New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 1 - General Provisions › Part 708 - Appropriateness Review › Section 708.3 - Procedures

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any person or
					 entity subject to review under this Part shall, at the request of the
					 commissioner, submit data relating to criteria developed for review in a manner
					 and format specified by the commissioner to effectuate his review. Any such
					 person or entity shall, in response to such request, furnish any information or
					 documentation as is required to effectuate the review by the commissioner
					 within 30 days of such request.
(b)
					 The commissioner shall provide to the applicable health systems agency that
					 information which he has collected and which is relevant to the review and the
					 preparation of a recommendation with regard to the appropriateness of the
					 hospital service or home care service being reviewed.
(c) The commissioner shall establish
					 procedures to be followed by health systems agencies for transmittal of
					 recommendations to the commissioner.
(d) The commissioner shall commence his
					 review by providing written notice to affected persons of the beginning of such
					 review.
(e) No review by the
					 commissioner shall, to the extent practicable, take longer than 180 days from
					 the date of notification of the beginning of a review to the date of the
					 commissioner's proposed finding. The commissioner shall not make a proposed
					 finding until the health systems agency has had 180 days to make a
					 recommendation to the commissioner.
(f) During the course of his review, the
					 commissioner shall provide an opportunity for affected persons to present their
					 views about the service under review in a public hearing.
(g) The commissioner shall, upon the written
					 request of persons or entities subject to appropriateness review, make
					 available information relative to such review to such persons or
					 entities.
(h) The commissioner
					 shall prepare an analysis of the service being reviewed, and shall forward the
					 health systems agency recommendation, together with his analysis and
					 recommendation, to the State Hospital Review and Planning Council. The State
					 Hospital Review and Planning Council shall review the commissioner's analysis
					 and recommendation and the health systems agency recommendation regarding the
					 appropriateness of the service being reviewed, and, in accordance with the
					 criteria established pursuant to this Part, make a recommendation to the
					 commissioner with regard to the appropriateness of the service. Where the State
					 Hospital Review and Planning Council recommends that the commissioner make a
					 finding that a service is not appropriate, such a recommendation shall include
					 a recommendation for remedial action.
(i) After consideration of the
					 recommendations made by a health systems agency and by the State Hospital
					 Review and Planning Council, the commissioner shall, in accordance with the
					 procedures and criteria set forth in this Part, make a written finding as to
					 the appropriateness of the service reviewed, subject to the provisions of
					 subdivisions (j), (k) and (l) of this section, and make such finding
					 public.
(j) The commissioner shall
					 afford to any affected person, for good cause shown, within 30 days of making
					 his proposed finding, a public hearing respecting such proposed finding. For
					 purposes of this section, "good cause" shall require such person to establish
					 that a public hearing is required for:
(1)
					 presentation of significant, relevant information not previously considered by
					 the commissioner; or
(2)
					 demonstration that there have been significant changes in factors or
					 circumstances relied upon by the commissioner in reaching his decision. "Good
					 cause" shall not be deemed to be established where information or documentation
					 was previously available and could reasonably have been submitted to the
					 commissioner.