Part 46 - State Aid For Physically Handicapped Children

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Statutory Authority: 
Public Health Law, Sections 2500-a, 2583

Section 46.1 - Definition of medical service

Section 46.1 Definition of medical service.

Medical service, as it relates to physically handicapped children, means such diagnostic, therapeutic and rehabilitative care by medical and paramedical personnel, including hospital and related care, and drugs, prostheses, appliances, equipment and devices, as necessary.
 

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Section 46.2 - Conditions eligible

46.2 Conditions eligible.

Conditions for which medical service is reimbursable under State aid to counties or the City of New York under the physically handicapped children program shall be only those approved by the Bureau of Medical Rehabilitation, the Bureau of Dental Health, or the Bureau of Maternal and Child Health of the State Department of Health.
 

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Section 46.3 - Qualified consultants

46.3 Qualified consultants.

Professional services rendered by medical and dental specialists or consultants will be approved for reimbursement only if rendered by personnel listed in the department's file of clinical consultants and, when in-hospital care is required, if the hospital meets standards set forth in section 46.4 of this Part.
 

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Section 46.4 - Accredited hospitals

46.4 Accredited hospitals.

Payment for care in hospitals will be made only if the hospital appears on the department's list of accredited hospitals, and the care is supervised by a consultant listed in the department's file of clinical consultants as set forth in section 46.3 of this Part.
 

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Section 46.5 - Maximum fees

46.5 Maximum fees.

State aid for service rendered will not be paid in excess of the fees included in the schedule of maximum fees established by the State Department of Health.
 

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Section 46.6 - Inpatient hospital and related care

46.6 Inpatient hospital and related care.

Reimbursement for inpatient care rendered by hospitals shall be made at all-inclusive per diem rates not to exceed those established by the State of New York Joint Committee on Hospital Rates.
 

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Section 46.7 - Payment for outpatient and related service

46.7 Payment for outpatient and related service.

Fees for outpatient and related service may not exceed those established in the department's schedule of maximum fees.
 

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Section 46.8 - Out-of-state care

46.8 Out-of-state care.

Out-of-state care will not be approved for State-aid reimbursement unless specific exception is made by the Commissioner of Health.
 

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Section 46.9 - Procedures and treatment at approved centers

46.9 Procedures and treatment at approved centers.

(a) Heart surgery. Definitive diagnoses and surgical procedures by open or closed techniques will be approved for State-aid reimbursement by the Bureau of Medical Rehabilitation only when such services are performed at centers specifically approved by the department for the type of heart surgery involved.

(b) Other specific conditions. Unless specific exception is made by the Commissioner of Health, State-aid reimbursement shall be made for the initial evaluation and recommendations for a treatment program for children with the following conditions only when such services are performed at centers approved by the Commissioner of Health for such care:

(1) amputation;

(2) chronic asthma;

(3) blood dyscrasias;

(4) cancer;

(5) convulsive disorders;

(6) cystic fibrosis;

(7) diabetes mellitus;

(8) impaired hearing;

(9) complicated injuries, particularly to head and back, and mutilating injuries of the face and extremities;

(10) prematurity;

(11) chronic renal disease;

(12) phenylketonuria;

(13) branched-chain ketonuria;

(14) galactosemia;

(15) homocystinuria;

(16) histidinemia;

(17) congenital hypothyroidism.
 

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Section 46.10 - Financial investigators

46.10 Financial investigators.

(a) Definition. A financial investigator is a person employed under a county physically handicapped children's program for the purpose of:

(1) conducting financial investigations of families of children for whom care has been requested under the program; and

(2) detecting problems in families which may have a bearing on the utilization or outcome of services provided under the program, and referring families to appropriate agencies for help regarding these problems.

(b) Qualifications. The financial investigator shall meet one of the following qualifications:

(1) graduation from a recognized college or university with a bachelor's degree;

(2) satisfactory completion of training leading to nursing registration, and one year of satisfactory full-time experience as a registered professional nurse;

(3) four years of satisfactory full-time paid experience either in financial investigations or in casework with a social work agency adhering to acceptable standards or in supervised teaching in an accredited school;

(4) a satisfactory combination of the training and experience described in paragraphs (1)-(3) of this subdivision; or

(5) full-time employment specifically in the performance of financial investigations under the physically handicapped children's program as of April 1, 1964.
 

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Section 46.11 - Foreign diplomatic personnel

46.11 Foreign diplomatic personnel.

No medical services shall be approved for State-aid reimbursement under this program for any staff member of a foreign legation, consulate, embassy or mission, or for any child of such staff member who resides with such staff member. Provision of medical services shall be the responsibility of the foreign country through its appropriate representative in the United States.
 

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