reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.29 - Foster family care demonstration programs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Definitions.
(1) Foster family care is assistance with
			 personal hygiene, dressing, and feeding and the performance of tasks essential
			 to the maintenance of a foster family care recipient's health and safety within
			 a foster family care home which is ordered by a physician, provided in
			 accordance with a plan of care, and supervised by a registered professional
			 nurse.
(2) A foster family
			 caregiver is a person who provides the following services in his or her home to
			 one or two foster family care recipients pursuant to an admission agreement
			 with a sponsoring agency and the standards set forth in this section: room and
			 board; supervision of, or assistance with, activities of daily living; and
			 personal care and other related services which are necessary to maintain the
			 recipient in the community.
(3) A
			 foster family care demonstration program is a demonstration program the purpose
			 of which is to determine whether foster family care is an appropriate
			 alternative to institutional placement for elderly or disabled persons who lack
			 the homes, the resources, or the family support to live in the
			 community.
(4) A respite caregiver
			 is a person who provides foster family care for up to 21 days per year, as
			 determined by the sponsoring agency, as a substitute for a foster family
			 caregiver.
(5) A sponsoring agency
			 is a general hospital, a residential health care facility (RHCF), a certified
			 home health agency, a long-term home health care program, or a social services
			 district which administers a foster family care demonstration
			 program.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.30 - Chronic hemodialysis services in the home

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Provision of chronic hemodialysis in the
			 home shall be based on recommendation for such home treatment plan from a renal
			 dialysis center or renal dialysis facility and shall require prior approval of
			 the local professional director, except that treatment plans for individuals
			 participating in the kidney disease institute's home dialysis assistance
			 program shall not require prior approval by the local professional
			 director.
(b) Provision and
			 installation of a hemodialyzer and other durable medical equipment, supplies
			 and drugs needed in the home care treatment plan shall be subject to prior
			 approval requirements for these items, unless the items are provided through
			 the kidney disease institute's home dialysis assistance program.
(c) State reimbursement for physician
			 services, laboratory procedures, appliances and other items of care not
			 included in an all-inclusive facility rate shall be made in accordance with the
			 appropriate fee schedule.
(d)
			 Payment to the kidney disease institute for equipment, drugs and supplies
			 necessary to home care treatment shall be made in accordance with the actual or
			 invoice charge to the kidney disease institute but shall not exceed the amount
			 specified in the appropriate fee schedule. Payment and reimbursement for items
			 provided through the kidney disease institute shall be available for services
			 rendered on and after April 1, 1981.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.31 - Audiology, hearing aid services and products

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Definitions.
(1)
Hearing aid services
means services that are provided in compliance with article 37 of the General
			 Business Law. These services include the selecting, fitting and dispensing of
			 hearing aids, hearing aid checks following dispensing, and hearing aid repairs.
Hearing aid products
means hearing aids, earmolds, batteries,
			 special fittings and replacement parts.
(2)
Audiology services
mean
			 audiometric examinations or testing, hearing aid evaluations, conformity
			 evaluations and hearing aid prescriptions or recommendations if
			 indicated.
(3)
Qualified
			 audiologist
means an audiologist that is licensed and currently
			 registered to practice audiology in the State by the State Education
			 Department.
(4)
Qualified
			 hearing aid dealer
means any person, partnership, association or
			 corporation engaged in the selecting, fitting and dispensing of hearing aids
			 and currently registered in the State by the Department of State pursuant to
			 article 37-A, section 789  of the General Business Law.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.32 - Nurse practitioner services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Definitions.
(1) Nurse practitioner means an individual
			 who is licensed and currently registered as a professional nurse in the State
			 and who is certified under section 6910  of the Education Law as a nurse
			 practitioner.
(2) Nurse
			 practitioner services means the provision of services to a medical assistance
			 (MA) recipient which are in conformity with the provisions of sections 6902 and
			 6910  of the Education Law, regulations of
			 the Education Department and regulations of the Department of Health.
(3) Collaborating physician means a physician
			 who is not excluded from participation in either the MA or the Medicare
			 programs, with whom the nurse practitioner maintains practice agreements and
			 practice protocols in accordance with section 6902  of the Education Law.
(4) Practice agreements and practice
			 protocols means written documents meeting the requirements of section 6902  of the Education Law and 8 NYCRR
			 section 64.6 of the Education Department's regulations.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.33 - Personal emergency response services (PERS)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Definitions.
(1) Personal emergency response services
			 mean:
(i) the provision and maintenance of
			 electronic communication equipment in the home of an individual which signals a
			 monitoring agency for help when activated by the individual, or after a period
			 of time if a timer mechanism has not been reset; and
(ii) the continuous monitoring of such
			 signals by a trained operator and, in case of receipt of such signals, the
			 immediate notification of such emergency response organizations or persons, if
			 necessary, as the individual has previously specified.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.34 - Chronic care management demonstration programs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Definitions.
(1) A chronic care management demonstration
			 program (program) is a program authorized by chapter 653 of the Laws of 1984,
			 chapter 832 of the Laws of 1987 or chapter 530 of the Laws of 1988 that tests
			 cost-effective methods of coordinating the arrangement and provision of
			 services to persons who require chronic or long-term care and determines
			 whether such a program can effectively meet these persons' needs.
(2) Multi-disciplinary team is a group
			 comprising one or more physicians, nurses, social workers, therapists, home
			 health aides, nutritionists or such other health care professionals as
			 determined necessary by the program, that assesses a person's eligibility for
			 program enrollment and provides case management services to program
			 enrollees.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.35 - Assisted living programs

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Purpose and scope. This section sets forth requirements governing the provision
			 of, and payment for, assisted living program services to recipients of medical
			 assistance (MA).
(b) Policy. If an
			 MA recipient is eligible for and can be served appropriately and more
			 cost-effectively through the provision of assisted living program services and
			 such services are available, assisted living program services should be used to
			 achieve the maximum reduction in the recipient's need for home health services
			 or other long term care services.
(c) Definitions.
(1) Assisted living program means an entity,
			 as defined in section
			 485.2(s) 
			 and section
			 494.2(a) 
			 of this Title, which has been approved to operate as an assisted living program
			 in accordance with section
			 485.6(n) 
			 of this Title and is operated in accordance with Parts 485, 486, 487, 488 and
			 494 of this Title.
(2) Unless
			 otherwise defined, all terms have the meanings set forth in Part 494 of this
			 Title.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.37 - Collateral services

Current through Register Vol. 46, No. 28, July 10, 2024
Collateral services are services that would otherwise be
			   reimbursed as MA services and which are provided to a family member or
			   significant other of an MA recipient, regardless of their eligibility for MA,
			   who has an interim or final individualized family services plan. For purposes
			   of this section, a significant other is a person who substitutes for the
			   recipient's family, interacts regularly with the recipient, and affects
			   directly the recipient's developmental status. Collateral services are
			   physicians services, nursing services, nurse practitioner services, audiology
			   services, psychiatric services, psychological services, and rehabilitation
			   services. Payment is available for collateral services furnished pursuant to an
			   interim or final individualized family services plan and which are provided by
			   an approved early intervention program or a municipality in the State.
			   Collateral services must relate to the medical treatment specified in the
			   recipient's interim or final individualized family services plan and must be
			   for the recipient's direct benefit. Persons who receive collateral services
			   must be identified in the interim or final individualized family services plan.
			   Reimbursement for such services must be made in accordance with the provider
			   agreement.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.38 - Children's Behavioral Health and Health Services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Purpose: This section promotes the
			 expansion of health and behavioral health services for children/youth under 21
			 years of age. The New York State Department of Health (DOH), the New York State
			 Office of Mental Health (OMH), the New York State Office of Alcoholism and
			 Substance Abuse Services (OASAS), and the New York State Office of Children and
			 Family Services (OCFS) (the "State Agencies") shall designate licensed,
			 certified or approved providers to deliver specifically defined services under
			 the Medicaid program.
(b) Services:
			 The following services shall be available to children and youth who are
			 eligible for Medicaid, when provided in accordance with the provisions of this
			 section.
(1) Crisis Intervention (CI) CI
			 services are provided to a child/ youth under age 21, and his/her
			 family/caregiver, who is experiencing a psychiatric or substance use
			 (behavioral health) crisis, and are designed to:
(i) Interrupt and/or ameliorate the crisis
			 experience
(ii) Include an
			 assessment that is culturally and linguistically sensitive
(iii)  Result in immediate crisis resolution
			 and de-escalation
(iv) Develop a
			 crisis plan
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.39 - Applied Behavior Analysis

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Definitions.
(1) Applied Behavior Analysis or
			 "ABA,'' as defined in section eighty-eight hundred one of NYS education law,
			 means the design, implementation, and evaluation of environmental
			 modifications, using behavioral stimuli and consequences, to produce socially
			 significant improvement in human behavior, including the use of direct
			 observation, measurement, and functional analysis of the relationship between
			 environment and behavior.
(2) A
			 licensed behavior analyst is an individual licensed to practice applied
			 behavior analysis under article one hundred sixty-seven of the education
			 law.
(3) A certified behavior
			 analyst assistant is an individual certified under article one hundred
			 sixty-seven of NYS education law who provides ABA and works under the
			 supervision of a licensed behavior analyst.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 506 - Dental Care › Section 506.2 - Dental care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Dental care
			 in the medical assistance program shall include only preventive, prophylactic
			 and other routine dental care, services and supplies, and dental prosthetic and
			 orthodontic appliances required to alleviate a serious health condition
			 including one which affects employability.
(b) Definition of preventive, prophylactic
			 and other routine dental care, services and supplies. Preventive, prophylactic
			 and other routine dental care, services and supplies shall mean dental care,
			 services and supplies deemed essential to maintain an adequate level of dental
			 health and shall include but need not be limited to:
(1) dental services required for emergency
			 care and/or the relief of pain or acute infection;
(2) oral examination, including treatment
			 plan, if necessary;
(3) periapical,
			 bitewing, occlusal and extraoral radiographs, as required;
(4) oral prophylaxis, including cleaning,
			 supra and subgingival scaling, and polishing of teeth;
(5) subgingival curettage and root
			 planning;
(6) topical fluoride
			 applications for persons 13 years of age and under;
(7) restoration of carious permanent and
			 primary teeth with:
(i) silver
			 amalgam;
(ii) silicate
			 cement;
(iii) plastic materials;
			 or
(iv) stainless steel
			 crowns;
(8) pulpotomy
			 for permanent or primary teeth;
(9)
			 endodontic therapy for incisor or cuspid teeth;
(10) extraction of infected or nonrestorable
			 teeth; and
(11) repair of full or
			 partial dentures, recementing crowns and fixed bridges, or replacing facings on
			 bridges.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 506 - Dental Care › Section 506.3 - Authorization for dental services and supplies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Identification card as authorization. The
			 identification card issued to persons eligible for medical assistance shall
			 constitute full authorization for providing any of the following dental
			 services and supplies and no special or prior authorization shall be required
			 therefor:
(1) dental services required for
			 emergency care and/or the relief of pain or acute infection;
(2) oral examination, including treatment
			 plan, if necessary;
(3) periapical,
			 bitewing, occlusal and extraoral radiograps, as required;
(4) oral propylaxis, including cleaning,
			 supra and subgingival scaling and polishing of teeth;
(5) topical fluoride applications for persons
			 13 years of age and under;
(6)
			 restoration of carious permanent and primary teeth with:
(i) silver amalgam;
(ii) silicate cement;
(iii) plastic materials;
(iv) stainless steel crowns when supported by
			 adequate justification;
(7) pulpotomy for permanent or primary
			 teeth;
(8) endodontic therapy for
			 incisor or cuspid teeth; however, prior authorization shall be required if
			 complete endodontic therapy is required for more than one tooth, or if a crown
			 is required to supplement endodontic therapy on one or more teeth;
(9) extraction of infected or nonrestorable
			 teeth; however, prior authorization shall be required if one or more
			 extractions will require the construction of a dental prosthetic appliance to
			 alleviate a serious health condition or one which affects
			 employability;
(10) repair of full
			 or partial dentures, recementing crowns and fixed bridges, or replacing facings
			 on bridges.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 506 - Dental Care › Section 506.4 - Orthodontic care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Orthodontic
			 care shall be provided, in accordance with criteria and procedures set forth in
			 the Medicaid Dental Provider Manual at https://
			 www.emedny.org/ProviderManuals/Dental/index.aspx, only:
(1) for a person under 21 years of age with a
			 severe physically handicapping malocclusion, up to a maximum of three years of
			 active orthodontic care, plus one year of retention care, provided that
			 treatment was approved and active therapy begun prior to the person's 21st
			 birthday; or
(2) for a person 21
			 years of age or older, in connection with necessary surgical treatment (e.g.,
			 approved orthognathic surgery, reconstructive surgery or cleft palate
			 treatment).
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 506 - Dental Care › Section 506.5 - Utilization review

Current through Register Vol. 46, No. 28, July 10, 2024
(a)  Part 511 of
			 this Title authorizes the department to establish a system for utilization
			 review for specific provider types, including dental services and supplies.
			 Part 511 also describes the services and procedures excluded from the
			 utilization review for all provider service types.
(b) General rule. The department will pay for
			 up to three dental service encounters in a benefit year. For purposes of this
			 section, each discrete visit to a dentist or to a dental clinic is one
			 encounter, regardless of the number of services provided or procedures
			 performed during the visit.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 507 - Health Supervision And Medical Care For Children › Section 507.2 - Special assessments, examinations and tests required for children in foster care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Assessment
			 of each child in foster care for risk factors related to HIV infection.
(1) Each child placed in foster care must be
			 assessed for risk factors related to HIV infection in accordance with section
			 441.22(b) 
			 of this Title as follows:
(i) Each child
			 entering foster care on or after September 1, 1995, must be assessed for risk
			 factors related to HIV infection within five business days of entry into care
			 if it is determined within five business days of entry into care that there is
			 no possibility that the child has capacity to consent to HIV-related testing,
			 or within 30 business days of entry into care if it is determined within five
			 business days of entry into care that there may be a possibility that the child
			 has capacity to consent to HIV-related testing.
(ii) Each child who entered foster care prior
			 to September 1, 1995, must be assessed for risk factors related to HIV
			 infection within 60 business days of the next periodic medical examination
			 required for the child according to the schedule for periodic medical
			 examinations provided in section
			 441.22(f) 
			 of this Title or within 60 business days of the child's next service plan
			 review date, whichever occurs sooner.
(iii) In addition, each service plan review
			 of a child and each periodic medical examination of a child required pursuant
			 to section
			 441.22(f) 
			 of this Title that occurs after the initial assessment of the child for risk
			 factors related to HIV infection must include an assessment of whether
			 HIV-related testing of the child is recommended based on the child's medical
			 history and any available information regarding the child obtained since the
			 initial assessment of the child, the prior service plan review of the child or
			 the prior periodic medical examination of the child, as applicable.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 507 - Health Supervision And Medical Care For Children › Section 507.3 - Payment for health supervision and care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Medical services.
(1) Fee schedules. The fee schedules of the
			 department shall prevail for purposes of reimbursement in accord with the
			 policies of the department.
(2)
			 Pediatric care. When children are placed under the care of a qualified
			 pediatrician for child health supervision and regular medical care, that
			 pediatrician shall be considered to be the personal physician to that child.
			 His fees shall be governed by the fee schedule.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 507 - Health Supervision And Medical Care For Children › Section 507.4 - Medical rehabilitation and mental health

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Medical rehabilitation. Children with
			 handicapping physical defects, including physically handicapping malocclusion,
			 the nature of which may make them eligible for care under the physically
			 handicapped children's program of the State Department of Health shall be
			 referred promptly to the local medical rehabilitation director for
			 determination of medical eligibility for such program. If a child is determined
			 to be medically eligible therefor, the local social services official shall
			 determine financial eligibility for medical assistance. If the case is
			 determined to be fully eligible financially for medical assistance, the medical
			 services shall be authorized by the local social services official and payments
			 for such services shall be made in full from medical assistance funds. If,
			 however, the social services official determines that the case is not fully
			 eligible financially and that the child's parents are required to contribute
			 toward the cost of his care under medical assistance eligibility standards, the
			 case shall be referred for payment for that care to the physically handicapped
			 children's program.
(b) Mental
			 health. Utilization of available child guidance or mental health clinics, or
			 other suitable resources, shall be arranged as indicated for children with
			 evidence of emotional disturbance or behavior disorder.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 507 - Health Supervision And Medical Care For Children › Section 507.5 - Emergency medical treatment for children in foster care

Current through Register Vol. 46, No. 28, July 10, 2024
Social services officials shall establish a procedure
			   under which an immediate determination as to permission for emergency medical
			   treatment will be sought from the person having custody of a child for each
			   child for whom a district provides or purchases foster care; immediate
			   determinations will be sought when emergency medical treatment is necessary and
			   the provider of medical services requires a consent. Each local social services
			   department shall assure that:
(a)
			 procedures are developed and implemented for receiving requests for consent,
			 and obtaining prompt consent, at any hour of the day or night;
(b) foster parents are fully informed of
			 those procedures at the time of placement; and
(c) consents are promptly made available to
			 the provider.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.0 - Scope

Current through Register Vol. 46, No. 28, July 10, 2024
This Part describes the Child/Teen Health Plan (C/THP),
			   the eligibility criteria for providers and recipients of C/THP services, the
			   requirements of a C/THP examination and the responsibility of the C/THP
			   provider in fulfilling those requirements, and the reimbursement
			   provisions.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Part:
(a) Child/Teen Health Plan(C/THP), formerly
			 known as the Child Health Assurance Program (CHAP), means a program established
			 and administered by local social services districts which is directed toward
			 assisting eligible persons to receive ongoing primary and preventive health
			 care in order to discover any physical and mental problems and to provide
			 treatment to correct or ameliorate such problems or chronic conditions through
			 the provision of the following services:
(1)
			 early and periodic screening and diagnosis of eligible persons are regularly
			 scheduled examinations and evaluations of the general physical and mental
			 health, growth development and nutritional status of infants, children and
			 youth. At a minimum, early and periodic screening and diagnosis must include,
			 but is not limited to, the development of a comprehensive health and
			 developmental history, a comprehensive unclothed physical examination, an
			 appropriate vision and hearing test, appropriate laboratory tests and dental
			 screening services furnished by direct referral to a dentist for children
			 beginning at three years of age, as described in section
			 508.8 
			 of this Part;
(2) inter-periodic
			 screens; and
(3) treatment or
			 referral for treatment for conditions including, but not limited to, defects in
			 vision and hearing, including eyeglasses and hearing aids, dental care needed
			 for the relief of pain and infections, restoration of teeth and maintenance of
			 dental health, and appropriate immunizations, as described in section
			 508.8 
			 of this Part.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.2 - General policy

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each local
			 social services district will establish and administer a C/THP for its
			 district, directly or through a contract, in accordance with a plan submitted
			 to and approved by the department. Revisions or amendments to the district's
			 initial C/THP plan must be submitted in writing to the department for approval.
			 Revisions must be approved by the department prior to being
			 implemented.
(b) Each local social
			 services district must assemble an outreach advisory council which will meet at
			 least annually to develop and monitor a plan for increasing the number of
			 eligible persons participating in C/THP. The council must include providers of
			 medical services, consumers, advocates, and representatives of local health
			 departments, and must report to the State Commissioner of Social Services
			 annually on the character and effectiveness of local outreach initiatives. The
			 first report should be submitted no later than 12 months from the effective
			 date of this Part [May 16, 1988].
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.3 - Identification of persons eligible for C/THP services

Current through Register Vol. 46, No. 28, July 10, 2024
Each local social services district will maintain a
			   system which would enable the district to monitor the status of each person
			   participating in the C/THP, and which would enable the district to identify
			   persons who are eligible to participate in the C/THP.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.4 - Informing persons eligible for C/THP services about C/THP

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each local
			 social services district must inform each household with children or a person
			 or persons having legal custody of a child eligible for C/THP services, in
			 writing, of the availability of C/THP services no later than 60 days following:
(1) the date initial eligibility for C/THP is
			 determined;
(2) the date
			 eligibility is determined after a 12-month or longer period of ineligibility;
			 or
(3) the date a person eligible
			 for C/THP services is added to a case. All persons eligible for C/THP services
			 must be informed in writing at least annually after eligibility is determined
			 of the availability of C/THP services.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.5 - Provision of C/THP services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 All persons eligible for C/THP services requesting examinations, diagnosis and
			 treatment under C/THP will be given the names and locations of providers
			 offering such services and will be informed that assistance is available for
			 scheduling appointments with those providers if such assistance is requested,
			 and that assistance with transportation services is available under the medical
			 assistance program if such assistance is requested.
(b) The initial C/THP examinations must be
			 provided within 90 days, a dental visit must be provided within 120 days, and
			 initiation of treatment for identified medical or physical conditions must be
			 provided within six months of the date of the request for services or of the
			 date eligibility is determined if the request for services is made prior to a
			 determination of eligibility.
(c)
			 The local social services district must offer C/THP services to households
			 containing children whose names appear on the State semiannual outreach report
			 described in section
			 508.10(b) 
			 of this Part.
(d) The local social
			 services district is not required to provide a C/THP examination to a person
			 eligible for C/THP services if there exists written verification from the
			 department, or from a provider authorized to provide services under the C/THP,
			 which indicates that the most recent age-appropriate screening services due
			 under the periodicity schedule contained in section
			 508.8 
			 of this Part have already been provided to the person eligible for C/THP
			 services.
(e) For children three
			 years of age and over, dental services must be furnished by a direct referral
			 to a dentist for diagnosis and treatment.
(f) If medical or dental services which are
			 needed as a result of conditions discovered during screening and treatment are
			 not covered by the medical assistance program, the local social services
			 district must provide referral assistance for these services.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.6 - Identification of available providers

Current through Register Vol. 46, No. 28, July 10, 2024
Each local social services district will identify and
			   maintain a list of the following:
(a)
			 Medicaid providers enrolled as C/THP providers who have agreed to perform the
			 components of the C/THP examination according to the C/THP periodicity
			 schedule;
(b) diagnostic and
			 treatment facilities;
(c) providers
			 of dental services;
(d) providers
			 of prenatal care;
(e) providers of
			 family planning services;
(f)
			 hospital outpatient departments; and
(g) free-standing clinics.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.7 - Agreements with providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To
			 assure maximum utilization of existing screening, diagnostic and treatment
			 services, each local social services district may enter into written agreements
			 for the provision of services under the C/THP with physicians or appropriate
			 public, voluntary and proprietary agencies, such as child health clinics,
			 neighborhood health centers, free-standing clinics, hospital outpatient
			 departments or similar facilities that provide ambulatory pediatric
			 care.
(b)
(1) Every facility subject to article 28 of
			 the Public Health Law must provide the examinations and services identified in
			 section
			 508.8(b) 
			 of this Part to persons eligible for C/THP services if such examinations and
			 services are provided to outpatients as well-child care services for which the
			 facility receives reimbursement under the medical assistance program.
(2) Facilities subject to the provisions of
			 paragraph (1) of this subdivision must provide the examination and services
			 identified in section
			 508.8(b) 
			 of this Part in accordance with the periodicity schedule contained in
			 subdivision (f) of such section, and must claim reimbursement for such
			 examinations and services under the C/THP.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.8 - Standards and periodicity

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Provision of care and services.
The periodicity schedule contained in this section and
			   the contents of the C/THP examination generally follow those recommended by the
			   Committee on Standards of Child Health of the American Academy of Pediatrics.
			   Appropriate modifications in the content of the examination can be made
			   according to the attending physician's medical judgment, consistent with the
			   needs of the individual child and current recommended standards of medical
			   practice.
(b)
Contents of an examination.
Every C/THP examination should include the following as
			   appropriate by age:
(1) Comprehensive
			 health history.
(i)
(a) For a new patient, a complete family
			 history, social history, past medical history, and review of body systems must
			 be obtained and recorded.
(b) When
			 obtaining the comprehensive health history of children five years of age or
			 younger, the history must include details of pregnancy, delivery, birth weight
			 and the neonatal period.
(c) When
			 obtaining the comprehensive health history of adolescents, a review of the body
			 systems should also include a history of sexual activity and use of
			 contraception and a menstrual history for females.
(d) For patients whose initial histories have
			 already been recorded by the C/THP provider, the family, social and medical
			 histories may be confined to the period since the histories were last
			 recorded.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.9 - Coordination with related programs

Current through Register Vol. 46, No. 28, July 10, 2024
Each local social services district must access other
			   related programs, such as those funded under titles V and XX of the Social
			   Security Act, title X of the Public Health Service Act and head-start programs
			   authorized by the Community Services and Partnership Act of 1974 ( P.L. 93-644
			 ) to ensure an effective child health program.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.10 - Forms and reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Local
			 social services officials and/or providers must, in reporting services
			 provided, claiming reimbursement for the services provided, tracking the
			 services provided and verifying receipt of services, use forms and reports
			 approved by the department.
(b) The
			 department will issue to each social services district a semiannual outreach
			 report that lists persons eligible for C/THP services residing in that district
			 who are identified as requiring the offer of C/THP services. Local social
			 services officials must report on a semiannual outreach report form the results
			 of contacts with persons eligible for C/THP services identified on the
			 semiannual outreach report. Such form must be submitted to the department in
			 accordance with instructions issued by the department.
(c) Local social services officials should
			 use the C/THP exam and referrals report prepared by the department to update
			 C/THP histories of C/THP recipients, to assist in conducting C/THP interviews
			 and to determine the success of outreach activities.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.11 - Payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Examinations
			 performed in accordance with section
			 508.8 
			 of this Part by providers who are certified under article 28 of the Public
			 Health Law will be reimbursed at the clinic rate established pursuant to such
			 article. Reimbursement will be based upon a complete examination performed
			 according to the periodicity schedule. The appropriate rate code identifying
			 the C/THP examination must be used on the claim form. Clinics billing for C/THP
			 examinations should use specialty code 908 and rate code 3110R on claims
			 submitted to the department.
(b)
			 Except for examinations covered under subdivision (a) of this section, the
			 reimbursable fees for services performed under the C/THP will be those
			 established by the State Department of Health and approved by the Division of
			 the Budget. The C/THP fee for a private physician will be based upon a complete
			 physical examination performed according to the periodicity schedule. Services
			 performed during a C/THP examination or as a follow-up to that examination
			 which are not part of the examination fee, such as immunizations, urinalysis,
			 and pure-tone conduction screening, are eligible for separate reimbursement on
			 a fee-for-service basis. These services should be billed on the same claim form
			 as the C/THP examination. In addition to the C/THP examination, children are
			 eligible to receive all the care and services available under the State medical
			 assistance program. However, only visits rendered in accordance with the
			 recommended C/THP periodicity schedule can be billed as a C/THP exam.
(c) If the child is brought back to complete
			 a component of the examination, a second visit fee or rate cannot be claimed
			 for reimbursement under the medical assistance program. Providers certified
			 pursuant to the provisions of article 28 of the Public Health Law cannot claim
			 an additional fee to complete a component of the previous C/THP examination,
			 regardless of the date of service. However, private physicians are eligible to
			 seek reimbursement for ancillary services (e.g., Mantoux test, immunizations)
			 on a fee-for-service basis, regardless of date of service.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 508 - Child/teen Health Plan (c/thp) › Section 508.12 - Continuing care providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Continuing care providers must provide at least the following services to
			 persons eligible for C/THP services formally enrolled with the provider:
(1) screening, diagnosis and treatment, and
			 follow-up services in accordance with C/THP standards contained in section
			 508.8 
			 of this Part;
(2) maintenance of a
			 comprehensive health history, including information received from other medical
			 or dental providers;
(3) direct
			 provision of, or referral for, medically necessary services;
(4) direct provision of, or referral for,
			 dental services, or referral to the local social services district for such
			 services;
(5) assistance with
			 transportation and/or scheduling assistance for medical or dental services, or
			 referral to the local social services district for such services; and
(6) physician's services as needed by the
			 recipient for acute, episodic or chronic illnesses or conditions.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 509 - Tuberculosis Care › Section 509.1 - Responsibilities of official welfare agencies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Local welfare districts are responsible
			 for providing home medical care for tuberculosis patients who are eligible
			 recipients of medical assistance.
(b) The local welfare district shall
			 ascertain that all recipients with tuberculosis are known to the local official
			 health agency.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 509 - Tuberculosis Care › Section 509.2 - General policies and standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Medical care for tuberculous persons at home shall include, unless otherwise
			 available through public health agencies, all necessary medical services such
			 as public health nursing supervision and treatment through clinics, provided
			 overnight stay is not involved.
(b)
			 Patients with active tuberculosis may not be placed in private nursing homes
			 (general type) or public home infirmaries.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 509 - Tuberculosis Care › Section 509.3 - Renumbered

Current through Register Vol. 46, No. 28, July 10, 2024