the provider's efforts to determine or
						obtain third-party reimbursement, as reported in the form are found
						unsatisfactory by the local health official, the provider shall make additional
						efforts and shall submit a supplemental form.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Responsibility for Payment for Services › Section 43-1.9 - Extent of responsibility for payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The local health official of the
						jurisdiction where a tuberculosis patient resides shall be responsible to pay
						providers for health care services rendered to a local charge tuberculosis
						patient when such services are authorized and provided in accordance with this
						Subpart, except:
(1) The maximum charges
						which the local health official shall be responsible for are the rates for the
						Medical Assistance Program established in accordance with the provisions of
						section 2807  of the Public Health Law and fees for
						services established in the State medical fee schedule for medical
						assistance.
(2) Amounts eligible
						for reimbursement or indemnification from any third-party payer shall not be
						paid by the local health official. Such amounts shall be deducted by the local
						health official from the charges billed by the provider or the established
						rates and/or fees in the State medical fee schedule for the health care
						services rendered, whichever are less.
(3) When a person has been admitted as an
						inpatient to a hospital for the treatment of a nontuberculous disease or
						condition and is subsequently found to have tuberculosis which requires
						inpatient care and treatment, a local health official has no responsibility to
						pay for care and treatment prior to the date of diagnosis of tuberculosis. If
						the person requires tuberculosis care and treatment, but hospitalization is not
						justified, the local health official shall not be responsible for
						hospitalization costs.
(4) If, upon
						review of a claim, the local health official determines that a tuberculosis
						patient had or was eligible for third-party coverage or indemnification and
						that the provider failed to make a good faith effort to determine whether there
						was such coverage or indemnification, the local health official may deny
						payment of the claim.
(5) A person
						who volunteers to assume and pay for the cost of tuberculosis health care
						services hereunder shall be liable therefor.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Responsibility for Payment for Services › Section 43-1.10 - No patient obligation to pay

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No tuberculosis patient or his legally
						responsible relatives shall be requested or required by a provider, local
						health official, the State, or any other party to pay personally for any
						portion of tuberculosis health care services received, as provided in section 2202  of the Public Health Law.
(b) No provider, local health official, the
						State or any other person shall inquire into the financial ability of a
						tuberculosis patient or his legally responsible relatives to pay for
						tuberculosis health care services except to determine third-party
						coverage.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Local Health Officials for Receiving State Aid for Tuberculosis Health Care Services › Section 43-1.11 - State aid for tuberculosis

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
						Expenses incurred by a local health official for health care services rendered
						to tuberculosis patients in accordance with the terms of this Subpart shall be
						eligible for State aid reimbursement.
(b) Such aid shall be provided to local
						health official through the same procedures and at the same rate as State aid
						for general public health work, pursuant to Part 39 of this Title.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Local Health Officials for Receiving State Aid for Tuberculosis Health Care Services › Section 43-1.12 - Limitations on state aid

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No
						State aid is available to local health officials or providers for tuberculosis
						health care services which do not meet the terms of this Subpart or:
(1) if payment of a claim is available from
						any other third-party payer which equals or exceeds the per diem rate or fee
						for services;
(2) for tuberculosis
						health care services for persons listed in subdivision (b) of section
						43-1.3 
						of this Subpart; or
(3) for
						services for which payment by a local health official is not required under
						this Subpart.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Local Health Officials for Receiving State Aid for Tuberculosis Health Care Services › Section 43-1.13 - Audits by local health officials

Current through Register Vol. 46, No. 28, July 10, 2024
Local health officials shall audit a sufficient number
						  of provider reports, medical records, and if necessary, interview physicians
						  and other personnel to determine whether a provider has furnished or is
						  furnishing tuberculosis health care services in accordance with the
						  requirements of this Subpart.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Requirements Applying to Local Health Officials for Receiving State Aid for Tuberculosis Health Care Services › Section 43-1.14 - Recovery

Current through Register Vol. 46, No. 28, July 10, 2024
Local health officials shall oversee all provider
						  efforts to identify third-party coverage and to be able to demonstrate on audit
						  that such third-party coverage was identified and fully utilized and that the
						  providers adhered to the terms of this Subpart. Upon receipt of audit
						  information by the State Health Department showing State aid overpayment, the
						  commissioner shall deduct from the next State aid voucher the amount previously
						  overpaid.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Local Health Official Records and Reports to State Health Department › Section 43-1.15 - Records and reports

Current through Register Vol. 46, No. 28, July 10, 2024
The local health officials shall submit all reports as
						  required by the department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Local Health Official Records and Reports to State Health Department › Section 43-1.16 - Return of a tuberculosis patient to location of residence

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A New York State resident who is
						receiving tuberculosis health care services in another state and desires to
						return to New York State shall be referred to the local health official where
						the patient resides. The information requested of the other state by the local
						health official regarding the patient, shall include at least the following:
(1) medical history including sufficient
						clinical data to indicate need for further care and treatment of
						tuberculosis;
(2) a statement that
						the patient is physically able to travel without harm to himself or others, and
						arrangements have been made for his transfer to New York State.
(3) information for residence
						verification;
(4) a statement
						indicating the patient's willingness to return to New York State for further
						care and treatment of tuberculosis; and
(5) names and addresses of individuals who
						will assume responsibility for the patient.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Local Health Official Records and Reports to State Health Department › Section 43-1.17 - Commissioner's orders

Current through Register Vol. 46, No. 28, July 10, 2024
If a local health official fails to provide or secure
						  tuberculosis health care services or to pay providers for such services
						  rendered under the terms of this Subpart, the State Health Commissioner upon
						  notice and opportunity to be heard may order the local health official to
						  provide or secure the services or to make such payment.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-1 - State Aid For Tuberculosis › Local Health Official Records and Reports to State Health Department › Section 43-1.18 - Violations by a provider

Current through Register Vol. 46, No. 28, July 10, 2024
A violation of any provision of this Subpart as applied
						  to a specific patient, shall be punishable by a denial of payment of State aid
						  reimbursement to a local health official or a provider or the repayment thereof
						  for tuberculosis health care services for such patient.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.1 - Scope

Current through Register Vol. 46, No. 28, July 10, 2024
These regulations govern the application and eligibility
						determination process for the Uninsured Care Programs and establish the rights
						and responsibilities of applicants, participants, providers, and contractors in
						that process.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An applicant is
					 a person who has directly or by a representative applied in writing to the New
					 York State Department of Health.
(b) An application is the process by which a
					 person indicates, in writing on a Department of Health approved form, his/her
					 desire to receive assistance.
(c)
					 Resident means a person domiciled within the State.
(d) Authorized representative means any
					 person authorized by an applicant or participant to act on his/her
					 behalf.
(e) Period of coverage.
					 Coverage for assistance for each individual program component is effective as
					 specified in the individual's notification of eligibility. Coverage will
					 terminate under the following circumstances:
(1) the applicant indicates in writing that
					 they no longer need or desire assistance;
(2) the department determines that a change
					 in the participant's circumstances or residence has affected their
					 eligibility;
(3) the participant
					 has died or cannot be located; and
(4) funding for the Uninsured Care Programs
					 is exhausted.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.3 - Confidentiality

Current through Register Vol. 46, No. 28, July 10, 2024
All information which may identify an applicant which is
						received by the program will be confidential and can only be used when
						necessary for supervision, monitoring or administration of the program.
						Information received by any contractor, his agents, employees, or by any other
						person or agency concerning applicants or participants in the program is
						confidential and may not be disclosed without the written approval of the
						Uninsured Care Program director, who shall approve disclosure only in
						conformance with Article 27-F of the Public Health Law and the federal
						standards with respect to the privacy and security of individually identifiable
						health information contained in Part 164 of Title 45 of the Code of Federal
						Regulations.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.4 - Use of the application form

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The State-approved application form must be completed:
(1) for each applicant upon initial
					 application and recertification, if required; and
(2) documentation may be required when there
					 is a change in status affecting eligibility.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.5 - Eligibility for coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
					 applicant must be confirmed as medically eligible to participate in the
					 program. The Department of Health will confirm medical eligibility based upon
					 information received from the applicant and the applicant's clinical
					 practitioner or their designee. The applicant's clinical practitioner or their
					 designee will be required to submit information regarding an applicant's
					 medical condition on a State-approved form consistent with their scope of
					 practice.
(b) Financial eligibility
					 will be based upon the available household income.
(1) In order to be eligible, an applicant's
					 available household income must be equal to or less than 500% of the amount
					 under the annual United States Department of Health and Human Services poverty
					 guidelines for the applicant's family size. Federal poverty guidelines are
					 published annually by the Department of Health and Human Services in the
					 Federal Register.
(2) Applicants
					 must provide income information for a reasonable period prior to application.
					 Applicants who are self-employed must provide business records for the three
					 months prior to application indicating type of business, gross income and net
					 income.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.6 - Decision on eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 department shall make one of the following decisions, based upon the
					 application information:
(1) Accepted for
					 coverage. This means that eligibility has been established through review and
					 verification to the satisfaction of the department; or
(2) Not accepted for coverage. Applications
					 are denied when the information given by the applicant establishes that the
					 applicant is ineligible, or when the applicant refuses to comply with any
					 requirement essential to the determination of eligibility.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.7 - Responsibility for prompt determination of eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
The decision to accept or deny the application shall be
						made as soon as sufficient information to make a determination about
						eligibility is obtained.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.8 - Notification

Current through Register Vol. 46, No. 28, July 10, 2024
Written notification shall be given of the decision to
						accept or deny an application. Notification of denial shall clearly set forth
						the specific reason why the application was denied.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.9 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.10 - Investigation

Current through Register Vol. 46, No. 28, July 10, 2024
The department official shall review and verify
						information received on applications, as required. Documents, personal
						observation, personal and collateral interviews and contacts, reports,
						correspondence and conferences are means of verification of information
						supplied. When information is sought from collateral sources other than public
						records or sources designated by the applicant on the application form, the
						department will inform the applicant/participant or his/her representative of
						what information is desired, why it is needed and how it will be
						used.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.11 - Fraud and abuse

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 commissioner, his agents or designees, shall investigate and refer for
					 prosecution any violations of State laws pertaining to fraud or abuse in the
					 program.
(b) Where review indicates
					 substantial evidence of abuse of the program, the participant may be removed
					 from the program or restricted to a single provider.
(c) If the recipient did not provide accurate
					 information regarding his income and expenses, the commissioner may summarily
					 suspend an enrollee's participation in the program, and the department can
					 recover the amount of assistance granted, to which the recipient is not
					 entitled.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.12 - Appeals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An applicant
					 may request a reconsideration of an adverse decision within 60 days of a
					 decision.
(b) The department shall
					 review any additional submissions and issue a written decision within 30 days
					 of an applicant's request and submission of additional documents.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.13 - Continuing eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Participants may be required to establish periodically that they remain
					 eligible for the program.
(b) The
					 applicant/participant must notify the department immediately of any changes in
					 circumstances that may affect eligibility.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.14 - Enrollment of providers

Current through Register Vol. 46, No. 28, July 10, 2024
The department will contract with or enter into provider
						agreements with providers, including providers of related laboratory and
						ancillary services, which demonstrate that they are qualified to provide
						prescription drugs.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.15 - Audit and review

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Providers
					 shall be subject to audit by the commissioner, his agents or designees. With
					 respect to such audits and reviews, the provider may be required:
(1) to reimburse the department for
					 overpayments discovered by audits; and
(2) to pay restitution for any direct or
					 indirect monetary damage to the program resulting from their improperly or
					 inappropriately furnishing covered drugs, services, supplies or
					 equipment.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.16 - Audits and recovery of overpayments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Recovery of overpayments shall be made
					 only upon a determination by the commissioner, his agents or designees, that
					 such overpayments have been made, and recovery shall be made of all money paid
					 to the provider to which it has no lawful right or entitlement.
(b) Recovery of overpayments pursuant to this
					 subject shall not preclude the commissioner or any other authorized
					 governmental body or agency from taking any other action with respect to the
					 provider, including auditing or reviewing other payments or claims for payment
					 for the same or similar periods, imposing program sanctions, or taking any
					 other action authorized by law.
(c)
					 The commissioner may utilize any lawful means to recover overpayments,
					 including civil lawsuit, participation in a proceeding in bankruptcy, common
					 law set-off, or such other actions or proceedings authorized or recognized by
					 law.
(d) All fiscal and statistical
					 records and reports of providers and prescriptions filled or refilled which are
					 used for the purpose of establishing the provider's right to payment under the
					 program and any underlying books, records, documentation which formed the basis
					 for such fiscal and statistical records and reports shall be subject to audit.
					 All underlying books, records and documentation including all prescriptions
					 filled or refilled shall be kept and maintained by the provider for a period of
					 not less than three years from the date of completion of such reports, or the
					 date upon which the fiscal and statistical records were required to be filed,
					 whichever is later, or the date the prescription was filled or
					 refilled.
(e) All claims made under
					 the program shall be subject to audit by the commissioner, his agents or
					 designees, for a period of six years from the date of their filing, or as
					 required by State law, regulation or funding source. This limitation shall not
					 apply to situations in which fraud may be involved or where the provider or an
					 agent thereof prevents or obstructs the performance of an audit pursuant to
					 this Part.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.17 - Recoupment of overpayments

Current through Register Vol. 46, No. 28, July 10, 2024
Overpayments determined to have been made pursuant to
						this section and section
						43-2.16 
						of this Subpart shall be recovered by billing the provider for reimbursement,
						withholding the provider's current or withholding future payments on claims
						submitted or a percentage of payments otherwise payable on such claims, or such
						other remedies as may be available through a court of law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 43 - State Aid for Tuberculosis and Uninsured Care Programs › Subpart 43-2 - Uninsured Care Programs › Section 43-2.18 - Claims submission

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Providers shall submit claims for drugs or services within 90 days of the date
					 of service in the manner and form proscribed by the program in order to receive
					 reimbursement.
(b) The department
					 will not be obligated to pay claims submitted more than 90 days after the date
					 of service. Claims submitted later than 90 days with written justification may
					 be considered for payment if funds are available.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 44 - State Aid For Approved Vector Surveillance And Control Programs › Section 44.10 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
Pursuant to Public Health Law, section 611, the New York
					 State Department of Health (NYSDH) is authorized to pay State aid for approved
					 vector surveillance and control programs. These rules and regulations are
					 promulgated to define the conditions under which the NYSDH will approve vector
					 surveillance and control activities for State aid.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 44 - State Aid For Approved Vector Surveillance And Control Programs › Section 44.20 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For the purposes of these rules and regulations, the
					 following definitions shall apply:
(a)
				  Arthropod shall mean a member of the phylum Arthropoda, animals with jointed
				  appendages.
(b) Presumptive human
				  case shall mean the occurrence of one or more of the following:
(1) California Encephalitis: Central nervous
				  system (CNS) symptoms plus serum titers consistent with the illness for
				  example, HI F 1:40, CF F 1:8 or Neut F 3 logs.
(2) Eastern Equine Encephalitis (EEE): CNS
				  symptoms and single serum titers consistent with the illness, for example, HI F
				  1:80, CF F 1:16.
(3) Rocky Mountain
				  Spotted Fever: headache, fever, rash, history of tick exposure and positive
				  serologies.
(4) St. Louis
				  Encephalitis: CNS symptoms plus single serum titers consistent with the
				  illness, for example, HI F 1:80, CF F 1:16.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 44 - State Aid For Approved Vector Surveillance And Control Programs › Section 44.30 - Eligibility for state aid

Current through Register Vol. 46, No. 28, July 10, 2024
State aid shall be paid for approved vector surveillance
					 and vector surveillance and control programs that:
(a) have been approved in advance of
				  implementation by the commissioner or his designee and operated in accordance
				  with that approval;
(b) have been
				  conducted by county or part-county departments of health or county boards of
				  health or municipal agencies which have been designated by the county or
				  part-county health department or county board of health for vector surveillance
				  or vector surveillance and control programs;
(c) have operated vector surveillance
				  programs only or have had vector surveillance and vector control activities
				  concurrently; and
(d) have been the
				  subject of a determination of significance pursuant to the State Environmental
				  Quality Review Act, article 8 of the Environmental Conservation Law and the
				  implementing regulations issued thereunder.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter B - State Aid And Funding › Part 44 - State Aid For Approved Vector Surveillance And Control Programs › Section 44.40 - Procedure for applying for state aid

Current through Register Vol. 46, No. 28, July 10, 2024
Applications for State aid for vector surveillance and
					 vector control activities shall be on a form prescribed by the commissioner and
					 shall be accompanied by a detailed, proposed plan of activity which shall
					 include the following:
(a) an
				  historical and chronological review of arthropod-borne disease activity in the
				  area with evidence of any substantive endemic disease which has occurred during
				  the past decade and to include the number of human cases (confirmed and
				  presumptive), clustering of human cases; and/or isolations of the agents from
				  vector species as well as the presence of vectors with a potential risk to
				  human health;
(b) a detailed
				  description of the geographic area where vector populations have occurred
				  previously or where they could occur; a map of the county identifying these
				  risk areas must be included; and
(c) methods by which vector populations or
				  areas will be monitored.