reglab/statecodes huggingface dataset:
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 635-7 - Environmental Requirements › Section 635-7.1 - Building codes (see glossary) and occupancy classifications for all facilities other than family care homes (see glossary)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In furtherance of the mandate of the New
				  York State Uniform Fire Prevention and Building Code (hereafter referred to as
				  the Uniform Code), any building or premises under the custody, supervision or
				  jurisdiction of a department or agency of the State of New York shall comply
				  with the Uniform Code. The occupancy classifications and requirements as
				  specified in subdivision (h) of this section are hereby established as
				  applicable to the premises, buildings and equipment of any facility certified
				  or operated by or under the auspices of the Office for People With
				  Developmental Disabilities.
(b) As
				  set forth in section 381  of the Executive Law, the State's
				  cities, towns and villages shall be responsible for administering and enforcing
				  the appropriate section of the 2002 edition of the New York State Uniform Fire
				  Prevention and Building Code as designated for a class of facility in
				  subdivision (h) of this section, where the buildings, premises and equipment
				  are owned or leased by parties or entities other than the State of New York,
				  its departments, agencies or offices. In the City of New York, the building
				  code of the City of New York shall be administered and enforced by the city as
				  to such facilities. Said codes are available as follows:
(1) Outside the City of New York. The code is
				  published by the New York State Department of State, 41 State Street, Albany,
				  NY 12231-0001; or is available for review during business hours and by
				  appointment at the following locations:
(i)
				  the Department of State, Division of Administrative Rules, 41 State Street,
				  Albany, NY 12231-0001; and
(ii) the
				  Office for People With Developmental Disabilities, Attention: Public Access
				  Officer, 44 Holland Avenue, Albany, NY 12229.
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 635-7 - Environmental Requirements › Section 635-7.4 - Family care homes and individualized residential alternatives (IRAs) for eight or fewer persons

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Building codes (see section
				  635-99.1  of
				  this Part) and occupancy classifications.
(1) As set forth in section 381  of the Executive Law, the State's
				  cities, towns and villages shall be responsible for administering and enforcing
				  the appropriate section of the 2002 edition of the New York State Uniform Fire
				  Prevention and Building Code (hereafter referred to as the Uniform Code) as
				  designated in paragraphs (3) and (4) of this subdivision, for homes that are
				  owned or leased by parties or entities other than the State of New York, its
				  departments, agencies or offices. In the City of New York, the Building Code of
				  the City of New York shall be administered and enforced by the city as to such
				  facilities. Said codes are available as follows:
(i) Outside the City of New York. The code is
				  published by the New York State Department of State, 41 State Street, Albany,
				  NY 12231-0001; or is available for review during business hours and by
				  appointment at the following locations:
(a)
				  the NYS Department of State, Division of Administrative Rules, 41 State Street,
				  Albany, NY 12231-0001; and
(b) the
				  Office for People With Developmental Disabilities, Attention: Public Access
				  Officer, 44 Holland Avenue, Albany, NY 12229.
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 635-7 - Environmental Requirements › Section 635-7.5 - Physical plant, environmental and certification requirements for site based day habilitation and for site based prevocational services sites established on and after September 1, 2016

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Any building or space purchased or leased for the purpose of the delivery of
				  day habilitation services or site based prevocational services through the home
				  and community-based services (HCBS) waiver shall be certified pursuant to the
				  requirements of section 16.05  of the Mental Hygiene Law.
(b) The requirements associated with the
				  Certification of Need (CON) application and approval process as set forth in
				  Part 620 of this Title shall be applicable to any day habilitation site or site
				  based prevocational services site for which an operating certificate will be
				  issued pursuant to this section.
(c) An operating certificate for such
				  building or space may only be issued to the entity that is also the authorized
				  provider (section
				  635-10.1[b] 
				  of this Part) of the HCBS waiver day habilitation services (see section
				  635-10.4[b][2] 
				  of this Part) or site based prevocational services (see section
				  635-10.4[k]) to be provided at the site.
(d)
				  The following physical plant requirements must be met for the certification of
				  day habilitation sites or site based prevocational services sites:
(1) The applicable nonresidential
				  environmental requirements found in this Subpart, sections
				  635-7.1
				  and
				  635-7.3.
(2) For purposes of the administration and
				  enforcement of the Uniform Code, or the Building Code of the City of New York,
				  by the authority having jurisdiction, the following occupancy classifications
				  shall apply to the specific site.
(i) If the
				  existing occupancy classification meets the intended use of the site, the
				  classification shall remain.
(ii)
				  Where the commissioner determines that the existing occupancy classification of
				  the premises does not meet the intended use for the services to be provided, or
				  the premises are not subject to an existing classification, the occupancy
				  classification to be applied shall be B (Business), outside of New York City,
				  and Classification E (Business) in the City of New York.
(3) Nothing herein precludes OPWDD from
				  requiring additional safety requirements based on the individualized safety
				  needs of the persons receiving services at the site.
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 635-9 - Provision of Required Supplies and services › Section 635-9.2 - Requirements for nonresidential facilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Principles of compliance.
(1) Nonresidential facilities shall assume
				  the cost of:
(i) Any item or service for
				  which local, State, or Federal funds are provided; or for which reimbursement
				  is made through a rate, fee, or grant-in-aid.
(ii) All staff personal service costs and
				  staff expenses incurred in the provision of services and activities which are
				  specified in a person's plan of service or are part of the facility's
				  recreational program.
(iii)
				  Physical plant maintenance and improvements.
(iv) All utilities including heat, light,
				  power, water and sewer.
(v) The
				  purchase, operation and/or maintenance of all equipment, furniture, or supplies
				  necessary to operate the facility in accordance with the regulations for the
				  class of facility or any other applicable regulations.
(vi) Special equipment necessary to meet the
				  developmental needs of persons at the facility.
(vii) Environmental adaptations made to the
				  facility to meet the needs of persons while there.
(viii) Any item required to meet treatment
				  needs at the facility as specified in a person's plan of services.
(ix) Damage caused by a person other than the
				  portion of the expense:
(a) Covered by
				  insurance.
(b) Received from a
				  person as part of a meaningful restitution process as devised by the program
				  planning team, approved in writing by the person's payee, if any, and approved
				  by a committee, or part thereof, charged with protecting the rights of the
				  person at the nonresidential facility.
(x) Nonresidential facilities providing day
				  treatment and day habilitation services shall assume the cost of service which:
(a) are necessary to meet the needs of
				  individuals while attending their programs; and
(b) prior to August 1, 2004 could have been
				  met by home health aide or personal care services separately billed to
				  Medicaid.
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 635-10 - Provision of Home and Community-Based Waiver Services › Section 635-10.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
				  contains requirements and specifications relative to the provision of home and
				  community-based services (HCBS) waiver as authorized by the Secretary of the
				  United States Department of Health and Human services pursuant to section
				  1915(c) of the Social Security Act (see glossary).
(b) All providers of home and community-based
				  waiver services shall be authorized pursuant to a Medicaid provider agreement
				  issued and approved by the New York State Department of Social services
				  specific to the type of services being offered.
(c) In addition, all authorized HCBS waiver
				  providers shall comply with the requirements of Parts 624 and 633 of this
				  Title.
(d) Also authorized pursuant
				  to the HCBS waiver referenced in subdivision (a) of this section, are community
				  residential habilitation services provided in OPWDD-certified community
				  residences pursuant to Part 671 of this Title.
(e) The allowable activities for waiver
				  community residential habilitation services provided in accordance with Part
				  671 of this Title are not subject to the provisions of section
				  635-10.4(b)(1) 
				  of this Subpart.
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 635-10 - Provision of Home and Community-Based Waiver Services › Section 635-10.2 - Intent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The intent of
				  home and community-based waiver services (hereinafter referred to a "HCBS
				  waiver services") is to create an individualized service environment (see
				  glossary). The purpose of the individualized service environment is to provide,
				  consistent with meeting the person's needs, preferences and personal goals, the
				  supports or services necessary to enable a person with a developmental
				  disability to live, work, socialize and participate in the community. Each
				  support or service is expected to contribute to the person's current or future
				  capacity for self- determination, integration with the community, independence
				  and productivity. Specific services and the intensity with which they are
				  delivered will be set forth in an individualized service plan (see glossary),
				  and will vary according to individual functional capacities, skill levels,
				  other supports available and the person's personal goals and desires.
(b) The availability of approved waiver
				  services is designed to allow Federal and State financing of options to meet
				  the programmatic and support needs of persons with developmental disabilities
				  as an alternative to placement in an institution (
i.e.,
ICF/IID) and to promote achievement of the goals of the individualized service
				  environment.
(c) Waiver services
				  are designed to facilitate the flexible arrangement of preferred and needed
				  services, individually tailored to the unique needs and personal goals of each
				  person approved for participation.
(d) Consistent with the provision of
				  community-based services, the delivery of one or more waiver services to an
				  approved participant is to be accompanied by case management services (see
				  section
				  635-10.4[a] 
				  of this Subpart) in order to ensure service coordination and the effective
				  management of care in accordance with the person's individualized service
				  plan.
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 635-10 - Provision of Home and Community-Based Waiver Services › Section 635-10.3 - Eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In order to be
				  approved for participation in the HCBS waiver, the person shall be approved by
				  OPWDD and in accordance with the forms and format approved by the
				  commissioner.
(b) The application
				  for participation approval shall document that the person:
(1) has a diagnosis of developmental
				  disability;
(2) is eligible for
				  ICF/IID level of care (i.e., placement in an ICF/IID);
(3) is an enrolled Medicaid recipient or is
				  eligible for enrollment;
(4)
				  exercised freedom of choice between receipt of waiver services or placement in
				  an ICF/IID;
(5) will reside in an
				  appropriate living arrangement (
i.e.,
their own home or that
				  of relatives, a supervised or supportive community residence, a certified
				  individualized residential alternative (per section
				  686.16 
				  of this Title), or in a certified family care home) at the time of enrollment.
				  A person may not reside in an ICF/IID, or if they have resided in an ICF/IID
				  (including a developmental center), be fully discharged from that setting prior
				  to receipt of HCBS waiver services; and
(6) has a demonstrated need for home and
				  community based waiver services as determined by OPWDD.
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 635-10 - Provision of Home and Community-Based Waiver Services › Section 635-10.5 - Reimbursement of HCBS waiver services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Plan of care support
				  services.
(1) Definitions applicable
				  to this subdivision.
(i)
Provider.
OPWDD or an authorized vendor of Medicaid service
				  coordination (MSC) (see Subpart 635-5 of this Part), which has also been
				  specifically authorized by OPWDD to deliver the HCBS waiver service known as
				  plan of care support services (PCSS).
(ii)
Eligible persons.
Those
				  persons meeting the criteria set forth at paragraph (2) of this
				  subdivision.
(iii)
Plan of
				  care support services
. Activities and assistance necessary to conduct
				  timely reviews and updates of a person's individualized service plan (ISP), to
				  maintain the documentation supporting the person's HCBS waiver level of care
				  eligibility determination and to meet the needs of the individual. PCSS shall
				  be provided during at least two months each year spaced at appropriate
				  intervals. For individuals who have not been enrolled in the HCBS waiver or in
				  MSC prior to receiving PCSS, PCSS may also include activities and assistance
				  necessary for initial service plan development and implementation.
(iv)
Qualified service
				  coordinator.
Someone who meets the requirements of either clause
				  (
a
) or (
b
) of this subparagraph:
(a) he or she:
(1) was providing OPWDD sponsored
				  comprehensive Medicaid case management or HCBS waiver service coordination on
				  2/29/00; and
(2) attends:
(i) 15 hours of professional development
				  annually for the first three years (starting from the date of hire);
				  and
(ii) 10 hours of professional
				  development annually after the first three years;
(b) he or she:
(1) has at least an associates degree, or
				  equivalent accredited college credit hours, in a health or human services field
				  or is a registered nurse;
(2) has
				  at least one year experience working with persons with developmental
				  disabilities or at least one year experience providing service coordination to
				  any population;
(3) completes an
				  OPWDD-approved core service coordination training program prior to providing
				  PCSS or within six months after the service coordinator begins to provide PCSS;
				  and
(4) attends:
(i) 15 hours of professional development
				  annually for the first three years (starting from the date of hire);
				  and
(ii) 10 hours of professional
				  development annually after the first three years.
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.1 - Applicability and definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Subpart
				  sets forth rules concerning:
(1) who can
				  enroll beneficiaries or individuals in:
(i) a
				  Medicare Part D prescription drug plan or in a Medicare advantage plan with
				  prescription drug coverage; or
(ii)
				  a Fully Integrated Duals Advantage Plan for Individuals with Intellectual and
				  Developmental Disabilities (FIDA-IDD) which is authorized to enroll individuals
				  with intellectual and/or developmental disabilities pursuant to section 364-j (27)(c)  of the
				  Social Services Law; and
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.3 - PDP enrollment and reviews for persons not residing in a residential facility or a family care home

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a person has
				  the ability to choose a PDP, the person may enroll himself or herself in a PDP
				  or appoint another party to enroll him or her. If a person has the ability to
				  act in the Part D review process, the person may act in the Part D review
				  process for himself or herself or appoint another party to act in the Part D
				  review process for him or her.
(b)
				  If a person lacks the ability to choose a PDP, but has a guardian lawfully
				  empowered to enroll him or her in a PDP, the guardian may enroll the person in
				  a PDP or appoint another party to enroll the person. If a person lacks the
				  ability to act in the Part D review process, but has a guardian lawfully
				  empowered to act in the Part D review process for the person, the guardian may
				  act in the Part D review process or appoint another party to act in the Part D
				  review process for the person.
(c)
				  If the person is a minor and does not have a guardian lawfully empowered to
				  enroll him or her in a PDP or to act in the Part D review process, a parent may
				  enroll the person or act in the Part D review process, or may appoint another
				  party to enroll the person or act in the Part D review process.
(d) In all other situations, or if any party
				  specified in subdivisions (a)-(c) of this section who would otherwise enroll
				  the person or act in the Part D review process is unwilling or unavailable, any
				  of the following parties may enroll the person, act in the Part D review
				  process or appoint another party to act in the Part D review process:
(1) an actively involved: spouse, parent,
				  adult child, adult sibling, adult family member or friend, an advocate or
				  correspondent; or
(2) if none of
				  the above are willing and available, the CEO (or designee) of the agency
				  providing service coordination for the person.
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.4 - FIDA-IDD enrollment and reviews for persons residing in a residential facility operated or certified by OPWDD or a family care home

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a person has
				  the ability to choose a FIDA-IDD plan, the person may enroll himself or herself
				  in a FIDA-IDD plan or appoint another party to enroll him or her. If a person
				  has the ability to act in the FIDA-IDD review process, the person may act in
				  the FIDA-IDD review process for himself or herself or appoint another party to
				  act in the FIDA-IDD review process for him or her.
(b) If a person lacks the ability to choose a
				  FIDA-IDD plan, but has a guardian lawfully empowered to enroll him or her in a
				  FIDA-IDD plan, the guardian may enroll the person in a FIDA-IDD plan or appoint
				  another party to enroll the person. If a person lacks the ability to act in the
				  FIDA-IDD review process, but has a guardian lawfully empowered to act in the
				  FIDA-IDD review process for that person, the guardian may act in the FIDA-IDD
				  review process or may appoint another party to act in the FIDA-IDD review
				  process for the person.
(c) If a
				  party specified in subdivisions (a) or (b) of this section who would otherwise
				  enroll the person or act in the FIDA-IDD review process is unwilling or
				  unavailable, then any of the following parties, in the order stated, may enroll
				  the person, act in the FIDA-IDD review process or appoint another party to act
				  in the FIDA-IDD review process:
(1) an
				  actively involved spouse;
(2) an
				  actively involved parent;
(3) an
				  actively involved adult child;
(4)
				  an actively involved adult sibling;
(5) an actively involved adult family
				  member;
(6) the Consumer Advisory
				  Board for the Willowbrook Class (only for class members it fully
				  represents).
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.5 - FIDA-IDD plan enrollment and reviews for persons not residing in a residential facility or a family care home

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a person has
				  the ability to choose a FIDA-IDD plan, the person may enroll himself or herself
				  in a FIDA-IDD plan or appoint another party to enroll him or her. If a person
				  has the ability to act in the FIDA-IDD review process, the person may act in
				  the FIDA-IDD review process for himself or herself or appoint another party to
				  act in the FIDA-IDD review process for him or her.
(b) If a person lacks the ability to choose a
				  FIDA-IDD plan, but has a guardian lawfully empowered to enroll him or her in a
				  FIDA-IDD plan, the guardian may enroll the person in a FIDA-IDD plan or appoint
				  another party to enroll the person. If a person lacks the ability to act in the
				  FIDA-IDD review process, but has a guardian lawfully empowered to act in the
				  FIDA-IDD review process for the person, the guardian may act in the FIDA-IDD
				  review process or appoint another party to act in the FIDA-IDD review process
				  for the person.
(c) In all other
				  situations, or if any party specified in subdivisions (a)-(c) of this section
				  who would otherwise enroll the person or act in the FIDA-IDD review process is
				  unwilling or unavailable, any of the following parties, in the order stated,
				  may enroll the person, act in the FIDA-IDD review process or appoint another
				  party to act in the FIDA-IDD review process:
(1) an actively involved spouse;
(2) an actively involved parent;
(3) an actively involved adult
				  child;
(4) an actively involved
				  adult sibling;
(5) an actively
				  involved adult family member;
(6)
				  the Consumer Advisory Board for the Willowbrook Class (only for class members
				  it fully represents).
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.6 - Other responsibilities and rights of agencies and sponsoring agencies regarding PDP enrollment and reviews

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No CEO,
				  officer, designee or employee of an agency or sponsoring agency shall solicit,
				  accept or receive from a PDP, pharmacy or contractor of a PDP or pharmacy, for
				  personal use or benefit (other than for the personal use or benefit of the
				  person being enrolled), any payment, discount or other remuneration in
				  consideration of, or as a result of, enrolling the person in a PDP.
(b) No CEO, officer, designee or employee of
				  an agency or sponsoring agency shall charge, accept or receive payment from the
				  person, family or anyone else for enrolling the person in a PDP, for providing
				  advice and assistance in choosing a PDP or for acting for the person in the
				  Part D review process.
(c) When a
				  CEO or designee is authorized to act by this section or appointed to act in the
				  Part D review process for a person, the CEO or designee may appoint a party
				  outside of the agency to act in the Part D review process for the
				  person.
(d) When a CEO or designee
				  enrolls a person he or she shall choose a PDP based on the best interests of
				  the person.
(e) Nothing in this
				  Subpart shall be deemed to diminish or remove the authority of a physician to
				  request a coverage determination or an expedited redetermination on behalf of a
				  beneficiary.
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.7 - Other responsibilities and rights of CEOs and DDSOO and DDRO directors or designees regarding FIDA-IDD plan enrollment and reviews

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No CEO or DDRO
				  or DDSOO director or designee shall solicit, accept or receive from a FIDA-IDD
				  plan operator, or an agent of the plan, for personal use or benefit (other than
				  for the personal use or benefit of the person being enrolled), any payment,
				  discount or other remuneration in consideration of, or as a result of,
				  enrolling the person in a FIDA-IDD plan.
(b) No CEO or DDRO or DDSOO director or
				  designee shall charge, accept or receive payment from the person, family or
				  anyone else for enrolling the person in a FIDA-IDD plan, for providing advice
				  and assistance in choosing a FIDA-IDD plan or for acting for the person in the
				  FIDA-IDD review process.
(c) When a
				  CEO or DDRO or DDSOO director or designee is authorized to act by this section
				  or appointed to act in the FIDA-IDD review process for a person, the director
				  or designee may appoint a party outside of the agency to act in the FIDA-IDD
				  review process for the person.
(d)
				  When a CEO or DDRO or DDSOO director or designee enrolls a person in a FIDA-IDD
				  plan or acts in the FIDA-IDD review process for a person he or she shall act
				  based on the best interests of the person.
(e) Nothing in this Subpart shall be deemed
				  to diminish or remove the authority of a physician to request a coverage
				  determination or an expedited redetermination on behalf of a
				  beneficiary.
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.8 - CCO enrollment and reviews for persons residing in a residential facility operated or certified by OPWDD or a family care home

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a person has
				  the ability to choose a CCO on his or her own, or with the assistance of
				  supported decision making, the person may:
(1) enroll himself or herself in a CCO
				  plan;
(2) act in the CCO review
				  process;
(3) disenroll himself or
				  herself from a CCO;
(4) appoint
				  another party to take actions on his or her behalf; or
(5) seek assistance with the above decisions
				  and actions.
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.9 - CCO enrollment and reviews for persons not residing in a residential facility or a family care home

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a person has
				  the ability to choose a CCO on his or her own, or with the assistance of
				  supported decision making, the person may:
(1) enroll himself or herself in a
				  CCO;
(2) act in the CCO review
				  process;
(3) disenroll himself or
				  herself from a CCO;
(4) appoint
				  another party to take actions on his or her behalf; or
(5) seek assistance with the above decisions
				  and actions.
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 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) › Section 635-11.10 - Other responsibilities and rights of CEOs and DDSOO and DDRO directors or designees regarding CCO enrollment and reviews

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No CEO or DDRO
				  or DDSOO director or designee shall solicit, accept or receive from a CCO or
				  Managed Care Plan operator, or an agent of the CCO or Managed Care Plan, for
				  personal use or benefit (other than for the personal use or benefit of the
				  person being enrolled), any payment, discount or other remuneration in
				  consideration of, or as a result of, enrolling the person in a CCO or Managed
				  Care Plan.
(b) No CEO or DDRO or
				  DDSOO director or designee shall charge, accept or receive payment from the
				  person, family or anyone else for enrolling the person in a CCO or Managed Care
				  Plan, for providing advice and assistance in choosing a CCO or Managed Care
				  Plan or for acting for the person in the CCO or Managed Care Plan review
				  process.
(c) When a CEO or DDRO or
				  DDSOO director or designee is authorized to act by this section or appointed to
				  act in the CCO or Managed Care Plan review process for a person, the director
				  or designee may appoint a party outside of the agency to act in the CCO or
				  Managed Care Plan review process for the person.
(d) When a CEO or DDRO or DDSOO director or
				  designee enrolls a person in a CCO or Managed Care Plan, disenrolls a person
				  from a CCO or Managed Care Plan, or acts in the CCO or Managed Care Plan review
				  process for a person he or she shall act based on the best interests of the
				  person, and shall fully document the reasons for such enrollment decision or
				  action.
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 635-12.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Subpart:
(a)
Full Medicaid coverage
means the type of coverage under the Medicaid program that pays for the
				  services requested or received.
(b)
HCBS waiver
means the home and community based services waiver
				  in effect from October 1, 2009 through September 30, 2014 for individuals with
				  developmental disabilities granted by the United States Department of Health
				  and Human services to New York State pursuant to section 1915(c) of the Social
				  Security Act, and any subsequent renewals of such waiver.
(c)
Liable party
means any
				  party other than a governmental entity who is legally liable to pay for
				  services pursuant to section 43.03  of the Mental Hygiene Law or any
				  other applicable provision of law.
(d)
Maintain full Medicaid
				  coverage
means taking all steps necessary to continue to receive full
				  Medicaid coverage, including, but not limited to, spending down income or
				  resources to meet the Medicaid eligibility level under section 366 (2)(a)  of the Social
				  Services Law.
(e)
Notice
				  date
means:
(1) March 15, 2009 for
				  ICF/DD services; the following HCBS waiver residential habilitation services:
				  community (in a community residence), IRA, and family care; and HCBS waiver day
				  habilitation services; or
(2) May
				  15, 2010 for Medicaid service coordination; day treatment services; the
				  following HCBS waiver services: at home residential habilitation services,
				  prevocational services, supported employment services, and respite services;
				  and blended services and comprehensive services.
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 635-12.2 - General provider obligations

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  This Subpart applies to all services, whether or not they are preexisting
				  services. However, a limited exception to the applicability of certain sections
				  of this Subpart has been made in the case of some individuals who are applying
				  for or receiving supported employment services or respite services (see section
				  635-12.12 
				  of this Subpart).
(b) Each provider
				  shall establish fee schedules for services it provides in accordance with
				  section
				  635-12.9 
				  of this Subpart.
(c) Each provider
				  shall have written policies/procedures in place to protect the privacy of
				  personal financial information concerning individuals requesting or receiving
				  services and other liable parties.
(1)
				  Providers shall designate staff who are authorized to obtain and access
				  personal financial information.
(2)
				  Providers may only disclose personal financial information obtained about the
				  individual and liable parties to entities as necessary for the individual to
				  obtain and maintain benefits and to OPWDD.
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 635-12.3 - Provider obligations for 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)
Disclosure of personal and
				  financial information.
(1) Prior to the
				  individual receiving services, the provider shall take such steps to obtain
				  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)
				  However, when individuals and/or other liable parties agree to pay the full fee
				  for the services, the provider is not required to obtain the information
				  specified in paragraph (1) of this subdivision. In these situations, the
				  provider may obtain such information at its discretion.
(3) The provider shall require that, during
				  the period that services are received, the individual and all other liable
				  parties 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.
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 635-12.4 - Provider obligations for preexisting services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This section applies only to preexisting
				  services.
(b)
Disclosure of
				  personal and financial information.
(1)
				  Prior to the notice date (see section
				  635-12.1 
				  of this Subpart) the provider shall take such steps to obtain personal and
				  financial information concerning individuals without full Medicaid coverage 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) However, when individuals or other liable
				  parties have agreed to pay the full fee for the services, the provider is not
				  required to obtain the information specified in paragraph (1) of this
				  subdivision. In these situations, the provider may obtain such information at
				  its discretion.
(3) The provider
				  may require that, during the period that an individual receives preexisting
				  services, the individual or liable party supply 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.
(4) The provider shall
				  require that, during the period an individual receives preexisting services,
				  the individual and other liable parties 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.
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 635-12.5 - Billing, collection and assignment of unpaid amounts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This section applies to all services,
				  whether or not they are preexisting services.
(b) If the individual does not have full
				  Medicaid coverage, the provider shall bill the individual and/or other liable
				  parties for the services in accordance with the applicable fee schedule in
				  section
				  635-12.9 
				  of this Subpart or with the reduced fee established by the provider with the
				  approval of OPWDD. However, if the fee has been waived by the provider with the
				  approval of OPWDD, the provider is not required to bill the individual or other
				  liable parties for the Service.
(c)
				  The provider must present the bill no later than 30 days after the month in
				  which the provider rendered the services.
(d) The provider shall make reasonable
				  efforts to collect unpaid bills.
(e) Collection efforts cannot interfere with
				  the individual's services.
(f)
				  After making reasonable collection efforts and upon consent of OPWDD, a
				  provider shall assign to OPWDD its claim for payment for any unpaid
				  amount.
(g) Any payments received
				  by the State for unpaid claims assigned pursuant to this section shall be paid
				  to the provider, minus any State funds paid to the provider pursuant to section
				  635-12.8  of this
				  Subpart.
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 635-12.8 - OPWDD payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Services other than preexisting services.
(1) OPWDD may, subject to the availability of
				  State funds, pay a provider for services given to an individual if:
(i) the individual is not now paying, and has
				  not paid in the past, the full fee for the services, and no one else is now
				  paying or has paid in the past the full fee for the services for the
				  individual; and
(ii) the individual
				  took all necessary steps to obtain and maintain full Medicaid coverage and was
				  denied full Medicaid coverage; and
(iii) the provider is meeting its obligations
				  under this Subpart; and
(iv) the
				  individual has an immediate need for services and delaying the start of the
				  services would endanger the individual's health or safety.
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 635-12.10 - Denial, discharge or discontinuation of services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Preexisting services.
A provider may not discharge an individual from preexisting
					 services or otherwise discontinue preexisting services to an individual because
					 of failure to pay.
(b)
Services other than preexisting services-denial of services.
(1) The provider may deny the request for
				  services:
(i) if the individual does not have
				  full Medicaid coverage; and
(ii) if
				  the provider has not received reasonable assurance that the individual or other
				  liable party will pay for the services in accordance with this Subpart;
				  and
(iii) if the fees have not been
				  waived.