reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-4 - Early Intervention Program › Section 69-4.22 - Third-party payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Providers shall, in the first instance and where applicable, seek payment from
					 all third party payors, including governmental agencies, prior to claiming
					 payment from a given municipality for evaluations conducted under the program
					 and for services rendered to eligible children residing in the municipality and
					 their families, provided, however, that the provider shall not obtain payment
					 from a third party payor who is not prohibited from applying such payment, and
					 may apply such payment, to an annual or lifetime limit specified in the
					 insured's policy.
(1) A municipality, or its
					 designee, and a provider shall be subrogated, to the extent of the expenditures
					 by such municipality or for early intervention services furnished to an
					 eligible child or parent, to any rights the child or parent may have or be
					 entitled to for third party reimbursement.
(2) The provider shall submit notice to the
					 insurer or plan administrator of his or her exercise of the right of
					 subrogation upon the provider's assignment as the early intervention service
					 provider for the child.
(i) The right of
					 subrogation does not attach to benefits paid or provided under any health
					 insurance policy or health benefits prior to written notice of the exercise of
					 subrogation rights by the insurer.
(3) Providers shall utilize the department's
					 fiscal agent and data system for claiming payment for evaluations and services
					 rendered under the Early Intervention Program.
(i) Providers shall enroll, on request of the
					 department or the department's fiscal agent, with one or more health care
					 clearinghouses, as necessary, for processing of claims to third party payors
					 and for receipt of remittance advices in standard electronic format and in
					 compliance with any applicable Federal or State regulations with respect to
					 electronic claims transactions.
(4) Providers shall submit all claims for
					 payment of evaluations and services within 90 days of the date of service,
					 unless the submission is delayed due to extraordinary circumstances documented
					 by the provider and the department's fiscal agent has been notified of the
					 extraordinary circumstances and has provided written acknowledgement.
(i) All claims submitted after 90 days shall
					 be submitted within 30 days from the time the provider was relieved from the
					 extraordinary circumstances that previously delayed a timely
					 submission.
(ii) Claims that are
					 not submitted within timeframes set forth shall not be reimbursed by the
					 department's fiscal agent from the escrow account funded by municipal
					 governmental payors.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-4 - Early Intervention Program › Section 69-4.25 - Standards for agency providers approved to use applied behavior analysis (ABA) aides in the delivery of ABA (Repealed)

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Part:
(a)
Client
means any person
					 seeking or receiving the services of a rape crisis counselor for the purpose of
					 securing counseling or assistance concerning any sexual offense, sexual abuse,
					 incest or attempt to commit a sexual offense, sexual abuse, or incest, as
					 defined in the Penal Law.
(b)
Governing authority
means the entity or individual responsible
					 for the quality of services and the operation of the rape crisis
					 program.
(c)
Rape crisis
					 counselor
means any person certified by an approved rape crisis
					 program as having satisfied the training standards set forth in section 206  of the Public Health Law, and who is
					 acting under the direction and supervision of an approved rape crisis
					 program.
(d)
Rape crisis
					 program
means any office, institution or center, which has been
					 approved, pursuant to subdivision 15 of section 206  of the Public Health Law, to offer
					 counseling and assistance to clients concerning sexual offenses, sexual abuse
					 or incest.
(e)
Training
					 coordinator
means the individual, designated by the governing
					 authority who is responsible for overseeing the training and certification of
					 rape crisis counselors.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.2 - Eligibility for rape crisis program approval

Current through Register Vol. 46, No. 28, July 10, 2024
To be eligible for approval:
(a) The program must provide services to
					 alleviate the immediate and long term negative physical and emotional effects
					 of sexual assault and abuse. Services shall be accessible, confidential,
					 provided without coercion, and available to individuals regardless of age,
					 gender, race, ethnicity, sexual orientation, disability status, or ability to
					 pay. Nothing herein, however, shall prevent the operation of a program formed
					 to meet the special needs of persons from a particular community or group,
					 provided that the program gives the department a written assurance that it will
					 not refuse to provide services to any person who seeks assistance from the
					 program who is not a member of the target community or group that the program
					 serves. These services must include but need not be limited to:
(1) twenty-four hour access to crisis
					 intervention services including telephone hotline and phone counseling
					 capabilities;
(2) in-person
					 individual or group counseling;
(3)
					 community prevention education programs;
(4) training of professionals concerning
					 sexual assault issues;
(5)
					 accompaniment of victims to medical facilities;
(6) advocacy on behalf of victims within the
					 criminal justice system; and
(7)
					 information and referral services, based on established relationships with
					 human service providers, medical personnel, and law enforcement
					 officials.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.3 - Minimum training standards

Current through Register Vol. 46, No. 28, July 10, 2024
Rape crisis counselors must have at least 40 hours of
						training, at least 30 hours of which must have been completed prior to
						certification and the remainder of which must be completed within one year from
						the date of certification. This training shall include, but need not be limited
						to, instruction in the following:
(a)
					 the dynamics of sexual offenses, sexual abuse and incest;
(b) crisis intervention techniques;
(c) client-counselor confidentiality
					 requirements;
(d) communication
					 skills and intervention techniques;
(e) an overview of the State criminal justice
					 system;
(f) an update and review of
					 State laws on sexual offenses, sexual abuse and incest;
(g) the availability of State and community
					 resources for clients;
(h) working
					 with a diverse population;
(i) an
					 overview of child abuse and maltreatment identification and reporting
					 responsibilities; and
(j)
					 information on the availability of medical and legal assistance for such
					 clients.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.4 - Application/reapplication for rape crisis program approval

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Application for approval shall be made on
					 forms provided by the department. Information required from the applicant shall
					 include:
(1) a description of services
					 provided to victims of sexual offenses, sexual abuse or incest;
(2) a description of the program's community
					 prevention education, training of professionals and outreach
					 services;
(3) the program's
					 curriculum for training rape crisis counselors, or confirmation of intent to
					 use a curriculum approved by the department;
(4) a description of the program's training
					 program, referred to in section
					 69-5.3 
					 of this Subpart; and
(5) a
					 description of the program's procedures to evaluate and monitor program
					 services, including the performance of rape crisis
					 counselors.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.5 - Granting of approval

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Within 45 days of receipt of a complete application, the department shall issue
					 to each rape crisis program that meets the requirements of this Subpart,
					 approval to certify its rape crisis counselors for the confidentiality
					 privilege.
(b) Approval obtained
					 pursuant to subdivision (a) of this section shall continue for three years from
					 the date of notification by the commissioner of approval of the application
					 submitted by the rape crisis program until receipt by the organization of
					 written notice, from the commissioner, terminating approval of the program,
					 whichever occurs first. The commissioner may extend approval of the program for
					 additional three-year periods if the organization has complied with all
					 requirements of this section during the prior period of approval.
(c) If a program submits an application that
					 does not meet the requirements of this Subpart, the department will provide the
					 applicant with written comments regarding the required modifications needed to
					 obtain approval.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.6 - Certification of rape crisis counselors

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Rape crisis programs shall certify that
					 rape crisis counselors have met the training requirements set forth in section
					 69-5.3 
					 of this Subpart and shall keep records regarding certified rape crisis
					 counselors consisting of the following:
(1)
					 documentation of training received on the provision of services to victims of
					 sexual offenses, sexual abuse or incest;
(2) for rape crisis counselors with less than
					 40 hours of training, a plan for completing the training requirements within
					 one year from the date of certification;
(3) documentation of ongoing education and
					 training;
(4) an agreement signed
					 by each counselor to adhere to the program's client confidentiality
					 policy;
(5) annual performance
					 evaluation reports;
(6) an
					 attestation signed by the training coordinator that the rape crisis counselor
					 meets the minimum training requirements for certification; and
(7) an attestation signed by the training
					 coordinator that the rape crisis counselor has completed the 40 hours of
					 required training.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.7 - Technical assistance

Current through Register Vol. 46, No. 28, July 10, 2024
The department of Health shall provide technical
						assistance to approved rape crisis programs to implement training programs in
						accordance with the minimum standards set forth in this
						Subpart.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-5 - Approval Of Rape Crisis Programs For The Purpose Of Rape Crisis Counselor Certification › Section 69-5.8 - Periodic review

Current through Register Vol. 46, No. 28, July 10, 2024
For each approved rape crisis program, the department of
						Health shall perform on-site visits, review records or reports related to the
						program, and/or observe the training of rape crisis counselors as necessary to
						ensure compliance with the requirements of this Subpart.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-6 - Testing Of Newborns For Human Immunodeficiency Virus › Section 69-6.1 - Approval of providers

Current through Register Vol. 46, No. 28, July 10, 2024
Notwithstanding any other regulation, the department may
						approve providers which have medically acceptable protocols to screen blood of
						newborns, or with consent, the mother's blood, for human immunodeficiency virus
						antibodies and to communicate the results of such screening test to the mother
						or, if the mother lacks capacity to consent to health care for the newborn, to
						the person authorized by law to give such consent.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-7 - Tinted Glass In Motor Vehicles › Section 69-7.1 - Medical conditions for which an exemption from restrictions on tinted glass may be issued

Current through Register Vol. 46, No. 28, July 10, 2024
The following medical conditions, when their existence is
						certified by a physician, physician assistant or nurse practitioner, justify
						granting an exemption from the limits on light transmittance found in Vehicle
						and Traffic Law, section 375(12-a)(b), provided that personal protective
						measures such as sun protective clothing, sunscreen, or eye protective devices
						do not offer adequate protection:
Albinism;
chronic actinic dermatitis/actinic reticuloid;
dermatomyositis;
lupus erythematosus;
porphyria;
xeroderma pigmentosum;
severe drug photosensitivity, provided that the course of
						treatment causing the photosensitivity is expected to be of prolonged
						duration;
photophobia associated with an ophthalmic or neurological
						disorder; and
any other condition or disorder causing severe
						photosensitivity in which the individual is required for medical reasons to be
						shielded from the direct rays of the sun.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-8 - Newborn Hearing Screening › Section 69-8.2 - General requirements for infant hearing screening programs and responsibilities of the administrative officers or designees of facilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each facility
					 shall administer an infant hearing screening program, directly or by contract
					 pursuant to section
					 400.4  of this Title, as required
					 by this Part and as generally described in subdivision (b) of this section,
					 except for those facilities identified in subdivision (c) of this section.
(1) Facilities that establish a contract(s)
					 with providers of infant hearing screening shall designate a staff member
					 responsible for contract management and general oversight of the
					 program.
(2) Contracts may be
					 established for the conduct of inpatient and/or outpatient infant hearing
					 screening.
(3) Contractors must be
					 article 28 facilities or health care providers licensed under State Education
					 Law and authorized under such law to perform infant hearing
					 screening.
(4) Contractors shall
					 have the capacity to meet general requirements for infant hearing screening
					 programs as set forth in subdivision (b) of this section.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-8 - Newborn Hearing Screening › Section 69-8.3 - General requirements for administration of the Infant Hearing Screening Program

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 administrative officer of each facility caring for infants or their
					 contractor(s) shall designate a program manager responsible for management and
					 oversight of the Infant Hearing Screening Program.
(1) The program manager shall be a licensed
					 audiologist, physician, physician's assistant, registered nurse or nurse
					 practitioner.
(2) If the program
					 manager is not an audiologist, infant hearing screening procedures and training
					 shall be established and monitored in consultation with an
					 audiologist.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-8 - Newborn Hearing Screening › Section 69-8.4 - Procedures for infant hearing screening

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All infants born in the facility shall
					 receive an initial hearing screening prior to discharge from the facility,
					 pursuant to section
					 69-8.2(b)  of this
					 Subpart, except as provided in section
					 69-8.2(c)  of this
					 Subpart.
(b) Prior to the hearing
					 screening, parents shall be provided educational materials, supplied by the
					 department to the facility, or consistent in content with department-supplied
					 materials, regarding infant hearing screening.
(c) If the infant passes the hearing
					 screening, the results shall be documented in the infant's record by the
					 individual who performed the screening and documented in the discharge summary.
(1) The parent shall be informed of the
					 screening results prior to the infant's discharge from the facility.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-8 - Newborn Hearing Screening › Section 69-8.5 - General requirements for institutions caring for infants that provide a referral for infants to obtain hearing screening

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This section shall apply to those exempt
					 from direct administration of the infant hearing screening program. The
					 administrative officer of a facility as described in section
					 69-8.2(c)  of this
					 Subpart shall designate a program manager responsible for infant hearing
					 screening who shall ensure infants are referred for an outpatient screening for
					 hearing loss.
(b) The program
					 manager for infant hearing screening shall ensure that infants are referred,
					 prior to discharge from the facility, to a provider licensed under State
					 Education Law and authorized under such law to perform infant hearing screening
					 or an article 28 facility.
(1) The parent
					 shall be informed that the screening should be completed within four weeks of
					 the infant's discharge from the facility if possible and not later than 12
					 weeks following birth.
(2) The
					 parent shall be provided with education materials on the importance of early
					 detection of hearing loss, supplied by or consistent with department materials;
					 and, a list of licensed providers and/or article 28 facilities where infant
					 hearing screening may be obtained.
(3) The parent shall receive a prescription
					 for an outpatient screening by an article 28 provider or a provider licensed
					 under the State Education Law and authorized by such law to perform infant
					 hearing screening. The prescription shall require that results be returned to
					 the facility issuing the prescription.
(4) The referral, including issuance of a
					 prescription, shall be documented in the infant's record and discharge summary
					 to facilitate follow-up by the infant's primary health care provider.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-8 - Newborn Hearing Screening › Section 69-8.6 - Responsibilities of institutions caring for infants in special circumstances

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the event
					 that an infant is transferred from one facility to another such facility, the
					 facility discharging the infant to home shall be responsible for ensuring that
					 infant hearing screening services are provided to the infant and reported to
					 the department in a manner consistent with the applicable provisions set forth
					 in this Subpart. If the infant fails the inpatient infant hearing screening and
					 any follow-up outpatient infant hearing screening, the infant shall be referred
					 for an evaluation to the early intervention official in his or her county of
					 residence, according to the procedures set forth in section
					 69-4.3  of this Part unless the
					 parent objects. The parent's objection to a follow-up screening must be entered
					 into EHDI-IS or any successor system.
(b) Medically unstable infants shall receive
					 infant hearing screening prior to discharge to home and as early as development
					 or medical stability will permit such screening. In instances where the medical
					 condition of the infant contraindicates infant hearing screening, a decision to
					 forgo such screening may be made and documented in the medical record and
					 reported to the department in a manner consistent with the applicable
					 provisions set forth in this Subpart.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-8 - Newborn Hearing Screening › Section 69-8.7 - Responsibilities of Persons Performing Infant Hearing Screening

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Anyone who
					 performs an infant hearing screening and/or diagnostic audiological evaluation
					 upon a child under six months of age shall report the results of such screening
					 or evaluation to the department through the Early Hearing Detection and
					 Intervention - Information System (EHDI-IS) or any successor system as directed
					 by the department.
(b) Infant
					 hearing screening reporting must include:
(1)
					 the results of each newborn infant hearing screening performed and
(2) such other information or data as may be
					 required by the department to fulfill the purposes of this section.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-9 - Standard Infant Autopsy Procedures › Section 69-9.1 - Definition

Current through Register Vol. 46, No. 28, July 10, 2024
Autopsy
means a post-mortem external and
						internal physical examination conducted in accordance with the laws of New York
						State, as well as the performance of needed special studies. Infant autopsies
						are to be performed in accordance with the State of New York Infant Autopsy
						Protocol.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-9 - Standard Infant Autopsy Procedures › Section 69-9.2 - Use of New York State Infant Autopsy Protocol

Current through Register Vol. 46, No. 28, July 10, 2024
When an autopsy is performed on a person under the age of
						one year who dies under circumstances in which death is not anticipated by
						medical history or the cause is unknown, such autopsy must be performed in
						accordance with the New York State Infant Autopsy Protocol. This provision
						shall be subject to the limitations of section 4210-c  of the Public Health
						Law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-9 - Standard Infant Autopsy Procedures › Section 69-9.3 - New York State Infant Autopsy Protocol

Current through Register Vol. 46, No. 28, July 10, 2024
New York State department Of Health Infant
						Autopsy Protocol................................
Decedent's name
Age
Sex
Race/Ethnicity
Local accession number
Date of birth
Date/time of death
Date of autopsy
Pathologist
County
1) FINAL CAUSE AND MANNER OF
								  DEATH
2) STUDIES
Routine Studies
Normal
Abnormal
Not Done
Findings
Photographs
[]
[]
[]
Full-body X-Rays
[]
[]
[]
Toxicology
[]
[]
[]
Histopathology
[]
[]
[]
Neuropathology
[]
[]
[]
Metabolic Screening
[]
[]
[]
Blood/Tissue for future studies
[]
[]
[]
Studies, as indicated
Normal
Abnormal
Not Done
Findings
Viterous samples for glucose
[]
[]
[]
Microbiology/Virology
[]
[]
[]
Genetic Studies
[]
[]
[]
Electrolytes
[]
[]
[]
HIV Testing
[]
[]
[]
COMMENTS:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____ DOH-4278 (9/30) p1
3) CLINICAL SUMMARY
Maternal Age:
Birth Weight (in grams):
Gestational Age:
Pregnancy Complications:
Medical History
YES
NO
NOT AVAILABLE
COMMENTS
Maternal Smoking
[]
[]
[]
Maternal Alcohol Use
[]
[]
[]
Maternal Drug Use
[]
[]
[]
Sibling with SIDS
[]
[]
[]
Other Relative with SIDS
[]
[]
[]
Other Infant or Child Deaths
[]
[]
[]
Sleeping Position (put to sleep):
[] Supine
[] Prone
[] Side
[] Unknown
Co-Sleeping:
[] Yes
[] No
[] Unknown
Describe sleep habits and bedding, if
								  known:
COMMENTS:
4) DEATH SCENE
								  INVESTIGATION
[] Indicated
If indicated, state date:
[] Not indicated
If not indicated, state reason:
COMMENTS:
PATHOLOGIST
Date Form Completed
DOH-4278 (9/03) p2
Autopsy Format
* Final Diagnoses
* Final Cause and Manner of Death
* External Examination
* Portmortem Changes
* Scars / Other Distinguishing Characteristics
* Clothing
* Weights and Measures
* General Appearance / Development
* Injuries (External and Internal)
* Therapeutic Procedures
* Resuscitation Evidence
* External Integument
* Internal Examination Head Neck Body Cavities
						Cardiovascular System Respiratory System Liver, Gallbladder and Pancreas
						Hemolymphatic System Genitourinary System Endocrine System Digestive System
						Musculoskeletal System
* Post-Mortem Studies Full body X-rays Histopathology
						Toxicology Metabolic Screen Neuropathology Cultures Blood/Tissue retained for
						future studies Other
_____ DOH-4278 (9/03) p3
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.2 - Application and enrollment process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An application for enrollment into the
					 fund may be submitted by:
(1) a qualified
					 plaintiff;
(2) a person who is
					 authorized to act on a qualified plaintiff's behalf; or
(3) a defendant in a medical malpractice
					 claim or action that results in a court-approved settlement or judgment issued
					 on or after April 1, 2011, stating that the plaintiff sustained a
					 "birth-related neurological injury."
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.3 - Claims assistance manager

Current through Register Vol. 46, No. 28, July 10, 2024
Duties of the claims assistance manager shall include,
						but not be limited to, the following:
(a) answering questions regarding the
					 information and documentation needed for completion of the application
					 process;
(b) handling any issues
					 raised about alleged delays by the fund administrator in processing
					 applications, claims, reviews of claim denials, prior approval initial
					 determinations, and prior approval reviews; and
(c) assisting in resolving any issues
					 involving enrollees and case managers or the assignment of case
					 managers.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.4 - Case management

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Case management
means functions, including but not limited to:
(1) conducting an initial assessment and
					 periodic reassessments of the enrollee's medical needs;
(2) evaluating the enrollee's strengths,
					 informal support system and environmental factors relevant to his/her
					 care;
(3) reviewing information
					 provided by the enrollee, the enrollee's informal support system, and current
					 providers (including any school related or habilitation services) regarding the
					 services presently being provided to the enrollee and any existing gaps in the
					 services being provided to the enrollee;
(4) establishing a comprehensive, written
					 case management plan to assist the enrollee or the enrollee's caregiver to
					 manage the delivery of all qualifying health care services needed by the
					 enrollee;
(5) assisting an enrollee
					 or the enrollee's caregiver to obtain services set forth in the case management
					 plan for the enrollee through referral to agencies or persons qualified to
					 provide those services;
(6)
					 assisting the enrollee with any forms necessary for the receipt of or payment
					 for services;
(7) assisting crisis
					 intervention in the event that the enrollee has emergency service
					 needs;
(8) developing and
					 maintaining a list of alternative provider sources that may be available to the
					 enrollee in the event of service disruption, and making that list available
					 upon the request of the enrollee or the enrollee's caregiver; and
(9) monitoring the services provided under
					 the case management plan, by:
(i) verifying
					 that the services identified in the case management plan are being received by
					 the enrollee in the amount and frequency specified in the case plan;
					 and
(ii) documenting the case
					 record regarding the enrollee's medical condition and progress made;
if the enrollee already has a case manager in another
						health related program, the fund administrator's case manager shall coordinate
						the enrollee's care in conjunction with the other case manager.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.5 - Claims submission process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All providers providing services to an
					 enrollee must accept assignment of payment from the fund.
(b) The claims submission process will
					 include both electronic and manual options for submission of claims.
(c) The unique enrollee identifier must be
					 included in the designated area of the claim form.
(d) Claims shall be submitted within 90 days
					 of the date of service and will be paid within 45 days of receipt of an
					 acceptable claim form. A request for permission to submit a claim later than 90
					 days from the date of service maybe granted by the fund administrator upon a
					 showing of good cause for the delay.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.6 - Prior approval request process

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Expenses that require prior approval.
Assistive technology, vehicle modifications,
						environmental modifications, myo-electric limbs, certain types of
						transportation for medical care and services (including travel involving
						overnight accommodations), private duty nursing, treatment with a specialty
						drug, experimental treatment for which the enrollee's provider has submitted
						documentation that complies with the same standards set out in section 4910 (2)(b)(i)-(iii)  of the
						Public Health Law, custom-made durable medical equipment, hearing aids, and
						more than 1,080 hours of respite care in a calendar year.
(b) Prior approval requests, other than
					 emergency requests as set forth in section
					 69-10.15 
					 of this Subpart, will be determined within 30 days from the date all necessary
					 documentation in support of the request has been received.
(c)
General documentation
					 requirements.
In the absence of more specific requirements for
						particular types of expenses, every request for prior approval except for
						private duty nursing, which is subject to the requirements of section
						69-10.10 
						of this Subpart, must be accompanied by a written statement from the enrollee's
						treating physician stating why the service, equipment, or treatment in issue is
						necessary.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.7 - Prior approval requests for emods

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An emod may be approved only when made to
					 the enrollee's primary residence, except that if physical custody is being
					 shared pursuant to a court order, an emod may also be approved pursuant to this
					 section when made to the primary residence of the enrollee's non-custodial
					 parent. Proof of ownership of the residence to which the modification(s) are
					 being requested must be submitted to the fund administrator. If the requesting
					 party does not own the residence, written permission of the property owner must
					 be provided. A non-custodial parent applying for an emod to his or her primary
					 residence must also provide a certified copy of the court order awarding shared
					 physical custody.
(b) Any emod
					 approved by the fund administrator must meet all applicable State and local
					 building codes.
(c) The fund
					 administrator may not approve any emod that:
(1) constitutes an improvement to the home
					 that is not medically necessary to ensure the health, welfare and safety of the
					 enrollee by enabling him or her to function with greater independence in the
					 community and/or by helping him or her to avoid institutionalization;
					 or
(2) does not comply with
					 Americans with Disabilities Act (ADA) Accessibility Standards or Guidelines or
					 the Fair Housing Act, if applicable, or has not been determined to be safe by a
					 rehabilitative evaluation agency or specialist or a building contractor as
					 required in paragraph (d)(2) of this section.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.8 - Conditional prior approval for emods to prospective primary residences

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An emod may be
					 conditionally approved for a prospective primary residence of an enrollee,
					 including new construction, provided payment is conditioned upon the following:
(1) the fund administrator approves the Emods
					 to be made to the specified property in accordance with the requirements of
					 this section;
(2) the enrollee or
					 the enrollee's custodial guardian has or obtains lawful title to the property
					 to which the Emods are to be made;
(3) installation or construction of the emod
					 is completed; and
(4) the fund
					 administrator has received a post-modification evaluation stating that the
					 modification meets the enrollee's functional needs and is in compliance with
					 the initial evaluation, including adherence to safety and all applicable
					 building code standards.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.10 - Prior approval requests for assistive technology (AT)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A request for
					 AT, as defined in section
					 69-10.1  of
					 this Subpart, will be considered to include a request for AT services, which is
					 assistance provided to the enrollee in the selection, acquisition, and use of
					 the appropriate AT device and necessary training of the enrollee, the
					 enrollee's informal supports, and any paid staff who provide assistance to the
					 enrollee at a time when he or she will be using the AT.
(b) Providers of AT to enrollees of the fund
					 must meet one of the following qualifications:
(1) be approved as provider pursuant to 18
					 NYCRR Part 504;
(2) be a provider
					 of AT services to the home and community based services waiver program
					 administered by the New York State Office for Persons with Developmental
					 Disabilities or, if the enrollee lives in the District of Columbia or a state
					 other than New York, be a provider for a similar waiver program in the district
					 or other state;
(3) be a licensed
					 and registered pharmacist;
(4) be a
					 durable medical equipment (DME) provider; or
(5) for personal emergency response systems
					 (PERS), be an approved PERS provider with existing contracts with local social
					 services districts or if provided in another state, or the District of Columbia
					 be approved by the appropriate state agency in that state or in the District of
					 Columbia.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.11 - Prior approval for private duty nursing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A request for private duty nursing in the
					 hospital or in the home must be accompanied by a physician's written order and
					 treatment plan.
(b) In a hospital
					 setting, the physician's order must state that the enrollee is in need of
					 individual and continuous care beyond that available by the staff of a
					 hospital, including that which is available in the hospital's critical care
					 area.
(c) For nursing services to
					 be provided in the enrollee's home, the physician's order must state either
					 that there is no approved home health agency available to provide the
					 intermittent or part-time nursing services needed by the enrollee or that the
					 enrollee is in need of individual and continuous care beyond that available
					 from an approved home health agency. The fund administrator may request such
					 periodic treatment plans and other medical information as he or she determines
					 the particular circumstances warrant prior to approving additional periods of
					 private duty nursing.
(d) In an
					 emergency situation, the treating physician may order the services of a private
					 duty nurse for no more than two nursing days and immediately submit a prior
					 approval request for private duty nursing services on behalf of the enrollee on
					 an expedited basis pursuant to section
					 69-10.15 
					 of this Subpart.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.12 - Prior approval requests for certain transportation for medical care and services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Requests for prior approval for transportation for medical care and services
					 may be made by the enrollee or a person authorized to act on the enrollee's
					 behalf. Such a request may be made for a one-time appointment or for multiple
					 appointments during a specific period of time. A request for prior approval for
					 non-emergency ambulance transportation or transportation by ambulette must be
					 accompanied by the order of the practitioner who is the enrollee's attending
					 physician, nurse practitioner, or physician assistant.
(b) Payments will only be made to commercial
					 providers of transportation that met all applicable requirements for providing
					 the transportation services requested on the date(s) that the transportation is
					 provided.
(c) The following
					 criteria will be used in determining whether to approve a transportation prior
					 approval request:
(1) whether the nature
					 and/or severity of the enrollee's condition necessitates a mode of
					 transportation other than that ordinarily used by the enrollee or the
					 transportation requested is the only mode of transportation that can safely be
					 used by the enrollee;
(2) whether
					 the enrollee needs multiple treatments or visits over a short period of time
					 that would cause an undue financial hardship to the enrollee or the enrollee's
					 family if required to pay for the transportation for such visits even though
					 the transportation being used is the same transportation used by the enrollee
					 for other activities in his or her community;
(3) whether the geographic location of the
					 enrollee and the provider of medical care and/or services are such that the
					 usual mode of transportation would be inappropriate;
(4) whether the distance to be traveled for
					 the medical care and/or services would require a large transportation expense
					 that would result in an undue financial hardship for the enrollee or the
					 enrollee's family;
(5) whether the
					 need to continue a regimen of medical care or services with a specific provider
					 requires travel outside of the geographic region in which the enrollee's
					 community customarily obtains its medical care and services; and
(6) whether there are any other circumstances
					 that are unique to the enrollee and support the payment of the transportation
					 expenses requested.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.13 - Prior approval for treatment with a specialty drug

Current through Register Vol. 46, No. 28, July 10, 2024
A request for prior approval of treatment with a
						specialty drug must be accompanied by a written statement from the enrollee's
						treating physician stating why treatment with the specialty drug is necessary,
						what other alternatives have been tried or explored, and what testing the
						enrollee has undergone for purposes of determining whether treatment with the
						specialty drug is appropriate and safe for the enrollee. All requests for prior
						approval for treatment with a specialty drug will be reviewed by the pharmacy
						benefits manager for the fund administrator and a determination will be made
						within three business days of receipt of all necessary information from the
						enrollee's treating physician.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.14 - Prior approval requests for experimental treatment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A request for prior approval for
					 experimental treatment must be accompanied by a letter from the treating
					 physician explaining why the enrollee needs the experimental treatment being
					 requested and documentation that either no standard treatment has been
					 effective in treating the enrollee or there is no standard treatment available
					 to treat the enrollee's condition, injury or impairment.
(b) All requests for prior approval for
					 experimental treatment involving the use of an experimental medication will be
					 reviewed by the fund administrator's pharmacy benefits manager.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter H - Family Health › Part 69 - Family Health › Subpart 69-10 - NYS Medical Indemnity Fund › Section 69-10.15 - Expedited prior approval process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An expedited prior approval determination
					 will be made within two business days of receiving a prior approval request of
					 a physician on the physician's letterhead that states that the enrollee has an
					 emergency need for a service or item that requires prior approval and the
					 reason that the service or item is needed on an expedited basis and any other
					 supporting documentation provided by the physician.
(b) The service or item may be provided to
					 the enrollee in an emergency situation when there is no one from the fund
					 administrator available to approve the request, provided that an expedited
					 approval request is submitted within two business days of the determination of
					 the emergency need. A claim for the provision of the service or item for the
					 period from the time the emergency need was determined to the time of issuance
					 of the review determination, if applicable, can be submitted to the fund
					 administrator for payment, provided that there are no delays as the result of
					 an untimely submission of supporting documentation or a request for an
					 extension of time on the part of the enrollee or any person acting on the
					 enrollee's behalf.