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 4 - Fees and Reimbursement › Part 538 - State Reimbursement for Telehealth Services › Section 538.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
Telehealth has the meaning set forth in Public Health Law
			   § 2999-cc and shall also include the following terms with the following
			   meanings:
(a) "Audio-only visits" means
			 the use of telephone and other audio-only technologies to deliver
			 services.
(b) "eConsults" means the
			 asynchronous or synchronous, consultative, provider-to-provider assessment and
			 management services conducted through telephone, internet, or electronic health
			 records.
(c) "Telehealth provider"
			 is defined in Public Health Law § 2999-cc(2) and shall also include:
(1) Voluntary foster care agencies certified
			 by the New York State Office of Children and Family Services and licensed
			 pursuant to article twenty-nine-I of Public Health Law, and providers employed
			 by those agencies.
(2) Providers
			 licensed or certified by the New York State Department of Education to provide
			 Applied Behavioral Analysis therapy.
(3) Radiologists licensed pursuant to Article
			 131 of the Education Law and credentialed by the site from which the
			 radiologist practices;
(4) All
			 Medicaid providers and providers employed by Medicaid facilities or provider
			 agencies who are authorized to provide in-person services are authorized to
			 provide such services via telehealth as long as such telehealth services are
			 appropriate to meet a patient's needs and are within a provider's scope of
			 practice.
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 4 - Fees and Reimbursement › Part 538 - State Reimbursement for Telehealth Services › Section 538.2 - Modalities and applicable standards

Current through Register Vol. 46, No. 28, July 10, 2024
Payment for telehealth services shall be made in
			   accordance with section
			   538.3  of this Part only if the
			   provision of such services appropriately reduces the need for on-site or
			   in-office visits and the following standards are met:
(a) An "audio-only visit" is reimbursable
			 when the service can be effectively delivered without a visual or in-person
			 component; and it is the only available modality or is the patient's preferred
			 method of service delivery; and the patient consents to an audio-only visit;
			 and it is determined clinically appropriate by the ordering or furnishing
			 provider; and the provider meets billing requirements, as determined and
			 specified by the commissioner in administrative guidance. Services provided via
			 audio-only visits shall contain all elements of the billable procedures or rate
			 codes and must meet all documentation requirements as if provided in person or
			 via an audio-visual visit.
(b)
			 "eConsults" are intended to improve access to specialty expertise through
			 consultations between consulting providers and treating providers. eConsults
			 are reimbursable when the providers meet minimum time and billing requirements,
			 as determined and specified by the commissioner in administrative
			 guidance.
(c) "Virtual Check-in"
			 visits are intended to be used for brief medical discussions or electronic
			 communications between a provider and a new or established patient, at the
			 patient's request. Virtual check-ins are reimbursable when the provider meets
			 certain billing requirements, as determined and specified by the commissioner
			 in administrative guidance.
(d)
			 "Virtual Patient Education" delivers health education to patients, their
			 families, or caregivers, and is reimbursable only for services that are
			 otherwise reimbursable when delivered in person and when the provider meets
			 certain billing requirements, as determined and specified by the commissioner
			 in administrative guidance.
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 4 - Fees and Reimbursement › Part 538 - State Reimbursement for Telehealth Services › Section 538.3 - Reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) As required by
			 Social Services Law § 367-u and, except for services paid by State only
			 funds, contingent upon federal financial participation, reimbursement shall be
			 made in accordance with fees determined by the commissioner based on and
			 benchmarked to in-person fees for equivalent or similar services.
(b) Reimbursement shall not be made for
			 services that do not warrant separate reimbursement as identified by the
			 department during fraud, waste and abuse detection efforts. The department
			 reserves the right to request additional documentation and deny payment for
			 services deemed duplicative or included in a primary service. Any potential
			 fraud, waste, or abuse, identified through claims monitoring or any other
			 source, will be referred to the Office of Medicaid Inspector General.
(c)
(i)
			 Subject to payment restrictions set forth in § 1842(n)(1) of the federal
			 social security act and
			 42
			 C.F.R. §
													414.50, reimbursement for
			 professional services delivered via teleradiology shall be made only for the
			 final radiology read and must be billed separately from the technical and
			 administrative component as specified by the commissioner in administrative
			 guidance.
(ii) Hospitals and
			 physicians shall bill the professional and technical and administrative
			 components separately in accordance with the relevant Radiology Fee Schedule
			 set forth in subdivision (a) of section
			 533.6  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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.1 - Authorization as basis for payment for medical assistance

Current through Register Vol. 46, No. 28, July 10, 2024
Vendor payments for medical care and other items of
			   medical assistance shall not be made unless such care or other items of
			   assistance have been furnished on the basis of the appropriate authorization
			   prescribed by the rules of the board and regulations 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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.2 - Limitations on nonmedical assistance emergency hospital care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The provisions of this section shall not
			 apply to nor limit payment of costs of care in the cases of emergency hospital
			 admissions when the costs of care are subject to payment as medical assistance.
			 However, in cases of emergency admissions of persons who have been determined
			 to be eligible for medical assistance, the hospital shall give the five days'
			 notice required by subdivision (d) of section
			 505.4  of this
			 Subchapter.
(b) Emergency hospital
			 care which may be provided without the specific prior authorization of the
			 public welfare official shall be limited to those instances in which immediate
			 admission is essential. Notification shall be given to the public welfare
			 official within five days, Saturdays, Sundays and legal holidays excepted.
			 Payment from public funds after such notification is subject to acceptance of
			 liability by the public welfare official.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.3 - Drug prescriptions

Current through Register Vol. 46, No. 28, July 10, 2024
Drug prescriptions may be rendered on order of a
			   physician at any time in the course of attendance on a case and without
			   specific prior authorization for the particular prescription.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.4 - Notification to public welfare official for medical services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General.
(1) Notification by a physician, dentist,
			 hospital or other vendor of a request for authorization to furnish items of
			 medical assistance shall be furnished to the appropriate public welfare
			 official for the purpose of receiving advance authorization to render service,
			 where such advance authorization is required by rules of the board or
			 regulations of the department, except by a hospital in case of emergency as
			 defined in section
			 540.2 
			 of this Part, in which case notification shall be given within the time
			 specified in that section.
(2)
			 Notification shall consist at least of:
(i)
			 case and patient (if other than name of household head), identification date
			 and place of services to be rendered, and/or already rendered if
			 emergent;
(ii) preliminary
			 diagnosis;
(iii) estimated scope of
			 services to be rendered (number of visits, and/or special auxiliary services
			 required);
(iv) name and address of
			 physician, dentist, hospital or other vendor providing services;
(v) identification of vendors of special
			 auxiliary services requested if known.
(3) Such notification may be furnished in
			 writing by the professional attendant or vendor or may be made verbally, in
			 which event the public agency shall reduce the contents of the notification to
			 writing at once. For either such purpose, the agency shall utilize a form
			 providing the minimum content of section A of the illustrative form M-1
			 contained in the instructions 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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.6 - Billing for medical assistance

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1)
			 Claims for payment for medical care, services or supplies furnished by any
			 provider under the medical assistance program must be initially submitted
			 within 90 days of the date the medical care, services or supplies were
			 furnished to an eligible person to be valid and enforceable against the
			 department or a social services district, unless the provider's submission of
			 the claims is delayed beyond 90 days due to circumstances outside of the
			 control of the provider. Such circumstances include but are not limited to
			 attempts to recover from a third party insuror, legal proceedings against a
			 responsible third-party or the recipient of the medical care, services or
			 supplies or delays in the determination of client eligibility by the social
			 services district. All claims submitted after 90 days must be accompanied by a
			 statement of the reason for such delay and must be submitted within 30 days
			 from the time submission came within the control of the provider, subject to
			 the limitations of paragraph (3) of this subdivision.
(2) Any claim returned to a provider due to
			 data insufficiency or claiming errors may be resubmitted by the provider upon
			 proper completion of the claim in accordance with the claims processing
			 requirements of the department within 60 days of the date of the notification
			 to the provider advising the provider of such insufficiency or invalidity. Any
			 returned claim not correctly resubmitted within 60 days or on the second
			 resubmission is neither valid nor enforceable against the department or a
			 social services district.
(3)
			 Notwithstanding paragraphs (1) and (2) of this subdivision to the contrary:
(i) all claims for payment for medical care,
			 services or supplies furnished by non-public providers under the medical
			 assistance program must be finally submitted to the department or its fiscal
			 agent and be payable within two years from the date the care, services or
			 supplies were furnished in order to be valid and enforceable as against the
			 department or a social services district; and
(ii) all claims for payment for medical care,
			 services or supplies furnished by public providers must be finally submitted to
			 the department or its fiscal agent and be payable within two years from the
			 date the care, services or supplies were furnished (or within such other period
			 as agreed by the department and the public provider for payments initially made
			 by the public provider under a program other than the medical assistance
			 program) in order to be valid and enforceable as against the department or a
			 social service district.
(4) For purposes of this subdivision, a claim
			 is considered submitted upon its receipt by the department or its fiscal
			 agent.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.8 - Verification, payment and recording of medical bills

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The public welfare official, on receipt
			 of bills rendered by vendors of medical assistance, shall cause such bills to
			 be classified on the basis of State or local charge status of each recipient
			 and the charges relative thereto and a verification of such bills within the
			 scope and limitations of authorizations issued by the public welfare official
			 for the services billed, and with the schedule of fees and rates promulgated by
			 the public welfare official for vendor services. Where the fees and rates
			 promulgated by the public welfare official exceed ceiling limits set by State
			 regulations, the amount by which the charges billed exceed the State limits
			 shall be identified and segregated for purposes of preparing proper claims for
			 State aid.
(1) Verification of bills against
			 authorization and against the schedule of fees and rates includes: verification
			 of mathematical accuracy of billing; conformity with all billing requirements
			 (properly signed, etc.); verification of technical or professional
			 qualifications where such may affect the fee to be allowed; verification of
			 mileage rates and total charges; etc. (Verification of such scope may
			 necessitate provisions of internal agency examination of billings by clerical
			 personnel, in part, and by professional personnel, in 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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.9 - Filing of authorizations, bills and related documents

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General.
(1) Notifications and authorizations for
			 medical services (either the originals, if available, or copies thereof) shall
			 be maintained on file in the public welfare agency in such a manner as to
			 facilitate audit. If the notification and authorization constitute separate
			 documents, each notification and the authorization relative to it shall be
			 filed together.
(2) Paid bills for
			 medical services shall be maintained on file by the public welfare agency in a
			 manner to facilitate audit and shall be filed in voucher number sequence, or in
			 sequence as listed on the payment rolls.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.10 - Claims for State aid

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 General.
(1) Claims for State (and Federal)
			 aid in behalf of expenditures for medical care shall be prepared and submitted
			 in accordance with departmental regulations with respect thereto.
(2) The internal controls established by the
			 public welfare official for the examination and verification prior to payment
			 of bills for medical services rendered shall identify and isolate any payments
			 or portions of payments that exceed limits stipulated by State regulations and
			 the claims for State (and Federal) aid prepared and submitted by the agency
			 shall exclude from calculations of such aid any such amounts, as require by
			 departmental regulations governing the preparation and submission of claims.
			 Other elements requiring case expenditure analysis entering into the
			 development of proper claims, such as program and residence status, shall also
			 be provided for in the internal analysis and processing of medical services
			 payments.
(3) Where claims and
			 rolls for State aid purposes must be supported by vouchers or statements of
			 services paid for medical care, the public welfare agency must ensure, in its
			 operating procedures, that sufficient copies of the appropiate documents are
			 developed to meet both its internal needs and the roll and claim
			 requirements.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.11 - Internal administrative safeguards over medical care expenditures

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General. The
			 public welfare official shall establish internal practices that will safeguard
			 the proper expenditure of funds for medical care.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.12 - Advance payments to hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Criteria for eligibility.
The department is authorized to make advance payments to
			   hospitals which meet the following criteria:
(1) The hospital is a voluntary
			 not-for-profit hospital.
(2) Prior
			 to January 1, 1978, the hospital received regular periodic advances from a
			 local government unit, which advances were based on anticipated medical
			 assistance claims payments.
(3)
			 That, historically, 10 percent or 5,000 patient days of hospital inpatient
			 services must have been provided to Medicaid recipients who reside in a
			 district for which the Medicaid Management Information System (MMIS) has taken
			 over payment responsibility.
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 5 - Procedures and Forms › Part 540 - Authorization Of Medical Care › Section 540.13 - Concurrent payments to hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To insure timely payment, while providing
			 for transition to a fee for services rendered payment system under the medical
			 assistance program the commissioner shall implement, for a limited period, a
			 concurrent payment system for any eligible nongovernmental general hospital
			 requesting participation to effectuate such transition. Eligible applicants
			 must have:
(1) participated in a limited
			 multi-hospital reimbursement demonstration project; and
(2) been receiving, in lieu of payment for
			 services rendered, fixed weekly payments pursuant to a contractual agreement,
			 during calendar years 1981 and 1982 or their contractual predecessors in a
			 limited multi-hospital reimbursement demonstration project must have;
			 and
(3) more than 25 percent of the
			 patients serviced by the hospital eligible for medical assistance.
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 5 - Procedures and Forms › Part 541 - Patient's Medical Record › Section 541.1 - Procedures for patient's medical record

Current through Register Vol. 46, No. 28, July 10, 2024
The agency shall maintain adequate records for each
			   patient to show diagnosis and medical services provided under the medical care
			   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 5 - Procedures and Forms › Part 542 - Subrogated Claims To Liable Third Parties › Section 542.1 - Claims to which social services officials are subrogated

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Pursuant to the Social Services Law, the
			 department, a social services district or a social services official may become
			 subrogated to any rights a person or such person's legally responsible relative
			 may have to health insurance, other medical care coverage, medical support or
			 third party reimbursement as a result of:
(1)
			 an assignment by an applicant for or recipient of medical assistance as
			 required by section 366(4)(h) of such law;
(2) an implied contract created by law when a
			 responsible relative refuses or fails to provide necessary care and assistance
			 as described in section 366(3)(a) of such law;
(3) subrogation by law when a legally
			 responsible relative agrees to or is ordered by a court or administrative
			 tribunal of competent jurisdiction to provide health insurance or other medical
			 care coverage for his or her dependents or other persons as described in
			 section 366(3)(b) of such law;
(4)
			 any assignment by agreement to a social services official; or
(5) any other circumstance by which the
			 department, a social services district or a social services official may become
			 subrogated by law, including common law, to rights to receive benefits or
			 payment from a third party.
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 5 - Procedures and Forms › Part 542 - Subrogated Claims To Liable Third Parties › Section 542.2 - Designation of providers as agents to file subrogated claims

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If medical care, services or supplies, as
			 described in sections 365-a (2) and
			 367-a (1)  of the Social
			 Services Law, are provided for which payment of part or all of the costs may be
			 claimed by the provider from the medical assistance program in accordance with
			 section
			 540.6 
			 of this Title, and if the department, a social services district or a social
			 services official is or would be subrogated to the rights a person or a legally
			 responsible relative has to reimbursement from a liable third party as
			 described in section
			 542.1 
			 of this Part, the provider is authorized by the department to act as its agent
			 for the purpose of submitting a claim for such reimbursement to the liable
			 third party.
(b) If a provider has
			 not been notified or is uncertain whether or not a claim is one to which the
			 department, a social services district or a social services official is
			 subrogated, the provider may request verification of the nature of the claim
			 from the social services district identified as the district responsible for
			 the recipient for whom the claim will be submitted.
(c) A provider may act as an agent for the
			 department and submit claims to liable third parties in the following
			 situations:
(1) when a medical assistance
			 recipient or responsible relative will not submit medical claims to an
			 appropriate insurance carrier or other liable third party;
(2) when a medical assistance recipient or
			 responsible relative has submitted a medical payment claim to an insurance
			 carrier or other liable third party in the past, but has not forwarded any
			 resulting payment to the medical assistance provider;
(3) when the medical assistance provider does
			 not participate in the health delivery or reimbursement plan of an insured
			 recipient or a responsible relative and the recipient or responsible relative
			 acts in the manner described in paragraph (1) or (2) of this
			 subdivision;
(4) when an insurance
			 carrier or other liable third party does not permit assignment of the payment
			 to the medical assistance provider and the medical assistance recipient or
			 responsible relative acts in the manner described in paragraph (1) or (2) of
			 this subdivision; or
(5) when an
			 insurance carrier or other liable third party asserts that only the medical
			 assistance recipient or responsible relative can submit a claim to a health
			 coverage plan or employer for reimbursement and the recipient or responsible
			 relative acts in the manner described in paragraph (1) or (2) of this
			 subdivision.
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 5 - Procedures and Forms › Part 542 - Subrogated Claims To Liable Third Parties › Section 542.3 - Assignment of subrogated claims proceeds to providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a provider submits a claim for
			 reimbursement to a liable third party in accordance with section
			 542.2 
			 of this Part, such provider will be entitled to receive and retain, subject to
			 any claim a recipient may have, any payment that is required to be paid to the
			 department as a subrogate of such recipient or a legally responsible
			 relative.
(b) A provider authorized
			 to receive payments in accordance with subdivision (a) of this section is
			 further authorized, as an agent of the department, to direct any liable third
			 party to which claims are submitted in accordance with section
			 542.2 
			 of this Part to make any payments to which the department is entitled to such
			 provider.
(c) If a provider
			 receives a payment from a liable third party, a recipient or responsible
			 relative and also from the medical assistance program for the same medical
			 care, services or supplies, the provider must return to the medical assistance
			 program the amounts of any medical assistance payments which have also been
			 paid by such third party, recipient or relative.
(d) If a provider receives a payment from a
			 liable third party, recipient or responsible relative for medical care,
			 services or supplies in an amount that is less than that which would be
			 reimbursed by the medical assistance program, the provider may submit a claim
			 for reimbursement to the medical assistance program for the difference between
			 the amount the medical assistance program would pay and the amount actually
			 received by the provider, provided that documentation of the amount received by
			 the provider is submitted with the claim made to the medical assistance program
			 or made available for review as required 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 5 - Procedures and Forms › Part 542 - Subrogated Claims To Liable Third Parties › Section 542.4 - Notice of subrogation to liable third parties

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If a provider submits a claim for
			 reimbursement to a liable third party as an agent of the department, such
			 liable third party is directed to make payment to the provider submitting the
			 claim. Such provider is authorized to submit with, or notate upon, its claim
			 the following statement:
"This claim is submitted by a medical assistance provider
			   as an agent of the New York State Department of Social Services in accordance
			   with 18 NYCRR Part 542 and any payment due to the Department must be made to
			   the provider submitting this claim."
(b) Instead of submitting the notice
			 described in subdivision (a) of this section, a provider may submit with its
			 claim any form supplied or prescribed by the department, a social services
			 district or a social services official which indicates that the provider is
			 acting as agent for the department, a social services district or a social
			 services official.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 600 - Principles Of Reimbursement Claiming › Section 600.1 - Reimbursement by the State

Current through Register Vol. 46, No. 28, July 10, 2024
Expenditures made by social services districts for public
			   assistance and care, or for other purposes for which reimbursement is available
			   pursuant to State law, will, if approved by the department, be subject to
			   reimbursement in accordance with the provisions 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 F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 600 - Principles Of Reimbursement Claiming › Section 600.3 - Reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Costs subject
			 to reimbursement.
(1) Expenditures for
			 recipients of public assistance, care or services. Assistance properly
			 furnished to eligible recipients of public assistance, care or services may be
			 reimbursed to the extent authorized by law if the social services district
			 which makes the expenditure submits claims to the department in accordance with
			 department regulations and directions.
(2) Administrative expenditures. Expenditures
			 for the administration of public assistance, care and services may be
			 reimbursed if the expenditure is properly made or incurred by a social services
			 district and the district submits a claim for reimbursement in accordance with
			 department regulations and directions.
(3) Other costs. Any costs or adjustments
			 specifically authorized by law will be subject to reimbursement or adjustment
			 as directed by the department, in accordance with applicable provisions of
			 State and Federal law and regulations.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 600 - Principles Of Reimbursement Claiming › Section 600.4 - Fiscal responsibilities

Current through Register Vol. 46, No. 28, July 10, 2024
Reimbursement for allowable expenditures may be claimed
			   by a social services district only if the district has fulfilled its
			   responsibilities related to the activities for which reimbursement is claimed,
			   including but not limited to the following:
(a) Local funds. The district supervises and
			 administers all funds in accordance with the provisions of sections 82, 83, 84, 86, 86-a and
			 87  of the Social Services Law or other
			 provisions of State or Federal law, regulation or policy.
(b) Appropriations. The district prepares and
			 submits estimates and requests for appropriations as required by sections 88, 89, 90, 91, 92 and
			 93  of the Social Services Law or as required
			 by any other provision of State or Federal law, regulation or policy.
(c) Reports. The district makes such reports
			 and furnishes such information to the department as required by section 81  of the Social Services Law or as required
			 by any other provision of State or Federal law, regulation or policy.
(d) Other fiscal responsibilities. The
			 district performs such other responsibilities as are required by State law,
			 regulation, policy or direction 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 F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 600 - Principles Of Reimbursement Claiming › Section 600.5 - Controls

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Monetary
			 controls. A social services district must maintain adequate monetary controls.
(1) Monetary controls include a predetermined
			 check processing procedure or an electronic verification and issuance procedure
			 to assure that a properly completed authorization, in a State-prescribed
			 format, is on file at the district which establishes eligibility for and amount
			 of assistance to be granted before there is an expenditure of public funds and
			 establishes that the amount of assistance granted is in accordance with the
			 amount authorized.
(2)
			 Documentation of monetary controls to be used by a social services district
			 will be maintained by the district in an appropriate record.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 600 - Principles Of Reimbursement Claiming › Section 600.6 - Records

Current through Register Vol. 46, No. 28, July 10, 2024
A social services district must maintain adequate and
			   accurate records relating to all claims for reimbursement.
(a) Records of assistance. A social services
			 district must maintain a basic fiscal record on State-prescribed formats or
			 approved local equivalents for each person who applies for or is in receipt of
			 public assistance, care or services. The use of such formats or equivalents is
			 mandatory for all activities for which reimbursement is claimed.
(b) Administrative records. Records relating
			 to the provision of public assistance, care and services or to administering
			 programs or expenditures subject to State or Federal reimbursement will be
			 prepared and maintained by the district in accordance with the instructions of
			 the department. Each district will:
(1)
			 conduct an annual review of personnel assignments to identify and allocate
			 administrative salary costs to specific functions, as defined by the
			 department;
(2) code each payroll
			 to distribute salaries and the number of staff to specific functions, as
			 instructed by the department;
(3)
			 code nonsalary administrative expenditures to specific functions, as instructed
			 by the department;
(4) certify
			 annually the existence of a cost allocation plan for services furnished to
			 social services districts by other governmental units of the same municipality
			 and distribute allowable costs according to instructions of the
			 department;
(5) maintain, for audit
			 purposes, fiscal records, statistics or required State approvals to support
			 claims which include exceptional reimbursement amounts; and
(6) submit claims, schedules and required
			 supporting documentation to the department in accordance with the directions 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 F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 601 - Procedures Of Reimbursement Claiming › Section 601.1 - Claims for reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Claims and reports for Federal and State reimbursement and supporting
			 documentation must be prepared in accordance with the directions of the
			 department or, absent such directions, in accordance with the requirements of
			 the relevant Federal agency. The information contained in the claims and
			 supporting documentation will be used by the department in determining whether
			 such claims should be reimbursed.
(b) Except as otherwise directed by the
			 department, claims and supporting documentation must be prepared monthly and
			 submitted to the department at its office in Albany by the 20th of the month
			 following the month to which they relate.
(c) An original statement of claim and
			 supporting documentation must be submitted to the department, and a copy of the
			 claim and documentation must be kept on file by the social services district in
			 a manner to facilitate audit. Any copies required by the fiscal officer of a
			 social services district or other authorities must be supplied by the
			 district.
(d) Claims for
			 reimbursement must be submitted by or through the commissioner of the social
			 services district charged with the administration of the program under which
			 reimbursement is sought. Claims must be certified by the authorized social
			 services official, or his or her deputy, or other official authorized to
			 certify claims for reimbursement, and by the fiscal officer, or his or her
			 deputy, of the municipality or other governmental unit making the
			 claim.
(e) Social services
			 districts must maintain records to supplement their accounts pertaining to
			 indirect expenses included in claims. Such records must reflect the volume of
			 service or supplies provided, the rates at which charges are computed, the
			 total charge for each period covered by a claim and the bases for the rates or
			 charges. The records must be maintained with the same care and protection
			 afforded the operating accounts of the district and must be retained and made
			 readily available for inspection and audit as the department
			 requires.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 601 - Procedures Of Reimbursement Claiming › Section 601.2 - Documentation and summaries

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 Documents and summaries must be established for each activity for which
			 reimbursement is claimed. Such documents and summaries must be established in
			 accordance with the requirements for such activity. Documents must show names
			 of recipients, vendors, providers or other persons or entities to whom payments
			 have been made, the amount of each payment, the character or purpose of the
			 payment and such other pertinent information as may be required by the
			 department. The summary or document must be further supported by such other
			 documents as are required or requested by the department or the State. Such
			 supporting documentation must separately identify the eligibility status of
			 each case covered by the documentation in accordance with procedures
			 established for the particular activity or program for which reimbursement is
			 claimed.
(b) Documents and
			 summaries must be prepared in support of claims for which reimbursement is
			 sought and must be prepared for claims for assistance and care or other
			 reimbursable expenditures made for specific recipients, including but not
			 limited to:
(1) public assistance or other
			 expenditures made in the form of regular or special cash grants to a
			 recipient;
(2) expenditures for
			 payments to vendors, providers or other persons or entities for assistance,
			 care, services or supplies furnished to or on behalf of a recipient;
			 and
(3) adjustments of benefits
			 made to or on behalf of a recipient.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 601 - Procedures Of Reimbursement Claiming › Section 601.5 - Claim audits

Current through Register Vol. 46, No. 28, July 10, 2024
At least one copy or comparable record of each of the
			   documents necessary to comply with the claiming requirements of this Part,
			   including the submitted claim, and one copy or comparable record of the
			   payroll, must be retained by the local district to facilitate audits conducted
			   by the department or its designees. The district must furnish copies of such
			   records to the department, other State agencies, a local fiscal officer or
			   other governmental entity when so directed by the department.
(a) Except as otherwise directed by the
			 department or required by law, records must be kept in a manner available for
			 review and audit for a period of at least six years.
(b) The district must cooperate in any audit
			 or review conducted by or with the approval of the department.
(c) The department must be notified in
			 writing within five working days after receipt of any request or notice that
			 the district participate in any audit not specifically requested or approved by
			 the department.
(d) Any adjustment
			 required by or resulting from any audit or review must be reflected in
			 adjustments to claims as directed by the department.
(e) Audit determinations by the department
			 are final and not subject to administrative review, except as otherwise
			 provided by paragraph (e) of subdivision (2) of section 22  of the Social Services Law, when reflected
			 in adjustments to claims of a social services district by direction of the
			 department or when the district is otherwise notified that the determination is
			 final.
(f) Adjustments resulting
			 from an audit or review conducted by an entity other than the department are
			 subject to review and audit by the department.
(g) Except as otherwise required by law, the
			 department may prescribe or direct any or all procedures or requirements that
			 the district must follow with respect to any audits, reviews or fiscal
			 investigations.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 602 - Cost Allocation For Reimbursement Claiming › Section 602.2 - Cost allocation plans

Current through Register Vol. 46, No. 28, July 10, 2024
If a cost allocation plan is determined to be the
			   appropriate means of distributing costs among governmental entities or
			   activities and such plan is accepted by the department, all costs subject to
			   the plan must be allocated in accordance with such plan. Approval of a cost
			   allocation plan will not preclude the department from requiring adjustments of
			   any costs derived by means of the methods set forth in the plan.
(a) Intergovernmental unit cost allocation
			 plans. Cost allocation plans which provide a basis for distribution of costs of
			 a county, municipality or other governmental subdivision to a social services
			 district should be established in accordance with Federal, State and department
			 requirements. Such plans may be administered by a fiscal officer not under the
			 direct control of the district, but the district will remain responsible to the
			 department for insuring that the plan adheres to the department's requirements.
(1) Districts are required to submit an
			 annual certification to establish their authority to claim costs pursuant to
			 the plan for that fiscal year.
(2)
			 Plans will not permit direct expenses to be included as indirect expenses when
			 Federal, State or department procedures preclude such inclusions.
(3) Allocated expenditures must be claimed
			 for reimbursement in accordance with the requirements applicable to the
			 district submitting the claim, including any purchase of service contract
			 requirements or other requirements.
(4) Agreements between the district and other
			 governmental agencies pertaining to the allocation of administrative costs,
			 either directly or indirectly, must be made in accordance with department
			 requirements.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter F - Finance; Claims for Reimbursement by Social Services Districts › Article 1 - Reimbursement and Claims › Part 602 - Cost Allocation For Reimbursement Claiming › Section 602.3 - Cost allocation process

Current through Register Vol. 46, No. 28, July 10, 2024
Except as otherwise permitted by the department, social
			   services districts must use the cost allocation process prescribed by the
			   department and must use formats and procedures approved by the department to
			   calculate and record cost distributions derived through cost allocation. Social
			   services districts must also, in accordance with department
			   instructions:
(a) codify payroll and
			 nonsalary expenditures by function classifications using local district payroll
			 lists, ledgers or other records;
(b) enter and summarize salary and nonsalary
			 costs and staff counts by function on schedules approved by the
			 department;
(c) disperse
			 expenditures to direct function classifications to obtain total direct costs by
			 function on schedules approved by the department;
(d) allocate function costs to
			 classifications using workload measures or distribution methods or formulas
			 approved by the department;
(e)
			 compute Federal, State, local or other reimbursement percentages on schedules
			 approved by the department and summarize claims using formats accepted by the
			 department; and
(f) perform any
			 other requirements in relation to the cost allocation and claiming
			 process.