New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-12 - Liability for Services › Section 635-12.6 - Obligations of individuals receiving or requesting services and liable parties - services other than Preexisting services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This section applies only to services
				  which are not preexisting services.
(b)
Responsibility for provision of
				  information.
(1) Prior to the receipt
				  of services, and upon request of the provider, individuals requesting or
				  receiving services, and other liable parties, shall provide personal and
				  financial information as may be reasonably required to identify liable parties
				  and to ascertain the individual's and any other liable parties' ability to pay
				  for services or the individual's ability to obtain and maintain full Medicaid
				  coverage.
(2) Subsequent to the
				  provision of information required in paragraph (1) of this subdivision and
				  throughout the period that services are received, the individual and other
				  liable parties shall notify the provider about any changes in liable parties,
				  any changes in the individual's Medicaid coverage and any changes that may
				  affect the individual's eligibility for full Medicaid coverage and/or the
				  individual's and other liable parties' ability to pay for services. If the
				  individual or any other party receives a notice from the Medicaid district that
				  the individual is losing full Medicaid coverage, the individual or party must
				  inform the provider within five days of receipt of the notice.
(3) Each individual requesting or receiving
				  services must:
(i) present evidence of and
				  maintain full Medicaid coverage; or
(ii) take all necessary steps to obtain and
				  maintain full Medicaid coverage; or
(iii) disclose to the provider such
				  information as may be reasonably required to obtain and maintain full Medicaid
				  coverage, and allow the provider to assist the individual to take all necessary
				  steps to obtain and maintain full Medicaid coverage or apply on the
				  individual's behalf; or
(iv) agree
				  to pay for the services in accordance with the applicable fee schedule in
				  section
				  635-12.9 
				  of this Subpart. Liable parties may agree in lieu of the individual;
				  or
(v) agree to pay for the
				  services in accordance with the reduced fee established by the provider and
				  acknowledge that any reduction of the fee shall not constitute nor be construed
				  as a release of the individual or any liable party from liability for payment
				  of the full fee. Other liable parties may agree and acknowledge same in lieu of
				  the individual; or
(vi) acknowledge
				  that the fee has been waived by the provider and that any waiver of the fee
				  shall not constitute nor be construed as a release of the individual or any
				  liable party from liability for payment of the full fee. Other liable parties
				  may acknowledge same in lieu of the individual.
(4) In addition, if HCBS waiver services are
				  requested, the individual must take all necessary steps to enroll in the HCBS
				  waiver and take all necessary steps to maintain enrollment in the HCBS
				  waiver.
(5) Unless the individual
				  has full Medicaid coverage or the fee is waived by the provider, the individual
				  and/or liable parties must either:
(i) pay for
				  the services in accordance with the applicable fee schedule in section
				  635-12.9 
				  of this Subpart; or
(ii) pay for
				  the services with the reduced fees established by the provider.