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 D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.3 - Proposed statement of charges

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In an appropriate case, the department
		    may commence an administrative action against an operator or respond to a
		    request for a hearing made by an operator, by delivering a proposed statement
		    of charges, in person or by certified mail, return receipt requested, to the
		    operator.
(b) The proposed
		    statement of charges must contain:
(1) a list
		    of witnesses whom the department intends to present and a statement indicating
		    the substance of their anticipated testimony;
(2) notification that the operator has the
		    opportunity to review all inspection reports and any other documents, such as
		    letters, charts, graphs and photographs upon which the department based its
		    decision, at the appropriate regional office of the department during normal
		    business hours; and
(3) a demand
		    that the operator provide the department with a written response to the
		    charges, either hand-delivered or postmarked within 30 days after the receipt
		    of the proposed statement of charges. The department also must inform the
		    operator that failure to comply with the provisions of section
		    493.4  of this
		    Part may preclude the possibility of settlement.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.4 - Response

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If in response
		    to the proposed statement of charges the operator wishes to attempt to settle
		    an action with the department, the operator must file a written response to the
		    proposed statement of charges with the department's counsel's office in Albany.
		    The written response must be either hand-delivered during normal business hours
		    within, or if mailed, postmarked no more than 30 days after the receipt of the
		    proposed statement of charges. The response must:
(1) specifically admit or deny each
		    charge;
(2) set forth with
		    particularity the operator's position with respect to each charge which is
		    denied. The operator must state the legal and factual basis for denying the
		    charge, and must submit copies of all documents, such as letters, charts,
		    graphs and photographs in support of the operator's position; and
(3) list the witnesses whom the operator
		    intends to present and a statement indicating the substance of their
		    anticipated testimony.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.5 - Joinder

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The department
		    may combine into a single hearing any of the actions for which a hearing may be
		    held pursuant to this Part.
(b) The
		    department may join in one action all operators against whom there is asserted
		    jointly, severally or in the alternative any violation arising out of the same
		    transaction or occurrence, and if there is a question of law or fact common to
		    all operators which will arise in the action.
(c) The determination of whether to combine
		    actions or join separate operators is wholly within the departments'
		    discretion.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.7 - Answer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The operator
		    must file a written answer to any factual allegation or point of law in the
		    statement of charges which is contained in the notice of hearing, by either
		    hand delivering the answer to the department's counsel's office in Albany
		    during normal business hours, or mailing the answer, so that it is received by
		    the department's counsel's office in Albany within the following time limits:
(1) The answer must be received by the
		    department no less than five days before the scheduled hearing date in an
		    action to assess a civil penalty against the operator of a facility who does
		    not possess a valid operating certificate issued pursuant to section 460-d (9)  of the Social
		    Services Law.
(2) The answer must
		    be received by the department no less than 10 days before the scheduled hearing
		    date in an action to assess a civil penalty against the operator of a facility
		    for failing to operate a facility in compliance with this Title or section 460-d (7)  of the Social
		    Services Law, or in an action to revoke, suspend or limit an operating
		    certificate pursuant to section 460-d (4)(b)  of the Social
		    Services Law.
(3) The answer must
		    be either hand-delivered or, if mailed, postmarked no less than 15 days before
		    the scheduled hearing date in an action to review the denial of an application
		    for, or renewal of, an operating certificate under section
		    493.2(c) 
		    of this Part, or in an action to modify an operating certificate pursuant to
		    section 461-b (7)  of the Social
		    Services Law.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.8 - Expedited hearings

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
		    Whenever the department finds that an operator is causing or failing to prevent
		    a condition which constitutes a danger to the physical or mental health of the
		    residents of a facility, and it appears contrary to the interests of the
		    residents to delay action pending a hearing, the commissioner or the
		    commissioner's designee may:
(1) order the
		    operator, by written notice which sets forth the basis for such finding, to
		    discontinue immediately such dangerous condition or activity or take certain
		    action immediately or within a specified period of time, not to exceed 30 days,
		    which will correct such condition or activity; or
(2) temporarily suspend the operating
		    certificate and order the removal of all residents from the facility pending
		    the issuance of a hearing decision under this Part.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.9 - Who may be present at hearing; authorized representative

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The operator, the operator's
		    representative or representatives, the operator's counsel, counsel for or other
		    representatives of the department, witnesses of both parties, any person who
		    may be called by the hearing officer and any other person, including members of
		    the media, may be present at the hearing. Upon his or her own motion, or upon
		    the motion of either party, the hearing officer may exclude the general public,
		    including members of the media. Such exclusion may only be made for compelling
		    reasons, such as ensuring the orderly conduct of the hearing, and may only be
		    made after the person or persons to be excluded have an opportunity to be
		    heard. Upon his or her own motion, or upon the motion of either party, the
		    hearing officer may exclude potential witnesses from the hearing during the
		    testimony of other witnesses.
(b)
		    An operator may be represented at a hearing by an attorney or by someone who is
		    not an attorney if that individual has written authorization from the operator.
		    The authorization must be submitted to the hearing officer and become part of
		    the record.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.11 - Removal of the hearing officer

Current through Register Vol. 46, No. 28, July 10, 2024
A party to a hearing may make a request to a hearing
			 officer that the hearing officer remove himself or herself from presiding at
			 the hearing.
(a) The grounds for
		    removing a hearing officer are that the hearing officer has:
(1) previously dealt in any way with the
		    substance of the matter which is the subject of the hearing except in the
		    capacity of hearing officer;
(2)
		    any interest in the matter, financial or otherwise, direct or indirect, which
		    will impair the independent judgment of the hearing officer; or
(3) displayed bias or partiality to any party
		    to the hearing.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.12 - The record

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The record
		    will include:
(1) all notices, pleadings and
		    intermediate rulings;
(2) the
		    transcript or recordings of the hearing;
(3) exhibits received into
		    evidence;
(4) matters officially
		    noticed; and
(5) the findings of
		    fact, conclusions of law and recommended decision of the hearing
		    officer.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.13 - Decision after hearing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
		    hearing decision must be issued by the commissioner or by the commissioner's
		    designee and must be based exclusively on the record of the hearing. The
		    decision must be in writing and must set forth the hearing issues, the relevant
		    facts, and the pertinent provisions of law and department regulations, make
		    appropriate findings, determine the issues, state reasons for the determination
		    and, when appropriate, direct specific action.
(b) A copy of the decision will be sent to
		    the operator and to the operator's representatives, if any.
(c) In the event the decision is adverse to
		    the operator, a copy of the decision will be sent together with a notice of the
		    right to judicial review in accordance with the provisions of article 78 of the
		    Civil Practice Law and Rules.
(d)
		    The hearing decision will be issued as soon as practicable but in no event more
		    than 90 days after the conclusion of the hearing.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 493 - Hearing Procedure: Residential Care Programs For Adults › Section 493.14 - Examination of the record after hearing

Current through Register Vol. 46, No. 28, July 10, 2024
Upon reasonable notice to the department, the hearing
			 record may be examined at the department's offices in Albany during regular
			 business hours.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
		    applies to assisted living programs as defined herein.
(b) Unless expressly provided otherwise in
		    this Part, an assisted living program is subject to any other Federal, State
		    and local laws, rules or regulations governing adult care facilities, long-term
		    home health care programs, certified home health agencies, licensed home care
		    agencies or personal care services.
(c) Notwithstanding the applicability of the
		    requirements in Parts 485, 486, 487 and 488 of this Title, for the purposes of
		    the assisted living program, the requirements of this Part supersede any
		    conflicting or contradictory rule or regulation governing adult care
		    facilities.
(d) The department and
		    the Department of Health will periodically review the respective requirements
		    of each agency for recordkeeping and reporting applicable to the operation of
		    an assisted living program and will make coordinated efforts to eliminate or
		    minimize inconsistent or duplicative requirements.
(e) This Part will not apply to any housing
		    projects established pursuant to the Private Housing Finance Law, the Public
		    Housing Law, the former Membership Corporations Law or the Not-for-Profit
		    Corporation Law, except for those distinct programs operated by such projects
		    which provide assisted living programs which are approved and certified by the
		    department.
(f) Any person,
		    partnership, corporation, organization, agency, government unit or other entity
		    which operates an assisted living program is subject to the jurisdiction of the
		    department, and must comply with this Part or cease operating such
		    program.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Assisted living
		    program means an entity which is approved to operate pursuant to section
		    485.6(n) 
		    of this Title, and which is established and operated for the purpose of
		    providing long-term residential care, room, board, housekeeping, personal care,
		    supervision, and providing or arranging for home health services to five or
		    more eligible adults unrelated to the operator.
(b) Capitated rate of payment means the rate
		    established annually by the Commissioner of the Department of Health for
		    services provided or arranged by the assisted living program in accordance with
		    section 3614 (6)  of the Public
		    Health Law.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.3 - General provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
		    operator of an assisted living program must provide, through its employees and
		    agents, an organized, 24-hour-a-day program of supervision, care and services
		    which:
(1) meets the standards set forth in
		    this Part;
(2) assures the
		    protection of resident rights; and
(3) promotes the social, physical and mental
		    well-being of the residents.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.4 - Admission and retention standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An operator must admit, retain and care
		    for only those individuals who do not require services beyond those the
		    operator is permitted by law and regulation to provide.
(b) An operator shall not exclude an
		    individual on the sole basis that such individual is a person who primarily
		    uses a wheelchair for mobility, and shall make reasonable accommodations to the
		    extent necessary to admit such individuals, consistent with the Americans with
		    Disabilities Act of 1990,  42 U.S.C. 12101  et seq. and with the provisions of
		    this section.
(c) Appropriate
		    services must be provided to or arranged for an eligible individual only in
		    accordance with a plan of care which is based upon an initial assessment and
		    periodic reassessments conducted by an assisted living program, or if the
		    assisted living program itself is not an approved long-term home health care
		    program or certified home health agency, by an assisted living program and a
		    long-term home health care program or certified home health agency.
(d) An assisted living program may care only
		    for a person who:
(1) is medically eligible
		    for, and would otherwise require placement in, a residential health care
		    facility due to the lack of a home or a suitable home environment in which to
		    live and safely receive services;
(2) requires more care and services to meet
		    daily health or functional needs than can be provided directly by an adult care
		    facility;
(3) exhibits a stable
		    medical condition as categorized by the long-term care patient classification
		    system as defined in Title 10 NYCRR;
(4) is able, with direction, to take action
		    sufficient to assure self-preservation in an emergency; and
(5) voluntarily chooses to participate in an
		    assisted living program after being provided with sufficient information to
		    make an informed choice.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.5 - Resident services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
		    operator is responsible for providing or arranging for resident services which
		    must include, at a minimum: room, board, housekeeping, supervision, personal
		    care, case management activities and home health services.
(b) Services included in the medical
		    assistance capitated rate are:
(1) personal
		    care services which are reimbursable under title XIX of the Federal Social
		    Security Act;
(2) home health aide
		    services;
(3) personal emergency
		    response services;
(4) nursing
		    services;
(5) physical
		    therapy;
(6) occupational
		    therapy;
(7) speech
		    therapy;
(8) medical supplies and
		    equipment not requiring prior authorization; and
(9) adult day health care in a program
		    approved by the Commissioner of Health.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.6 - Personnel

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General
		    requirements.
(1) The operator must provide
		    staff sufficient in number and qualified by training and experience to render,
		    at a minimum, those services mandated by statute or regulation.
(2) The operator must designate an individual
		    to be responsible for operating the program in compliance with applicable
		    regulations and executing through direct performance or coordination, the
		    services and functions specified in section
		    494.5  of this
		    Part. The designated individual must, at a minimum, either:
(i) meet the applicable training and
		    experience requirements for an approved adult home administrator or enriched
		    housing coordinator; or
(ii) be an
		    approved director of the home health care program.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter D - Adult-Care Facilities › Part 494 - Assisted Living Program › Section 494.7 - Environmental standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
		    operator of an assisted living program must comply with the following standards
		    in addition to the applicable standards contained in sections
		    487.11
		    and
		    488.11  of
		    this Title.
(b) Space must be
		    provided for the administrative activities and records associated with the
		    provision of home care services and to accommodate the care needs of
		    residents.
(c) In a building used
		    by an adult home or enriched housing program operator for an approved assisted
		    living program where residents share all space other than bedrooms:
(1) A supervised smoke detection system,
		    which is listed by an acceptable testing laboratory, must be installed in the
		    following locations:
(i) in each corridor at
		    least every 40 feet on center, or less if required by the
		    manufacturer;
(ii) at the top of
		    all stairways, elevators and hoistways and other unsealed shafts; and
(iii) in attics, basements and open floor
		    areas designated for public or resident use, at least one detector for each
		    1,000 square feet of open or unpartitioned space.
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 1 - General › Part 500 - General Provisions › Section 500.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Medical care
			 which may be provided under the medical assistance program, as authorized by
			 title 11 of article five of the Social Services Law, consists of the care,
			 services and supplies enumerated therein, together with any other care,
			 services or supplies authorized to be provided by these regulations and
			 furnished in accordance with these regulations, sound medical practice and the
			 rules and regulations of the state board or body supervising the respective
			 professions.
(b) The department
			 will limit the amount, duration and scope of medical assistance authorized to
			 be provided under the Social Services Law and this Title to medical care,
			 services and supplies which are medically necessary and appropriate, consistent
			 with quality care and generally accepted professional standards.
(c) The department will employ methods and
			 procedures to deter unnecessary utilization of medical care, services and
			 supplies reimbursed under the medical assistance program including, but not
			 limited to, requiring prior authorization or prior approval of medical care,
			 services and supplies and the use of utilization controls, recipient
			 restrictions, utilization thresholds, and service limits.
(d) The department will employ such methods
			 and procedures as are necessary to ensure the proper and efficient operation
			 and administration of the medical assistance program and the delivery of
			 medically necessary and appropriate care, services and supplies to medical
			 assistance recipients.
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 1 - General › Part 500 - General Provisions › Section 500.2 - How provided

Current through Register Vol. 46, No. 28, July 10, 2024
[Additional statutory authority: N.Y. Const., art. XVII,
			   2; Social Security Law, § 17]
(a)
			 Medical care as herein defined shall be provided by social services officials
			 in accordance with regulations of the department, which shall require full and
			 proper use of existing public and private medical and health
			 services.
(b) Such medical care may
			 be secured through the use of medical personnel who provide services:
(1) as individual independent medical
			 practitioners;
(2) through medical
			 professional service corporations organized under article 15 of the Business
			 Corporations Law;
(3) as members of
			 a medical facility;
(4) through the
			 auspices of insurance or indemnity plans, provided the organization employing
			 such methods of group medical protection or treatment are, when required by
			 law, appropriately licensed by the New York State Department of Insurance;
			 or
(5) through the auspices of
			 comprehensive health care organizations or plans using the prepayment
			 capitation principle, provided the organizations employing such methods of
			 group medical care are, when required by law, appropriately qualified,
			 licensed, or certified by the New York State Departments of Insurance or
			 Health, or other designated regulatory 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 1 - General › Part 500 - General Provisions › Section 500.3 - Reimbursement for expenditures

Current through Register Vol. 46, No. 28, July 10, 2024
Except as otherwise provided by the Social Services Law,
			   expenditures for medical care shall be eligible for reimbursement, provided
			   such expenditures are made and reimbursement therefor claimed in accordance
			   with the rules of the board and such regulations as have been established, or
			   may hereafter be established, by the department.
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 1 - General › Part 500 - General Provisions › Section 500.5 - Reimbursement and payment for appointments not kept

Current through Register Vol. 46, No. 28, July 10, 2024
Reimbursement shall not be available to the local
			   districts nor shall payment be made through the Medicaid Management Information
			   System under the Medical Assistance Program for appointments for medical care
			   which are not kept.
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 2 - Program Administration › Part 501 - Medical Care - Department Policy › Section 501.1 - Local medical plans

Current through Register Vol. 46, No. 28, July 10, 2024
A local social services medical plan shall be developed
			   and maintained by each social services district under the guidance or direction
			   of the medical director. Such plan shall conform to the regulations of the
			   department and shall be submitted to the department and the State Department of
			   Health for review, certification and approval pursuant to the regulations of
			   the department and applicable provisions of 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 2 - Program Administration › Part 501 - Medical Care - Department Policy › Section 501.2 - Supervisor of medical services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 The commissioner of public welfare, or other appointive officer, shall appoint
			 a qualified physician to serve as supervisor of medical services, on a full- or
			 part-time basis. This physician shall serve under the general direction of the
			 commissioner and shall have the responsibility for developing and supervising
			 the professional aspects of the medical care program.
(b) Qualifications.
(1) Minimum requirements:
(i) residence in New York State;
(ii) a degree of doctor of
			 medicine;
(iii) a license and
			 current registration to practice in New York State.
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 2 - Program Administration › Part 501 - Medical Care - Department Policy › Section 501.3 - Staff duties

Current through Register Vol. 46, No. 28, July 10, 2024
The functions listed in this section shall be carried out
			   by personnel assigned to the medical care unit or by other personnel as
			   designated by the commissioner:
(a)
			 authorize medical services or supplies in accord with policies and standards
			 defined in instructions of the department. One or more staff members shall be
			 deputized to issue these authorizations;
(b) refer to the supervisor of medical
			 services requests for medical services or supplies which require his written
			 authorization or approval;
(c)
			 maintain an adequate system for maintaining medical information on all patients
			 on individual cards or in family folders, and other medical records required by
			 the agency, such as a file of patients in State-approved nursing homes or a
			 file of patients receiving special diets;
(d) communicate directly with the social
			 service staff regarding matters not requiring the personal attention of the
			 supervisor of medical services;
(e)
			 act as liaison between the commissioner and other staff of the agency, and the
			 professional and clerical personnel of the Medical Care Unit regarding the
			 administrative details not requiring the personal attention of the supervisor
			 of medical services;
(f) when
			 delegated, approve bills for medical services and forward to accounting unit
			 for payment;
(g) assure that
			 practitioners and vendors are routinely kept informed of changes in standards,
			 procedures and fees in the agency's medical care program;
(h) carry out additional responsibilities as
			 may be delegated to them by the commissioner.
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 2 - Program Administration › Part 501 - Medical Care - Department Policy › Section 501.4 - Utilization of existing resources

Current through Register Vol. 46, No. 28, July 10, 2024
Each agency in planning and administering its medical
			   care program shall make full and proper use of all public and private medical
			   and health facilities and services that are already established in the
			   community.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.1 - General requirements

Current through Register Vol. 46, No. 28, July 10, 2024
To be eligible to receive medical assistance payments for
			   services, providers and fiscal agents (known as disclosing entities) are
			   required with respect to their organizations or institutions to:
(a) disclose certain direct or indirect
			 ownership and control information; and
(b) disclose information about any owner,
			 agent or managing employee convicted of criminal offenses against programs
			 operated pursuant to title XVIII (Medicare), title XIX (Medicaid) and title XX
			 (Social Services) of the Federal Social Security Act.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Agent means any
			 person who has been delegated the authority to obligate or act on behalf of a
			 provider.
(b) Convicted means that
			 a plea of guilty or verdict of guilty has been entered in a Federal, State or
			 local court, regardless of whether an appeal from that judgment is pending or
			 whether a certificate of relief from civil disability has been
			 granted.
(c) Disclosing entity
			 means a Medicaid provider (other than an individual practitioner or group of
			 practitioners), or a fiscal agent.
(d) Other disclosing entity means any other
			 Medicaid disclosing entity and any entity that does not participate in
			 Medicaid, but is required to disclose certain ownership and control information
			 because of participation in any of the programs established under title V,
			 XVIII, or XX of the Federal Social Security Act. This includes:
(1) any hospital, skilled nursing facility,
			 home health agency, independent clinical laboratory, renal disease facility,
			 rural health clinic, or health maintenance organization that participates in
			 Medicare;
(2) any Medicare
			 intermediary or carrier;
(3) any
			 entity (other than an individual practitioner or group of practitioners) that
			 furnishes, or arranges for the furnishing of, health-related services for which
			 it claims payment under any plan or program established under title V or title
			 XX of the Federal Social Security Act.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.3 - Determination of ownership or control percentages

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Indirect ownership interest. The amount
			 of indirect ownership interest is determined by multiplying the percentages of
			 ownership in each entity. For example, if A owns 10 percent of the stock in a
			 corporation which owns 80 percent of the stock of the disclosing entity, A's
			 interest equates to an eight-percent indirect ownership interest in the
			 disclosing entity and must be reported. Conversely, if B owns 80 percent of the
			 stock of a corporation which owns five percent of the stock of the disclosing
			 entity, B's interest equates to a four-percent indirect ownership interest in
			 the disclosing entity and need not be reported.
(b) Persons with an ownership or control
			 interest. In order to determine percentage of ownership, mortgage, deed of
			 trust, note, or other obligation, the percentage of interest owned in the
			 obligation is multiplied by the percentage of the disclosing entity's assets
			 used to secure the obligation. For example, if A owns 10 percent of a note
			 accrued by 60 percent of the provider's assets, A's interest in the provider's
			 assets equates to six percent and must be reported. Conversely, if B owns 40
			 percent of a note secured by 10 percent of the provider's assets, B's interest
			 in the provider's assets equates to four percent and need not be
			 reported.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.4 - Disclosure by providers and fiscal agents; information on ownership and control

Current through Register Vol. 46, No. 28, July 10, 2024
Each provider and fiscal agent must disclose the
			   following information:
(a) the name
			 and address of each person with an ownership or control interest in the
			 disclosing entity or in any subcontractor in which the disclosing entity has
			 direct or indirect ownership of five percent or more or who is a managing
			 employee in the disclosing entity;
(b) whether any of the persons named in
			 compliance with section
			 502.2  of
			 this Part is related to another as spouse, parent, child or sibling;
			 and
(c) the name of any other
			 disclosing entity in which a person with an ownership or control interest in
			 the disclosing entity also has an ownership or control interest. This
			 requirement applies to the extent that the disclosing entity can obtain this
			 information by requesting it in writing from the person. The disclosing entity
			 must:
(1) keep copies of all these requests
			 and the responses to them;
(2) make
			 them available to the department upon request; and
(3) advise the department when there is no
			 response to a request.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.5 - Time and manner of disclosure

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 The information specified in section
			 502.4 
			 of this Part must be provided upon application for enrollment and annually
			 thereafter to the department. Except where the provider is certified on an
			 other than annual basis, the disclosure requirement may coincide with the
			 certification/recertification period. Where the provider discloses the
			 ownership and control information for the purposes of Medicare
			 certification/recertification, such disclosures will be deemed to satisfy these
			 disclosure requirements.
(b) Any
			 change in the ownership or control or change of a managing employee excepting
			 only changes in the operator of a hospital subject to the provisions of section 2801-a  of the Public Health Law, of the
			 provider occurring within the annual disclosure period must be reported within
			 15 days of the change of ownership or control or change of a managing employee,
			 by filing an amended, signed ownership and disclosure form with the department.
			 Failure to report any change in ownership or control or change of a managing
			 employee, may result in the termination of the disclosing entity's provider
			 agreement and require the newly constituted entity to enroll as a new
			 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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.6 - Disclosure by providers; information related to business transactions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each provider
			 must also submit on the request of the department full and complete information
			 about the following:
(1) the ownership of any
			 subcontractor with whom the provider has had business transactions totaling
			 more than $25,000 during the 12-month period ending on the date of the
			 request;
(2) any significant
			 business transactions between the provider and any wholly owned supplier, or
			 between the provider and any subcontractor, during the five-year period ending
			 on the date of the request.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.7 - Disclosure by providers; information on persons convicted of crimes

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Before the
			 department enters into or renews a provider agreement, or at any time upon
			 written request by the department, a provider must disclose to the department
			 the identity of any person who:
(1) has
			 ownership or control interest in the provider, or is an agent or managing
			 employee of the provider; and
(2)
			 has been convicted of a criminal offense related to that person's involvement
			 in any program under Medicare, Medicaid, or the title XX services program since
			 the inception of those programs.
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 2 - Program Administration › Part 502 - Disclosure Of Information By Providers And Fiscal Agents › Section 502.8 - Additional time requirements for submission of requested information, and basis for penalties

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Requested information must be provided to the department within 35 days of the
			 written request for such information. Payment may be denied for services
			 provided during the period beginning on the day following the date the
			 information was required to be provided to the department and ending on the day
			 before the date on which the information was actually received by the
			 department.
(b) The department may
			 refuse to approve any claims submitted, a provider agreement or a contract with
			 a fiscal agent, and may terminate an existing agreement or contract, if the
			 provider or fiscal agent fails to provide the requested information.
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 2 - Program Administration › Part 504 - Medical Care-enrollment Of Providers › Section 504.1 - Policy and scope

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The policy
			 of this State is to make available to everyone, regardless of race, age,
			 national origin or economic standing, uniform high quality medical care. In
			 pursuit of this goal the department will contract with only those persons who
			 can demonstrate that they are qualified to provide medical care, services or
			 supplies and who can provide reasonable assurance that public funds will be
			 properly utilized. Only qualified and responsible persons may be enrolled as
			 providers of care, services and supplies.
(b)
(1) Any
			 person who furnishes medical care, services or supplies for which payments
			 under the medical assistance program are to be claimed; or who arranges the
			 furnishing of such care, services or supplies; or who submits claims for or on
			 behalf of any person furnishing or arranging for the furnishing of such care,
			 services or supplies must enroll as a provider of services prior to being
			 eligible to receive such payments, to arrange for such care, services or
			 supplies or to submit claims for such care or supplies.
(2) Those persons who are required to enroll
			 as providers of services under paragraph (1) of this subdivision include, but
			 are not limited to, laboratory directors, supervising pharmacists, nurse
			 practitioners and physician's assistants.
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 2 - Program Administration › Part 504 - Medical Care-enrollment Of Providers › Section 504.2 - Application for participation

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Information regarding application for enrollment may be obtained by writing to
			 the Provider Enrollment Unit of the department.
(b) To apply for enrollment as a provider of
			 services, an applicant must submit a complete, original, signed and sworn
			 application in the form and manner as may be required by the department. The
			 ownership and disclosure form required by Part 502 of this Title is part of the
			 application.
(c) The department may
			 require the provision of information relative to the applicant's ability to
			 provide high-quality care, services and supplies and to be financially
			 responsible. The department may use different applications for each provider
			 type, for certain types of providers only, or for different geographic
			 areas.
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 2 - Program Administration › Part 504 - Medical Care-enrollment Of Providers › Section 504.3 - Duties of the provider

Current through Register Vol. 46, No. 28, July 10, 2024
By enrolling the provider agrees:
(a) to prepare and to maintain
			 contemporaneous records demonstrating its right to receive payment under the
			 medical assistance program and to keep for a period of six years from the date
			 the care, services or supplies were furnished, all records necessary to
			 disclose the nature and extent of services furnished and all information
			 regarding claims for payment submitted by, or on behalf of, the provider and to
			 furnish such records and information, upon request, to the department, the
			 Secretary of the United States Department of Health and Human Services, the
			 Deputy Attorney General for Medicaid Fraud Control and the New York State
			 Department of Health;
(b) to comply
			 with the disclosure requirements of Part 502 of this Title with respect to
			 ownership and control interests, significant business transactions and
			 involvement with convicted persons;
(c) to accept payment from the medical
			 assistance program as payment in full for all care, services and supplies
			 billed under the program, except where specifically provided in law to the
			 contrary;
(d) not to illegally
			 discriminate on the basis of handicap, race, color, religion, national origin,
			 sex or age;
(e) to submit claims
			 for payment only for services actually furnished and which were medically
			 necessary or otherwise authorized under the Social Services Law when furnished
			 and which were provided to eligible persons;
(f) to submit claims on officially authorized
			 claim forms in the manner specified by the department in conformance with the
			 standards and procedures for claims submission;
(g) to permit audits, by the persons and
			 agencies denominated in subdivision (a) of this section, of all books and
			 records or, in the discretion of the auditing agency, a sample thereof,
			 relating to services furnished and payments received under the medical
			 assistance program, including patient histories, case files and
			 patient-specific data;
(h) that the
			 information provided in relation to any claim for payment shall be true,
			 accurate and complete; and
(i) to
			 comply with the rules, regulations and official directives of the
			 department.
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 2 - Program Administration › Part 504 - Medical Care-enrollment Of Providers › Section 504.4 - Duties of the department

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon
			 receipt of a complete, original and signed application, an investigation will
			 be conducted to verify or supplement the information contained in the
			 application. The background and qualifications of the applicant shall also be
			 reviewed.
(b) The department may
			 request further information from an applicant. In such a case, it shall make a
			 clear and precise request to the applicant for the information and inform the
			 applicant whether or not action on the application will be postponed pending
			 receipt of the requested information. Delay occasioned by the applicant's
			 failure to timely reply shall not be counted in calculating the time within
			 which the department shall make its determination on the application.
(c) The department shall complete its
			 investigation and determine whether or not to enroll the applicant within 90
			 calendar days after receipt of an application.
(d) If an applicant cannot be fully
			 investigated within 90 days, the department may extend the time for acting on
			 an application for up to 120 calendar days from the date of receipt of the
			 application. Written notice of this extension will be mailed to the applicant
			 within 60 calendar days from the time the application was received.
(e) Upon completion of its consideration of
			 an application, the department shall either:
(1) enroll the applicant as a provider;
			 or
(2) deny the application, if it
			 is in the best interest of the medical assistance program to do so, specifying
			 the reasons for denial.