New York Social Services Law Title 11 - MEDICAL ASSISTANCE FOR NEEDY PERSONS

• 363 - Declaration of Objects.
  Medical assistance for needy persons is hereby declared to be a matter of public concern and a necessity in promoting the public health and welfare...
• 363-a - Federal Aid; State Plan.
  1. The department of health shall submit and maintain a plan for medical assistance, as required by title XIX, or any successor title, of the...
• 363-b - Agreements for Federal Determination of Eligibility of Aged, Blind and Disabled Persons for Medical Assistance.
  1. In order to avoid costly, duplicative administrative responsibility, the department on behalf of the state may, with the approval of the director of the...
• 363-c - Medicaid Management.
  1. The commissioner of the department periodically shall convene, but not less than quarterly and no more than monthly, meetings of the directors and commissioners...
• 363-d - Provider Compliance Program.
  1. The legislature finds that medical assistance providers may be able to detect and correct payment and billing mistakes and fraud if required to develop...
• 363-e - Medicaid Plan, Applications for Waivers and Plan Amendments; Public Disclosure.
  * 1. The commissioner of health shall post on the department of health internet website in as timely a manner as practical the entirety of...
• 363-e*2 - Preclaim Review for Participating Providers of Medical Assistance Program Services and Items.
  * 363-e. Preclaim review for participating providers of medical assistance program services and items. The department of health and the office of the Medicaid inspector...
• 364 - Responsibility for Standards.
  To assure that the medical care and services rendered pursuant to this title are of the highest quality and are available to all who are...
• 364-a - Cooperation of State Departments.
  1. There shall be such cooperative arrangements, between and among the department of health and other state departments and agencies as shall be necessary to...
• 364-b - Residential and Medical Care Placement Demonstration Projects.
  * 1. Notwithstanding any inconsistent provisions of this chapter or any other law to the contrary, social services districts are hereby authorized to conduct or...
• 364-c - National Long Term Care Channeling Demonstration Project.
  * 1. Notwithstanding any inconsistent provisions of this chapter or any other law to the contrary, the Rensselaer county social services district is hereby authorized...
• 364-d - Medical Assistance Research and Demonstration Projects.
  * 1. The department is authorized to sponsor, conduct and participate in the following research and demonstration projects: "Eldercare: A Social Health Maintenance Organization", "New...
• 364-e - Aid to Families With Dependent Children Homemaker/home Health Aide Demonstration Projects.
  * 1. Notwithstanding sections three hundred sixty-six and three hundred sixty-eight-a of this chapter, the department shall have the authority to enter into agreements with...
• 364-f - Primary Care Case Management Programs.
  * 1. The department is authorized to establish primary care case management programs, under the medical assistance program, in accordance with applicable federal law and...
• 364-g - Medical Assistance Capitation Rate Demonstration Project.
  * 1. The department and the county of Monroe are authorized to participate in the "Monroe County Medicap Plan" research and demonstration project, for the...
• 364-h - Foster Family Care Demonstration Programs for Elderly or Disabled Persons.
  * 1. The department is authorized to designate up to ten entities which may include general hospitals, residential health care facilities, home health care programs,...
• 364-i - Medical Assistance Presumptive Eligibility Program.
  1. An individual, upon application for medical assistance, shall be presumed eligible for such assistance for a period of sixty days from the date of...
• 364-j - Managed Care Programs.
  * 1. Definitions. As used in this section, unless the context clearly requires otherwise, the following terms shall mean: (a) "Participant". A medical assistance recipient...
• 364-j-2 - Transitional Supplemental Payments.
  1. As used in this section, "covered provider" shall mean a voluntary not-for-profit health care provider that is any of the following: (a) a freestanding...
• 364-Jj - Special Advisory Review Panel on Medicaid Managed Care.
  * (a) There is hereby established a special advisory review panel on Medicaid managed care. The panel shall consist of sixteen members who shall be...
• 364-Kk - Condition of Participation.
  1. Notwithstanding any provision of law to the contrary, in addition to the requirements for participation in the medical assistance program as may be required...
• 364-m - Statewide Patient Centered Medical Home Program.
  * 1. The commissioner of health is authorized to certify certain clinicians and clinics as health care homes in order to improve health outcomes and...
• 365 - Responsibility for Assistance.
  1. Subject to supervision by the department: (a) each public welfare district shall furnish medical assistance to the persons eligible therefor who reside in its...
• 365-a - Character and Adequacy of Assistance.
  The amount, nature and manner of providing medical assistance for needy persons shall be determined by the public welfare official with the advice of a...
• 365-b - Local Medical Plans: Professional Directors.
  1. A local social services medical plan shall be developed and maintained by each social services district under the guidance or direction of a professional...
• 365-c - Medical Advisory Committee.
  1. A medical advisory committee is hereby established to consist of twenty members who shall be appointed by the governor, by and with the advice...
• 365-d - Medicaid Evidence Based Benefit Review Advisory Committee.
  1. The department shall convene a Medicaid evidence based benefit review advisory committee. The committee shall provide advice and make recommendations regarding coverage of health...
• 365-e - Optional or Continued Membership in Entities Offering Comprehensive Health Services Plans.
  1. In accordance with applicable federal requirements and subject to the approval of the commissioner and the director of the budget, a district shall offer...
• 365-f - Consumer Directed Personal Assistance Program.
  1. Purpose and intent. The consumer directed personal assistance program is intended to permit chronically ill and/or physically disabled individuals receiving home care services under...
• 365-g - Utilization Thresholds for Certain Care, Services and Supplies.
  1. The department may implement a system for utilization controls, pursuant to this section, for persons eligible for benefits under this title, including annual service...
• 365-h - Provision and Reimbursement of Transportation Costs.
  * 1. The local social services official and, subject to the provisions of subdivision four of this section, the commissioner of health shall have responsibility...
• 365-j - Advisory Opinions.
  1. General. (a) Definition and nature of advisory opinions. An advisory opinion is a written statement, issued pursuant to the provisions of this chapter, by...
• 365-k - Provision of Prenatal Care Services.
  1. The commissioner shall establish standards and guidelines for the provision of prenatal care services under the medical assistance program. In establishing such standards and...
• 365-l - Health Homes.
  1. Notwithstanding any law, rule or regulation to the contrary, the commissioner of health is authorized, in consultation with the commissioners of the office of...
• 365-m - Administration and Management of Behavioral Health Services.
  1. The commissioners of the office of mental health and the office of alcoholism and substance abuse services, in consultation with the commissioner of health,...
• 365-n - Department of Health Assumption of Program Administration.
  1. Notwithstanding the provisions of title two of article three of this chapter or of section three hundred sixty-five of this title or of any...
• 366 - Eligibility.
  1. (a) Definitions. For purposes of this section: (1) "benchmark coverage" refers to medical assistance coverage defined in subdivision one of section three hundred sixty-five-a...
• 366-a - Applications for Assistance; Investigations; Reconsideration.
  1. Any person requesting medical assistance may make application therefor by a written application to the social services official of the county in which the...
• 366-b - Penalties for Fraudulent Practices.
  1. Any person who knowingly makes a false statement or representation, or who by deliberate concealment of any material fact, or by impersonation or other...
• 366-c - Treatment of Income and Resources of Institutionalized Persons.
  1. Notwithstanding any other provision of law to the contrary, in determining the eligibility for medical assistance of a person defined as an institutionalized spouse,...
• 366-d - Medical Assistance Provider; Prohibited Practices.
  1. Definitions. As used in this section, "medical assistance provider" means any person, firm, partnership, group, association, fiduciary, employer or representative thereof or other entity...
• 366-e - Certified Home Health Agency Medicare Billing.
  (a) Certified home health agencies shall bill under title XVIII of the federal social security act for services provided to all patients eligible for such...
• 366-f - Persons Acting in Concert With a Medical Assistance Provider; Prohibited Practices.
  1. No person acting in concert with a medical assistance provider shall, with intent to defraud: (a) solicit, receive, accept or agree to receive or...
• 366-g - Newborn Enrollment for Medical Assistance.
  1. Each hospital licensed under article twenty-eight of the public health law shall report to the department of health, or such other entity designated by...
• 366-h - Automated System; Established.
  Notwithstanding any inconsistent provision of law or regulation, the commissioner of health shall, as soon as practicable, establish an automated system to ensure that persons...
• 366-i - Long-Term Care Financing Demonstration Program.
  1. Notwithstanding any inconsistent provision of sections three hundred sixty-six or three hundred sixty-six-c of this title, or any other provision of law, the commissioner...
• 367 - Authorization for Hospital Care.
  1. Except as permitted by the regulations of the department, so far as practicable, no patient shall be admitted to a hospital as a public...
• 367-a - Payments; Insurance.
  1. (a) Any inconsistent provision of this chapter or other law notwithstanding, no assignment of the claim of any supplier of medical assistance shall be...
• 367-b - Medical Assistance Information and Payment System.
  1. The department shall design and implement a statewide medical assistance information and payments system for the purpose of providing individual and aggregate data to...
• 367-c - Payment for Long Term Home Health Care Programs.
  1. If a long term home health care program as defined under article thirty-six of the public health law is provided in the social services...
• 367-d - Personal Care Need Determination.
  * The commissioner shall annually determine the statewide need for personal care services for all recipients except for those receiving personal care services pursuant to...
• 367-e - Payment for Aids Home Care Programs.
  1. If an AIDS home care program as defined under article thirty-six of the public health law is provided in the social services district for...
• 367-f - Partnership for Long Term Care Program.
  1. Definitions. As used in this section: (a) "Medicaid extended coverage" shall mean eligibility for medical assistance (i) without regard to the resource requirements of...
• 367-g - Authorization and Provision of Personal Emergency Response Services.
  1. Personal care services and home health services shall include, where appropriate as determined by the social services district, the provision of personal emergency response...
• 367-h - Payment for Assisted Living Programs.
  1. Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for assisted living...
• 367-i - Personal Care Services Provider Assessments.
  1. Providers of personal care services, excepting those certified under article thirty-six of the public health law, are charged assessments on their gross receipts received...
• 367-o - Health Insurance Demonstration Programs.
  1. Notwithstanding any inconsistent provision of law, the commissioner of health is authorized to establish one or more demonstration programs for the purposes of providing...
• 367-p - Responsibilities of Local Districts for Personal Care Services, Home Care Services and Private Duty Nursing.
  * Consistent with the provisions of section three hundred sixty-seven-n of this title, local social services district responsibilities for personal care services, home care services...
• 367-p*2 - Payment for Limited Home Care Services Agencies.
  * 367-p. Payment for limited home care services agencies. 1. Notwithstanding any law to the contrary, the commissioner shall, subject to the approval of the...
• 367-q - Personal Care Services Worker Recruitment and Retention Program.
  1. The commissioner of health shall, subject to the availability of federal financial participation adjust personal care services medical assistance rates of payment established pursuant...
• 367-r - Private Duty Nursing Services Worker Recruitment and Retention Program.
  1. The commissioner of health shall, subject to the provisions of subdivision two of this section and to the availability of federal financial participation, increase...
• 367-s - Long Term Care Demonstration Program.
  * 1. Notwithstanding any inconsistent provision of law, the commissioner of health is authorized to establish a long term care demonstration program for persons eligible...
• 367-s*2 - Emergency Medical Transportation Services.
  * 367-s. Emergency medical transportation services. 1. Notwithstanding any provision of law to the contrary, a supplemental medical assistance payment shall be made on an...
• 367-t - Payment for Emergency Physician Services.
  Amounts payable under this title for medical assistance for items and services provided to eligible persons by qualified emergency physicians, provided in an emergency room...
• 367-u - Payment for Home Telehealth Services.
  1. Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates...
• 367-v - County Long-Term Care Financing Demonstration Program.
  1. Notwithstanding any inconsistent provision of law, the commissioner is authorized to establish a long-term care financing demonstration program, to operate in up to five...
• 368 - Quarterly Estimates.
  Each public welfare district shall submit to the department quarterly estimates of its anticipated expenditures for medical assistance for needy persons and administrative expenses not...
• 368-a - State Reimbursement.
  1. The department shall review the expenditures made by social services districts for medical assistance for needy persons, and the administration thereof, before making reimbursement....
• 368-b - State Reimbursement to Local Health Districts; Chargebacks.
  1. Each approved local health district which enters into a contract with the department of health pursuant to section three hundred sixty-four-a of this title...
• 368-c - Audit of State Rates of Payment to Providers of Health Care Services.
  1. The commissioner may conduct, or have conducted, an audit of financial and statistical reports used for the purpose of establishing rates of payment or...
• 368-d - Reimbursement to Public School Districts and State Operated/state Supported Schools Which Operate Pursuant to Article Eighty-Five, Eighty-Seven or Eig
  368-d. Reimbursement to public school districts and state operated/state supported schools which operate pursuant to article eighty-five, eighty-seven or eighty-eight of the education law. 1....
• 368-e - Reimbursement to Counties for Pre-School Children With Handicapping Conditions.
  1. The department of health shall review claims for expenditures made by counties and the city of New York for medical care, services and supplies...
• 368-f - Reimbursement of Costs Under the Early Intervention Program.
  1. The department shall review claims for expenditures made by or on behalf of social services districts for the administration of the early intervention program...
• 369 - Application of Other Provisions.
  1. All provisions of this chapter not inconsistent with this title shall be applicable to medical assistance for needy persons and the administration thereof by...

Last modified: February 3, 2019