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 505.2 - Physicians' services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 General policies. Care provided by physicians to eligible persons shall not be
			 reimbursable as an item of medical assistance when such care does not meet the
			 standards for coverability pursuant to Part 85 of Department of Health
			 regulations or when such care does not meet the definition of medical care or
			 is not considered to be an available service as defined in this Subchapter.
(1) Qualifications of physicians. Physicians
			 shall be licensed and currently registered by the New York State Education
			 Department, or, if in practice in another state, by the appropriate agency of
			 that state. In addition thereto, services ordinarily performed by general
			 practitioners shall be provided only by physicians meeting the qualifications
			 set forth in subparagraph (i) of this paragraph and services ordinarily
			 performed by specialists shall be provided only by physicians meeting the
			 qualifications set forth in subparagraph (ii) of this paragraph.
(i) Qualifications of general practitioners.
			 A general practitioner is a physician who:
(a) is a member of the active or attending
			 staff at a hospital holding a valid operating certificate from the New York
			 State Department of Health; or
(b)
			 is a member in good standing of the American Academy of General Practice or of
			 the American College of General Practitioners in Osteopathic Medicine and
			 Surgery; or
(c) has given
			 satisfactory evidence of completion of a total of 150 hours of continuation
			 education over a three-year period based on standards approved by the State
			 Commissioner of Health in accordance with the following:
(1) not less than 50 hours of the 150 hours
			 required shall be attendance at planned instruction which shall include one or
			 more of the following:
(i) courses conducted
			 by a medical school or school of osteopathy;
(ii) planned continuation education
			 preceptorships or similar practical training approved on an individual basis by
			 the Medical Society of the State of New York or the New York State Osteopathic
			 Society, jointly with the Office of Medical Manpower of the State Department of
			 Health;
(iii) for not more than 20
			 hours' credit in any given year, preparation and/or presentation of acceptable
			 scientific exhibits or papers evaluated by the Medical Society of the State of
			 New York or the New York State Osteopathic Society, jointly with the Office of
			 Medical Manpower of the State Department of Health;
(iv) continuation education approved for this
			 purpose by the Medical Society of the State of New York or the New York State
			 Osteopathic Society, jointly with the Office of Medical Manpower of the State
			 Department of Health;
(2) the remaining 100 hours of continuation
			 education shall be satisfied by allowing credit on an hour-for-hour basis for
			 attendance at specific scientific meetings, such as the following:
(i) attendance at meetings of medical groups,
			 such as local, State or national, including but not limited to county medical
			 societies, county osteopathic societies, academies of medicine, academies of
			 general practice, district and State medical societies, district and State
			 osteopathic societies, specialty medical meetings and meetings of the American
			 Medical Association and of the American Osteopathic Association;
(ii) attendance at scientific programs,
			 hospital staff meetings or similar medical meetings;
(iii) teaching responsibilities in a teaching
			 hospital or in a medical school, a nursing school or other accredited school
			 which teaches some branch of the health sciences;
(iv) as a preceptor for medical
			 students;
(v) other continuation
			 education activities accepted by the Office of Professional Education of the
			 State Department of Health, jointly with the Medical Society of the State of
			 New York or the New York State Osteopathic Society, as meeting these
			 requirements.
(d) Physicians not possessing the above
			 qualifications shall be given not less than one year, from a date to be
			 determined by the State Commissioner of Health, to meet the
			 qualifications.
(e) If
			 qualification is to be achieved by approved continuation education as provided
			 for in clause (c) of this subparagraph, the physician shall complete such
			 continuation education within three years of the date specified in clause
			 (d).
(f) In extenuating
			 circumstances involving personal or family illness or disability, health
			 emergencies or epidemics in the community endangering the public health, or
			 unavailability of adequate medical coverage through other sources, the above
			 requirements may be waived for any individual physician at the discretion of
			 the State Commissioner of Health.