Opinion ID: 610562
Heading Depth: 2
Heading Rank: 2

Heading: New York's Statutory Scheme

Text: 5 In April 1992, New York amended Social Services Law Section 367-a(6)(a) to reduce payments to medical providers by an amount not to exceed the maximum amount authorized by federal law and regulations as a co-payment amount, which co-payment amount the provider of such services may charge the recipient. N.Y.Soc.Serv.Law § 367-a(6)(a). The statute sets maximum charges for particular services, ranging generally from $.50 to $3.00, see id. § 367-a(6)(c), and sets an annual recipient cap of $100. See id. § 367-a(6)(f) (beginning April 1, 1993). The DSS established standard co-payments for services based on the average cost of the services. See N.Y.Comp.Codes R. & Regs. tit. 18, § 360-7.12(f)(2) (1992). 6 Only those services actually listed in Section 367-a(6)(d) are subject to co-payments. Pursuant to federal law, New York exempts certain services from co-payments, including services for emergencies, family planning, mental health, mental retardation, developmental disabilities, and substance abuse. See N.Y.Soc.Serv.Law § 367-a(6)(d). Psychotropic drugs and drugs for the treatment of tuberculosis are also exempted. See id. § 367-a(6)(d)(v). Also as required by the federal Medicaid statute, New York exempts certain persons from co-payments, including individuals under twenty-one years of age, pregnant women, residents of medical institutions, and persons enrolled in managed care programs, including health maintenance organizations (HMOs). See id. § 367-a(6)(b). 7 Even if the service or the recipient does not fall within an exemption, the recipient need not make the co-payment if unable to afford it. Section 367-a(6)(a) provides that no provider may deny such services to an individual eligible for services based on the individual's inability to pay the co-payment amount. Id. § 367-a(6)(a). Section 367-a(6)(g)(i) also instructs the commissioner to promulgate a regulation making it an unacceptable practice under the medical assistance program for a provider to deny services to an individual eligible for services based on the individual's inability to pay the co-pay amount. Finally, the statute requires DSS to establish and maintain a toll-free hotline for recipients to report violations of such regulations, see id. § 367-a(6)(g)(ii), and to provide notice to all recipients summarizing their rights and obligations under this subdivision. Id. § 367-a(6)(g)(iii).