SubChapter B - State Aid and Funding

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete

Part 39 REPEALED

Effective Date: 
Wednesday, December 31, 2014

Part 40 - State Aid For Public Health Services: Counties And Cities

Effective Date: 
Wednesday, November 23, 2016
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, art. 6

SubPart 40-1 - Application and Payment

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.0 - Applications for State aid

Section 40-1.0 Applications for State Aid

(a) To be eligible for State Aid, local health departments shall annually submit to the department a detailed application for State Aid in a form specified by the commissioner.

(b) Each local health department shall submit its application for State Aid to the department no later than two months after the commencement of the fiscal year for which it is seeking State Aid.

(c) The application for State Aid shall include:
(1) an organizational chart of the local health agency and a list of the number of employees by job title providing public health services;

(2) a budget of proposed expenditures; (3) a description of how the local health department will provide public health services in a form determined by the commissioner;

(4) an attestation by the chief executive officer of the municipality that sufficient local funds have been appropriated to provide the public health services for which the local health department is seeking State Aid; (5) an attestation by the public health commissioner or director that the local health department has exercised due diligence in reviewing the State Aid application and that the application seeks State Aid only for eligible public health services; (6) a list of public health services provided by the local health department that are not eligible for State Aid, and the cost of each service; (7) a projection of the fees and revenues to be collected for public health services eligible for State Aid; and (8) any other information or documents required by the commissioner.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.10 - Performance and accountability; reporting

Section 40-1.10 Performance and accountability; reporting

(a) The commissioner shall establish, in consultation with the local health departments and the New York State Association of County Health Officials, uniform statewide performance standards for the services funded pursuant to Article 6 of the Public Health Law; provided, however, that upon request the commissioner may approve a modification of a specific standard for a local health department if such local health department demonstrates adequate justification. The commissioner shall recognize the particular needs and capabilities of the various local health departments. The commissioner shall monitor the performance and expenditures of each local health department to ensure that each one satisfies the performance standards.

(b) The commissioner shall establish, in consultation with the local health departments and the New York State Association of County Health Officials, a uniform accounting system for monitoring the expenditures for services of each local health department to which aid is granted and the amount of state aid received including any performance payments pursuant to section six hundred nineteen-a of Article 6 of the Public Health Law. Such reporting system shall require information on the amount of public health moneys received from the federal government, the private sector, grants, and fees.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.20 - Personnel

Section 40-1.20 Personnel

(a) Local health department personnel must meet the entry and supervisory level qualifications established by Part 11 of the State Sanitary Code (10 NYCRR Part 11), as applicable.

(b) All public health services shall be supervised by a local commissioner of health or public health director, to ensure that such services are provided in accordance with the approved State Aid application. Such supervising official shall devote his or her entire time to public health duties, provided that:

(1) such official may serve as the head of a merged agency or multiple agencies if the approval of the commissioner is obtained; or

(2) such official may serve as the local commissioner of health or public health director of additional counties when authorized pursuant to section 351 of the public health law.

(c) All local health departments referred to herein shall not be in violation of the Civil Rights Act of 1964 (42 USCA 2000 et seq.) and the regulations promulgated by the United States Department of Health and Human Services (45 CFR part 80). The purpose of such statute and regulations is to assure that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program activity receiving Federal financial assistance from the Department of Health and Human Services. The local health department shall submit to the commissioner, in triplicate, the Assurance of Compliance form required by the Department of Health and Human Services. Such form must be submitted by present recipients of State Aid as well as by all future applicants.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.30 - Maintenance of effort

Section 40-1.30 Maintenance of effort

(a) A local health department shall maintain public health programs and services and gross expenditures for those services at “base year” levels, as defined below.

(b) The base year shall be the most recent local health department fiscal year for which the local health department has filed all quarterly claim forms with the department.

(c) Maintenance of effort shall be monitored by the department throughout the fiscal year.

(d) Adjustment to State Aid reimbursement shall be made when a local health department reduces its expenditures beneath the amount expended in its base year. State Aid shall be reduced by the percentage reduction in expenditures between the base year and the current fiscal year. When calculating the amount by which a local health department has reduced its expenditure, the Commissioner shall exclude extraordinary expenditures of a temporary nature, such as disaster relief; unavoidable or justifiable program reductions, such as a program being subsumed by another agency; or expenditures for which the local health department can demonstrate to the Commissioner’s satisfaction that the need for the expenditure no longer exists.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.40 - Limitation on State Aid

Section 40-1.40 Limitation on State Aid

(a) State Aid may be limited, in whole in or part, if the commissioner determines, upon review of a local health department’s State Aid application, that the local health department will not deliver a core public health service required by Subpart 40-2 of this title. In that event, the Commissioner may use the proportionate share that is not granted to the local health department to contract with agencies, associations, or organizations to provide such services, or expend such share to provide such services upon approval of the director of the division of budget, as authorized by section 605 of the Public Health Law.

(b) Partial service counties.The commissioner may approve a State Aid application that seeks funding for fewer than all core public health services required pursuant to Subpart 40-2 of this Part, provided that:

(1) a community health assessment is completed by the municipality pursuant to section 40-2.40 of this Part;

(2) the selected core services meet all standards for those services set forth in this Part; and

(3) the State Aid application identifies the availability of core public health services not provided by the local health department, who will provide those services and the manner in which the services will be provided and financed.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.41 - Withholding of State Aid

Section 40-1.41 Withholding of State Aid

(a) State Aid may be withheld, in whole or in part, if the commissioner determines, upon program review, that:

(1) core public health services were not performed in accordance with this Part, Article 6 of the Public Health Law, or the approved application for State Aid; or

(2) the local health department has not made every reasonable effort to collect fees for services set forth in section 40-1.51 of this Part.

(b) If, after notification that State Aid will be withheld pursuant this section, the local health department provides written justification within 60 days why such action is not warranted that is satisfactory to the commissioner, the commissioner may, within his or her discretion, adjust or cancel the withholding of State Aid.

(c) If the commissioner withholds funds pursuant to this section, the amount withheld shall be based on the cost of providing the missing or inadequate services by another agency or by the State.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.50 - Fees and revenue; quarterly reporting

Section 40-1.50 Fees and revenue; quarterly reporting

Each local health department shall:

(a) make every reasonable effort to collect fees and third-party billings revenue;

(b) maintain a written protocol for third-party billing and for assessment and collection of fees, including follow-up procedures for unpaid claims; and

(c) report quarterly to the commissioner, with its State Aid claim, each category of revenue collected.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.51 - Fees and revenue; services for which fees are charged

Section 40-1.51 Fees and revenue; services for which fees are charged

(a) Environmental health services. Each local health department must charge a fee for the granting of a permit, inspections and other services prerequisite to the issuance of a permit:
X-ray and radioactive materials (authorized programs only)Food service establishments (all types)Camps and recreation facilitiesIndividual water and sewerageRealty subdivisionsMobile home parksCommunity and noncommunity water systemsTanning facilities
Bathing beaches
Swimming pools
Recreational aquatic spray grounds
Temporary residences (hotels/motels/bungalow colonies/cottage colonies, cabins)
Mass gatherings and public functions
Children’s camps
Agricultural fairgrounds
Migrant farm worker housing
Multipurpose recreational facility
Plan review

(b) Clinic health services. Where third-party reimbursement is not available, the local health department shall charge a fee for the following clinic health services, regardless of whether such services are provided directly or by contract. Subject to subdivision (b) of section 40-1.52 of this Part, where third-party reimbursement is available, the local health department shall ensure that every reasonable effort is made to collect such reimbursement and any relevant co-payments.

Sexually transmitted diseases, consistent with Public Health Law § 2304
HIV counseling, testing, diagnosis and prevention
Family planning
Prenatal and postpartum care
Primary care for children less than 21 years of age;
Immunization

(c) Tuberculosis control. Fees for clinical health services related to tuberculosis control shall be governed by Part 43 of this Title.

(d) Rabies control. Local health departments shall make every reasonable effort to collect third-party reimbursement for the clinical health services for rabies control, when such services are provided by the local health department.

(e) Nothing in this section shall be deemed as prohibiting local health departments from charging fees for other public health services.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.52 - Fees and revenue; calculation

Section 40-1.52 Fees and revenue; calculation

(a) For all fees, the calculation of fees shall be based on the cost to the municipality of providing the service and shall not exceed the cost to the local health department of providing the service for which the fee is to be charged.

(b) For those clinic health services for which a fee is authorized, the fee to the individual shall be based upon the ability of the recipient to pay. A sliding fee schedule shall be established for this purpose and made available to all recipients of service.

(c) The local health department may request the commissioner’s approval to waive fee assessments, based on documentation that charging a fee would create a substantial barrier to obtaining the public health service. The commissioner's decision on whether or not to grant such waivers shall be conclusive.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.53 - Fees and revenue; deduction and offset

Section 40-1.53 Fees and revenue; deduction and offset

(a) All revenues collected by the local health department or the contractor shall be deducted from eligible expenditures to produce a net amount of expenditures eligible for State Aid, except that municipalities may provide accounting documentation for the withholding from deduction any earned revenue attributable to projects and services ineligible for State Aid reimbursement, as enumerated in 40-2.3. The commissioner may exclude such revenue from deduction limited to documentation submitted.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.60 - Submission of claims

Section 40-1.60 Submission of claims

(a) Quarterly claims for State Aid reimbursement must be accompanied by supporting documentation to enable calculation of State Aid amounts as shall be determined by the commissioner or his or her designee. Such documentation shall include, but not be limited to:

(1) a duly certified State Aid claim form;

(2) a clear statement of expenditures for each service included in the State Aid application; and

(3) a clear statement of each item of revenue earned during the reporting period.

(b) All expenses for which a claim is submitted shall be accounted for and reported using the cash basis method of accounting.

(c) Claims shall be prepared in accordance with 2 CFR Part 200 – “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.”

(d) A claim shall be deemed complete if it complies with subdivisions (a), (b) and (c) of this section.

(e) Complete claims for the first three quarters of a program year must be submitted by the local health department for State Aid no later than two months after the end of the quarter in which the expenditures claimed occurred. Complete fourth quarter claims must be submitted no later than three months from the end of the program year in which expenditures claimed occurred. Claims received later than such prescribed time limits may be returned unpaid by the commissioner. Returned claims may not be resubmitted.

(f) In the event that a local health department submits any quarterly claim later than six months after the end of the program year in which the expenditures claimed occurred, the commissioner may accept such claim only if the local health department has submitted a written statement which, in the commissioner’s discretion, adequately explains the extraordinary circumstances justifying the delay.

(g) Claims for State Aid reimbursement must be supported by expenditure and revenue records, to be retained and made available to facilitate concurrent or post audit, until concurrent or post audit is completed. Records supporting actual revenues and costs incurred shall be maintained by the municipality for the period of six years after the close of the fiscal year to which they pertain and are subject to audit and review by the State.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.61 - Method of payment

Section 40-1.61 Method of payment

Expenditures by local health departments shall be reimbursed as follows, provided all requirements of this Part are met:

(a) Base grant:

(1) For local health departments providing all of the core services set forth in Subpart 40-2 of this Part, the State Aid base grant shall be 100 percent of net eligible expenditures for performance of these services to a maximum of $650,000 or the amount representing 65 cents per capita, whichever is greater.

(2) For local health departments that the commissioner has approved to provide fewer than all of the core services set forth in Subpart 40-2 of this Part, the State Aid base grant shall be 100 percent of net eligible expenditures for performance of approved core services to a maximum amount determined by the commissioner that reflects the reduced scope of services.

(3) For the purposes of this section, population shall be determined by the local population data published as of January 1 of each calendar year by the New York State Department of Health.

(b) A local health department’s net eligible expenses for performance of core public health services, in excess of the base grant, shall be reimbursed at a rate consistent with section 616 of the Public Health Law, after review and approval of all State Aid applications.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-1.62 - Claims and method of payment; State Aid for physically handicapped children

Section 40-1.62 Claims and method of payment; State Aid for physically handicapped children

(a) For local health departments, State Aid for authorized medical services for physically handicapped children shall be paid at 50% of net expenses, where net expenses means total expenses less revenues received for such services. State Aid may be withheld if, on post-audit and review, the Commissioner finds that a medical service rendered was not in conformance with a plan submitted by the municipality or that the recipient of the medical service was not a physically handicapped child as defined in section 2581 of the Public Health Law.

(b) For American Indian children residing on a reservation, State Aid for authorized medical services for physically handicapped children shall be paid at 100% of net expenses for such services.

(c) To receive State Aid, the clerk of the board of supervisors or other similar governing body of each county, or chief fiscal officer of the city of New York, shall quarterly transmit to the Commissioner a certified statement stating the amount expended for the purposes specified herein, the date of each expenditure and date of service, and the purpose for which it was made.

(d) To receive State Aid, complete claims for physically handicapped children must be received by the Commissioner within two years of the date of service.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

SubPart 40-2 - Performance Standards and Minimum Requirements for Core Public Health Services

Effective Date: 
Wednesday, November 23, 2016
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, art. 6, Sections 602, 603

GENERAL PROVISIONS

Section 40-2.0 - Scope of Subpart 40-2

GENERAL PROVISIONS
Section 40-2.0 Scope of Subpart 40-2. In accordance with applicable provisions of article 6 of the Public Health Law, this Subpart establishes standards of performance and minimum requirements for core public health services relating to Family Health, Communicable Disease Control, Chronic Disease Prevention, Community Health Assessment, Environmental Health, and Emergency Preparedness and Response.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.1 - General provisions concerning State Aid eligibility

Section 40-2.1 General provisions concerning State Aid eligibility

(a) Core public health services are eligible for State Aid reimbursement only if such services are included in an approved State Aid application and only if performed in accordance with this Subpart.

(b) Local health departments may contract for core public health services provided, however, that:

(1) to remain eligible for State Aid, any contract for core public health services must require that:

(i) core public health services shall be performed under the general supervision and control of the local health department commissioner or public health director;

(ii) if a contract relates to a core public health service for which a fee must be collected pursuant to section 40-1.51 of this Part, the contractor shall make every reasonable effort to collect such fee and, for clinic health services, the contractor shall make every reasonable effort to collect third-party reimbursement and any relevant co-payments; and

(iii) the contractor shall report to the local health department all fees, co-payments, and third-party reimbursement collected;

(2) pursuant to section 616 of the Public Health Law, the local health department shall not claim as State Aid eligible expenses any portion of the contract cost relating to indirect costs or fringe benefits, including but not limited to retirement funds, health insurance and federal old age and survivors insurance; and

(3) when the local health department provides clinic services pursuant to section 40-2.2 of this Part through a contract with another provider, the Commissioner has discretion to review and approve or disapprove the contract. When exercising such discretion, the Commissioner shall examine factors including, but not limited to, the quality of the proposed contractor’s services, the ability the local health department to oversee the contracted services, and the contractor’s efficiency in delivering services.

(c) The following costs related to the facility space used by the local health department are eligible for State Aid:

(1) Rent paid to a person, a private entity, or a public entity other than the municipality that operates the local health department.

(2) For space owned by the municipality that operates the local health department, the cost of maintenance of space in lieu of rent (MILOR).

Effective Date: 
Wednesday, March 16, 2016
Doc Status: 
Complete

Section 40-2.2 - State Aid eligibility; clinic services

Section 40-2.2 State Aid eligibility; clinic services

The cost of public health clinic services is allowable for only the following:

(a) clinic health services identified in subdivision (b) of section 40-1.51 of this Part, including clinics for sexually transmitted diseases, consistent with Public Health Law § 2304; HIV counseling, testing, diagnosis and prevention; family planning; immunization; primary care for children less than 21 years of age, provided that such services are only eligible for State Aid to the extent that the local health department makes good faith efforts to assist such persons with Medicaid or insurance enrollment, as applicable, and only until such time as insurance coverage becomes effective; and prenatal and postpartum care, provided that such services are only eligible for State Aid to the extent that the local health department makes good faith efforts to assist such women with Medicaid or insurance enrollment, as applicable, and only until such time as insurance coverage becomes effective;

(b) tuberculosis control;

(c) rabies control;

(d) dispensing countermeasures in the event of an actual or threatened public health emergency;

(e) other services consistent with section 602 of the Public Health Law and approved by the commissioner for State Aid reimbursement.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.3 - Projects and services ineligible for State Aid

Section 40-2.3 Projects and services ineligible for State Aid

Activities, services, and costs that are ineligible for State Aid include, but are not limited to, the following:

(a) activities and services involving other agencies:

(1) Joint activities. If joint State-local or Federal-local activities have been approved in the State Aid Application, the portion financed from State funds, other than State Aid under this section, and Federal funds will be excluded from consideration for reimbursement.

(2) Activities carried out by any other agency. The cost of activities for which any other government agency has been given legal responsibility.

(b) health care programs and services:

(1) Primary care and medical treatment, except as specified in this Subpart.

(2) Hospitals and other health facilities. The construction, establishment, maintenance and operation of hospitals, clinics, laboratories, dispensaries or similar facilities, except for the costs of providing eligible public health services in public health clinics as specified in section 40-2.2 of this Part.

(3) The cost of inpatient hospital care of patients with communicable disease, except tuberculosis and syphilis patients.

(4) Home health services provided by a local health department, except for public health home visiting as described in this Subpart.

(5) Laboratory services unrelated to eligible services. The cost of laboratory services related to public health services that are ineligible for State Aid are also ineligible for State Aid.

(6) Emergency Medical Service or Ambulance service. The maintenance and operation of Emergency Medical Service and ambulance service or the dispatching of ambulances.

(7) Medical examiner programs, services or activities.

(8) Jail medical services. The cost of providing routine medical treatment to inmates of jails operated by the local health department or in the municipality, including routine admission screenings and primary care to inmates older than 21 years of age.

(9) Any and all health care services for the screening or treatment of chronic diseases.

(c) environmental health programs and services:

(1) The cost of abatement, remediation, management in place or any action that removes a public health nuisance from a property, or the cost of relocating persons exposed to public health nuisances, consistent with section 40-2.55 of this Part.

(2) The cost of removal or covering lead paint or of relocating persons exposed to lead paint, consistent with section 40-2.58 of this Part.

(d) infrastructure and administration costs:

(1) Treatment plants and other facilities. The construction, maintenance and operation of water or waste water treatment plants, swimming pools and bathing beaches, and public bathhouses.
(2) Treatment of water supplies. The cost of treatment of public water supplies, including costs of chemicals for fluoridation.
(3) Garbage and refuse disposal facilities. The cost of construction, maintenance and operation of facilities for garbage and refuse collection, incineration or disposal and air cleaning facilities.

(4) Plumbing inspection. Plumbing inspection for the purpose of checking conformity with building code provisions.

(5) Boards of examiners. Compensation or expenses paid to boards of examiners (e.g., boards of examiners for plumbers and barbers).

(6) Insurance coverage of local health department employees. The cost of personal liability or malpractice insurance purchased by the local health department or the cost of funded self-insurance for such liability when such expense is related to protection against personal liability or malpractice of its employees.

(7) Real property. The cost of acquisition or development of real property.

(8) Depreciation and interest on funding, including:

(i) The cost of depreciation of the space utilized by a health agency in a building owned by the same municipality that operates the health agency.

(ii) The cost of interest on the funding of buildings utilized by a health agency and owned by the same municipality that operates the health agency.

(9) Rent paid to city or county. All rent for space utilized for health agency purposes, if such rent is payable to the same municipality that operates the health agency.
(10) Indirect costs and fringe benefits. Contributions by the local health department for indirect costs and fringe benefits, including but not limited to contractor fringe and indirect costs, employee retirement funds, health insurance, workers' compensation, and Federal old age and survivor's insurance.

(e) other programs and services that the commissioner reasonably determines are not eligible under this Part.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

FAMILY HEALTH

Section 40-2.10 - Family health; performance standards

Section 40-2.10 Family health; performance standards

(a) The local health department shall maintain a family health program designed to achieve the following goals:

(1) improve the health of persons under the age of 21, including children with special health care needs;

(2) increase the proportion of persons under the age of 21 who receive comprehensive well child primary and preventive care, including oral health care;

(3) improve birth outcomes, decrease maternal and infant mortality and morbidity, and increase the number of pregnant and postpartum women who receive early, continuous and comprehensive prenatal and postpartum care, including oral health care, and other supportive services to address risks and needs; and

(4) decrease the rate of unintended pregnancies, increase optimal spacing of pregnancies, decrease the prevalence and morbidity of sexually transmitted disease, and improve availability and accessibility of comprehensive reproductive health care and family planning services to men and women of reproductive age.

(b) To be eligible for State Aid, the local health department shall conduct public health activities in the following areas:

(1) Child Health;

(2) Maternal and Infant Health; and

(3) Reproductive Health.

(c) The activities required under this subdivision (b) of this section shall include, at a minimum:

(1) utilization of available public health data and information to shape strategies related to child health, maternal and infant health and reproductive health, including:

(i) using available data from

the community health assessment, other local assessments, and local knowledge;

(ii) identifying communities and/or neighborhoods where children, women and families are potentially in need of services;

(iii) identifying any specific local factors that influence children's health status, health care needs, maternal and infant birth outcomes, unintended pregnancy, and use of reproductive health care services; and

(iv) assess currently available services;

(2) public health marketing and communication, including developing or adapting public education materials or campaigns, and promoting and disseminating such materials or campaigns, to:

(i) promote the use of comprehensive health care services for children, women and families;

(ii) promote healthy behaviors, including the preconception, prenatal, postpartum and interconception periods; and

(iii) reduce risk factors associated with poor maternal and infant outcomes, unintended pregnancy, and sexually transmitted diseases and related health disparities;

(3) information, referral and assistance to women and families in accessing and effectively utilizing available services;

(4) outreach, education, training and technical assistance for health and human service providers, designed to improve the delivery of comprehensive primary and preventive care to women and families, including, at least one annual communication to health care providers on health data and interventions related to family health;

(5) efforts with multiple sectors in the community to promote policy, environmental and systems change to address population and community level factors that influence child health outcomes and use of health care services, birth outcomes, and reproductive health outcomes and services; and

(6) activities to identify uninsured women and families and to provide such persons, either directly or through referral, with assistance with enrollment in health insurance coverage and comprehensive prenatal care, child health care, primary care services, and reproductive health services.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.11 - Family health; services eligible, but not required, for State Aid

Section 40-2.11

Family health; services eligible, but not required, for State Aid

The following public health services are eligible for State Aid but not required as a condition of State Aid eligibility:

(a) primary care services to uninsured persons under 21 years of age, in a clinic setting, provided that such services shall be eligible for State Aid only to the extent that the local health department makes good faith efforts to assist such persons with Medicaid or other insurance enrollment, as applicable, and only until such time as insurance coverage becomes effective;

(b) provision of public health home visits associated with eligible services. Such public health home visits may include visits only for the following purposes: assessing women’s preconception, prenatal, postpartum and interconception health and social support needs; assessing child and family health and social support needs; providing information to promote positive birth outcomes and child health; and referring persons to needed services. Activities undertaken in relation to the Child Find System under the Early Intervention Program, as required pursuant to 10 NYCRR 69-4.1(c) and 69-4.2, shall not be eligible for State Aid;

(c) provision of reproductive health care and family planning services for men and women of reproductive age, in a clinic setting; and

(d) prenatal and postpartum care, in a clinic setting, provided that such services shall be eligible for State Aid only to the extent that the local health department makes good faith efforts to assist such women with Medicaid or insurance enrollment, as applicable, and only until such time as insurance coverage becomes effective.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

COMMUNICABLE DISEASE CONTROL

Section 40-2.20 - Sexually Transmitted Diseases (STDs) and Human Immunodeficiency Virus (HIV); performance standards

Section 40-2.20 Sexually Transmitted Diseases (STDs) and Human Immunodeficiency Virus (HIV); performance standards

The local health department shall maintain a program designed to minimize the incidence of STDs and HIV. The program shall include, at a minimum, activities to ensure:
(a) epidemiologic case finding, timely disease surveillance and reporting, in accordance with Part 2 of this Title;

(b) availability of accessible laboratory testing for STDs and HIV;

(c) provision of adequate facilities for diagnosis and treatment of STDs, directly or by contract, pursuant to Article 23 of the Public Health Law;

(d) provision of partner notification and referral services for priority patients, as determined in an investigation undertaken pursuant to 10 NYCRR 2.6;

(e) provision of prophylactic treatment to exposed partners for STDs;

(f) information, referral and assistance in utilizing appropriate community service programs;

(g) public health marketing and communication, including developing or adapting public education materials or campaigns, and promoting and disseminating such materials and campaigns, to promote healthy behaviors and reduce risk factors associated with STDs, HIV and related health disparities; and

(h) distribution of at least one communication per year to health care providers, clinics and laboratories on local and regional morbidity rates, CDC guidelines, diagnostic and treatment modalities and Department reporting requirements for STDs and HIV.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.21 - Tuberculosis; performance standards

Section 40-2.21 Tuberculosis; performance standards

The local health department shall maintain a program designed to minimize the incidence of tuberculosis. The program shall include, at a minimum, activities to ensure:

(a) timely tuberculosis surveillance and reporting;

(b) detection and follow-up with individuals identified as infected with tuberculosis, including contact investigations performed in close collaboration with healthcare facilities, schools, workplaces, and other settings;

(c) provision of clinical services for tuberculosis disease or infection, either directly,

through referral, or by contract;

(d) provision, or activities to ensure provision, of directly observed therapy for persons with tuberculosis, regardless of whether the local health department is the primary medical provider; and

(e) distribution of at least one communication per year to healthcare providers, clinics and laboratories regarding local and regional morbidity rates, CDC guidelines, diagnostic and treatment modalities, and Department reporting requirements for tuberculosis.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.22 - Communicable disease control; performance standards

Section 40-2.22 Communicable disease control; performance standards

The local health department shall maintain a program designed to minimize the incidence of communicable disease. The program shall include, at a minimum, activities to ensure:

(a) compliance with disease specific protocols, as established by the Department or, for New York City, the Department of Health and Mental Hygiene, for:

(1) disease surveillance;

(2) timely disease investigation;

(3) reporting of diseases to the commissioner, pursuant to Part 2 of this Title;

(b) verification and diagnosis of infections in a timely manner, ascertainment of the sources of infections, and follow up with infected persons as needed;

(c) minimization of the spread of disease, through the identification and, when appropriate, prophylaxis of persons possibly exposed to disease;

(d) performance of multiple, simultaneous investigations of communicable diseases, and maintenance of capacity to do so; and

(e) distribution of at least one communication per year to healthcare providers, clinics and laboratories regarding local and regional morbidity rates, CDC guidelines, diagnostic and treatment modalities, and Department reporting requirements for reportable diseases.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.23 - Immunization; performance standards

Section 40-2.23 Immunization; performance standards

The local health department shall maintain a program designed to minimize the occurrence and transmission of vaccine-preventable diseases. The program shall include, at a minimum, activities to ensure:
(a) compliance with all statutes and regulations concerning immunization applicable to local health departments, including but not limited to:

(1) Public Health Law § 613, concerning programs of immunization for children;

(2) Public Health Law § 2164, concerning vaccination of school children against certain diseases;

(3) Public Health Law § 2165, concerning vaccination of post-secondary students against certain diseases;

(4) Public Health Law § 2168 concerning the New York Statewide Immunization Information System (NYSIIS);

(5) Subpart 69-3 of this Title, concerning pregnant women, testing for Hepatitis B, and follow-up care;

(b) disease surveillance for vaccine preventable diseases, in accordance with Part 2 of this Title;

(c) assistance with and follow-up on school immunization surveys;

(d) educational efforts in the community, including:

(1) collaboration and communication with healthcare providers and schools to maintain required immunization levels in schools; and

(2) public health marketing and communication, including developing or adapting public education materials or campaigns, and promoting and disseminating such materials or campaigns, to increase awareness of diseases and the control measures required to prevent the spread of disease;

(e) coordination with medical providers and laboratories to encourage and advise them to conduct recommended diagnostic testing in the event of a disease outbreak; and

(f) engagement in quality assurance activities with providers in the community to improve immunization practices, including but not limited to, improving compliance with the NYSIIS reporting requirements, as applicable.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 40-2.24 - Zika Action Plan; performance standards

40-2.24 Zika Action Plan; performance standards. 

(a) By April 15, 2016, the local health department shall adopt and implement a Zika Action Plan (ZAP), in accordance with guidance to be issued by the Department, and which shall include, but not be limited to, the following activities: 

(1) for all local health departments: 

(i) human disease monitoring, response and control; and 

(ii) education about Zika virus and its prevention; and 

(2) in addition, for those local health departments identified by the Department as jurisdictions where mosquitoes capable of transmitting the Zika virus are currently located or may be located in the future: 

(i) enhanced human disease monitoring, response, control;  

(ii) enhanced education about Zika virus and its prevention;  

(iii) mosquito trapping, testing and habitat inspections specific to Aedes albopictus, and for such other species as the Department may deem appropriate; 

(iv) mosquito control; and 

(v) identification and commitment of appropriate staff available to join State-coordinated rapid response teams, which may be deployed to those areas where the Department determines that there is the potential for transmission of Zika virus by mosquitoes. 

(b) Local health departments shall update their ZAPs annually, or as directed by the Department, to include activities identified by the Department in guidance issued pursuant to subdivision (a) of this section.

(c) Local health departments shall submit such plans to the Department as part of the annual Application for State Aid made pursuant to section 40-1.0 of this Part.  State Aid shall only be available for activities within ZAPs determined by the Department to be necessary and appropriate to control the spread of the Zika virus in guidance issued pursuant to subdivision (a) of this section.

 

Effective Date: 
Wednesday, November 23, 2016
Statutory Authority: 
Public Health Law, Sections 602, 603, 619

CHRONIC DISEASE PREVENTION

Section 40-2.30 - Chronic disease prevention; performance standards

Section 40-2.30 Chronic disease prevention; performance standards

(a) The local health department shall maintain a program designed to reduce the prevalence or incidence of chronic diseases and conditions such as

cancer, cardiovascular diseases, diabetes, asthma, arthritis and obesity, and the underlying risk factors of tobacco use, physical inactivity and poor nutrition. The activities required in this program shall include, at a minimum:

(1) Analysis and utilization of public health data and information to shape objectives and strategies related to chronic disease prevention. This analysis shall:

(i) use available data from the community health assessment and other local assessments;

(ii) identify communities and/or neighborhoods where the population is at increased risk of chronic diseases and conditions and underlying risk factors;

(iii) identify the specific local factors and available policies, practices, underlying risk factors, and interventions that influence chronic disease;

(2) leadership of, or participation in, efforts with multiple sectors in the community to improve social and physical environments to support healthy behaviors;

(3) public health marketing and communication, including developing or adapting public education materials or campaigns, and promoting or disseminating such materials or campaigns, to reduce risk factors for chronic disease morbidity, mortality and related health disparities; and

(4) activities to promote the delivery of early detection and guideline-concordant health care by health care providers.

(b) Any and all health care services for the screening or treatment of chronic diseases are ineligible for State Aid.

Effective Date: 
Wednesday, December 31, 2014
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Complete

COMMUNITY HEALTH ASSESSMENT

Section 40-2.40 - Community health assessment; performance standards

Section 40-2.40 Community health assessment; performance standards

Local health departments shall work with community partners to conduct a Community Health Assessment (“Assessment”) and a Community Health Improvement Plan (“Plan”). Together, the Assessment and Plan shall include, at a minimum:

(a) an analysis of secondary data and, where available, primary data on health status and demographics;

(b) a description of the demographics of the population of the jurisdiction served by the local health department,

(c) a description of the health issues of the population, the distribution of health issues, and the contributing causes of the health challenges based on the data analyzed,

(d) the identification of priority areas for health improvement based on valid criteria;

(e) a description of public health services in the community and other resources that can be mobilized to improve population health, particularly in the priority areas;

(f) improvement strategies and measurable objectives through which the municipality and its community partners will address areas for health improvement and performance targets that will be used to track progress toward improvement of public health outcomes;

(g) methods by which access to the reports is to be provided to interested stakeholders including hospitals, nursing homes, medical societies, libraries, schools, government facilities, or other agencies and other organizations; and

(h) a description of the community partners that participated in the development of the community health assessment and improvement plan and their roles in the plan.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

ENVIRONMENTAL HEALTH

Section 40-2.50 - Public water supply protection; performance standards

Section 40-2.50 Public water supply protection; performance standards

The local health department shall maintain a program that ensures public water systems are operated pursuant to the New York State Public Health Law, Part 5 of the State Sanitary Code (10 NYCRR Part 5), and applicable federal Safe Drinking Water Act (SDWA) requirements.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.51 - Environmental radiation protection; performance standards

Section 40-2.51 Environmental radiation protection; performance standards

The local health department shall maintain a program to conduct environmental radiation surveillance activities, if the Department has authorized the local health department to conduct such a program. Such program shall, at a minimum, maintain appropriate equipment and supplies, ensure that personnel are properly trained, and collect environmental samples for radiological analysis.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.52 - Community environmental health and food protection; performance standards

Section 40-2.52 Community environmental health and food protection; performance standards

The local health department shall maintain a program that ensures that facilities operated pursuant to Parts 6, 7, 14, 15 and 17 of the State Sanitary Code comply with all relevant provisions of the State Sanitary Code and the Public Health Law.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.53 - Realty subdivisions; performance standards

Section 40-2.53 Realty subdivisions; performance standards

The local health department shall maintain a program for approving realty subdivisions and assuring construction is in accordance with approved plans; provided that this provision shall not apply to New York City. The program shall include, at a minimum:

(a) procedures for approval of all realty subdivisions in accordance with the Public Health Law, Environmental Conservation Law, Education Law, and applicable State regulations prior to the start of construction activities; and

(b) provisions for site evaluation and construction inspections as necessary to assure that approved plans are followed.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.54 - Individual water and sewage systems; performance standards

Section 40-2.54 Individual water and sewage systems; performance standards

The local health department shall, at a minimum, maintain a program for providing technical assistance to property owners regarding the installation, maintenance and operation of individual water supplies and individual sewage systems.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.55 - Public health nuisances; performance standards

Section 40-2.55 Public health nuisances; performance standards

The local health department shall:

(a) respond to all reported nuisances which may affect public health and safety; and

(b) maintain a program, consistent with Part 8 of the State Sanitary Code, as applicable, for responding to public health nuisances and ensuring abatement of such public health nuisances; provided, however, that abatement, remediation, management in place or any action that removes the public health nuisance from a property or relocating persons exposed to public health nuisances shall not be eligible for State Aid.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.56 - Injury prevention and control; performance standards

Section 40-2.56 Injury prevention and control; performance standards

The local health department shall maintain a program designed to reduce morbidity and mortality associated with injuries, utilizing reasonably available data. The program shall include, at a minimum, development and implementation of education programs to inform the public and providers of measures to avoid intentional and unintentional injury.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.57 - Environmental health exposure investigation, assessment and response; performance standards

Section 40-2.57 Environmental health exposure investigation, assessment and response; performance standards

The local health department shall maintain and conduct a program that includes, at a minimum:

(a) responding to reports of exposure to chemical and non-infectious biological hazards attributable to environmental and occupational settings. Such responses shall include, at a minimum, preliminary evaluation and exposure investigation; appropriate environmental, biological, clinical or epidemiological monitoring; appropriate public health interventions to reduce and/or eliminate exposures; public or professional information and education; and consultation and referral as needed; and

(b) maintaining a log of reported exposures and alleged health effects, including a timeline and description of the response provided.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.58 - Lead poisoning prevention; performance standards

Section 40-2.58 Lead poisoning prevention; performance standards

(a) The local health department shall maintain a lead poisoning prevention program, which shall include, at a minimum:

(1) activities to identify risk factors for childhood lead poisoning, including locations in the municipality where exposure of children to lead is likely;

(2) activities to educate the community as to the dangers of lead toxicity;

(3) for all children aged one and two years old, and other children at risk of exposure to lead, ensuring provision of:

(i) access to blood lead testing services;

(ii) appropriate case coordination; and

(iii) environmental intervention;

(4) reporting of pertinent blood lead testing information and follow up activities in a manner acceptable to the Commissioner, provided that this provision shall not be interpreted to limit the jurisdiction of the local health department to require additional reporting in accordance with local law.

(b) The cost of removal or covering lead paint or of relocating persons exposed to lead paint shall not be eligible for State Aid.

Effective Date: 
Wednesday, December 31, 2014
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ENVIRONMENTAL HEALTH – ONLY WHERE AUTHORIZED

Section 40-2.60 - Authorized radioactive materials licensing and inspection program; performance standards

Section 40-2.60 Authorized radioactive materials licensing and inspection program; performance standards

Where a local health department has received authorization to maintain a radioactive materials licensing and inspection program pursuant to Part 16 of this Title, the municipality shall conduct such program consistent with that Part.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.61 - Authorized radiation-producing equipment inspection program; performance standards

Section 40-2.61 Authorized radiation-producing equipment inspection program; performance standards

Where a local health department has been certified to maintain a radiation producing equipment inspection program pursuant to Part 16 of this Title, the municipality shall conduct such program consistent with that Part.

Effective Date: 
Wednesday, December 31, 2014
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Section 40-2.62 - Authorized tanning facilities licensing and inspection program; performance standards

Section 40-2.62 Authorized tanning facilities licensing and inspection program; performance standards

Where a local health department’s health officer has received authorization to act as a permit-issuing official for the licensing and inspection of tanning facilities pursuant to Subpart 72-1 of this Title, the municipality shall conduct such program consistent with that Subpart or, if applicable, local regulations issued pursuant to 10 NYCRR 72-1.2.

Effective Date: 
Wednesday, December 31, 2014
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Complete

EMERGENCY PREPAREDNESS AND RESPONSE

Section 40-2.70 - Emergency preparedness and response; performance standards

Section 40-2.70 Emergency preparedness and response; performance standards

The local health department shall conduct a program designed to ensure readiness to respond to health emergencies, whether naturally occurring or deliberate, to protect the health of its residents. The program shall include at a minimum:

(a) development and maintenance of an All Hazards Health Emergency Preparedness and Response Plan;

(b) activities designed to maintain readiness to provide appropriate medical countermeasures to the public in response to an emergency;

(c) ensure training and health education to local health department staff, health care providers and the community on health emergency preparedness;

(d) participation and implementation of exercises and drills that include appropriate response partners; and

(e) responding to emergencies as described in the All Hazards Health Emergency Preparedness and Response Plan.

Effective Date: 
Wednesday, December 31, 2014
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SubPart 40-3 - REPEALED

Effective Date: 
Wednesday, July 7, 2010

SubPart 40-4 - Fee and Revenue Plan for Departmental Services

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Statutory Authority: 
Public Health Law, art. 6, Section 606

Section 40-4.0 - Fee and revenue plan

Section 40-4.0 Fee and revenue plan.

(a) Fees and revenues received by the department pursuant to section 606 of the Public Health Law shall be deposited in a local public health services program account, and distributed to municipalities as supplemental health services grants.

(b) Such revenues shall include fees for services provided by the department, fines levied and collected by the department from enforcement actions associated with these services, and monies received or recovered as a result of State aid audit exceptions.
 

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Section 40-4.1 - Fees for departmental services

40-4.1 Fees for departmental services.

(a) The department must charge a fee for the granting of a permit, inspections, or other services prerequisite to the issuance of a permit, or for other environmental health services. Such fee shall be nonrefundable.

(b) Annual fees for facility inspection and permit issuance services, where such services are provided by the department and not directly by the municipality, are based on the costs of providing such services and shall be revised periodically.

(c) Cumulative fees for a single operator at a single location shall not exceed $1,000 per year.

(d) Definitions. (1) As used in this Subpart, "multipurpose recreational facilities," are defined as large tracts of land upon which a recreational facility owned and operated by a single person, partnership or corporation is located. Such facilities may encompass multiple food, swimming or recreational facilities permittable under the State Sanitary Code. In completing a Fee Determination Schedule, the facility operator may exercise an option to pay either a registration fee as provided for in paragraph (10) of subdivision (e) of this section or fees separately calculated for each individual activity.

(2) "Primary service" is defined as the principal or major function of such multipurpose recreational facilities (e.g. water slides). All such primary services are covered by the base fee. Other services, (e.g. food,) are chargeable as add-ons for each individual facility (e.g., 10 food booths x $50. = $500.00 additional fee).

(3) "Seasonal facility," for the purpose of determining the annual fee levels for such facility, is defined as a facility permittable under the provisions of the State Sanitary Code which operates 26 weeks or less in a calendar year. Such seasonal facility must be designated as such on any permit issued to it, which shall also state the starting and ending dates of the seasonal operating period. Such seasonal facility shall be entitled to a 10% reduction from the normal annual fee.

(e) Fees for departmental environmental services, excluding plan review unless otherwise stated, are established as follows:

(1) Food service establishments, taverns, bars (includes $25 frozen dessert fee except for free-standing soft ice cream and slush machine units, etc.).

Seating Capacity 100 or less, including takeout or stand up service $ 75.00 101 or more 150.00

(2) Caterers and Commissaries. 200.00

(3) Temporary Food Service Mobile 30.00 Vendors.

(4) Hotels, Motels, Bungalow Colonies, Cabins, Cottage Colonies. (Base fee (i) and added fees (ii-iv))

(i) Number of rental units 1-20 units 50.00 21-50 100.00 51-100 150.00 101-200 200.00 201+ 400.00

(ii) Food service dining areas (which may include a cocktail lounge, night club, etc.)

Capacity 1 - 100 add 50.00 for each separate area/facility

Capacity 101 or more add 100.00 for each separate area/facility

(iii) Pool add 30.00 for each separate pool

(iv) Beach add 20.00 for each separate beach

(5) Campgrounds and Travel Trailer Parks. (Base fee (i) and added fees (ii-iv))

(i) Number of Sites

50 or less 50.00 51 - 200 75.00 201 - 500 100.00 501 - 750 150.00 751 or more 250.00

(ii) Food service dining areas (which may include a cocktail lounge, night club, etc.)

Capacity 1 - 100 add 50.00 for each separate area/facility

Capacity 101 or more add 100.00 for each sep area/facility

(iii) Pool add 30.00 for each separate pool

(iv) Beach add 20.00 for each beach

(6) Mobile Home Parks. Base fee (i) and added fees (ii-iv))

(i) Number of Sites

Less than 50 50.00 50-100 100.00 101 or more 200.00

(ii) Food service dining areas (which may include a cocktail lounge, night club, etc.) Capacity 1-100 add 50.00 for each separate area/facility

Capacity 101 or more add 100.00 for each separate area/facility

(iii) Pool add 30.00 for each separate pool

(iv) Beach add 20.00 for each separate beach

(7) Migrant Labor Camps.

Occupancy 5 - 50 50.00 51 or more 100.00

(8) Swimming Pools and Common Use Spa Pools.

Maximum number of Bathers (25 sq. ft./bather) 1 - 100 50.00 101 or more plus wave pools and slides 100.00

(9) Bathing Beaches.

Less than 5000 sq. ft. 30.00 5000 sq. ft. or more 70.00

(10) Multipurpose Recreational Facilities.

(i) Base fee for primary service 500.00 (food, pool, beach, etc. as as designated by operator)

(ii) Additional services (other than primary)

Food service add 50.00 for each separate area/facility

Pool add 30.00 for each separate area/facility

Beach add 20.00 for each separate area/facility

(11) Community Water Supplies.

Population Served: Less than 1000 100.00 1000 - 9999 500.00 10,000 or more 1000.00

(12) Unpermitted Noncommunity Water Supplies. 100.00

(13) Mass Gatherings, Including Plan Review. 500.00

(14) Public Functions of Over 5000 People Not Constituting Mass Gatherings.

Number of emergency health care units Less than 3 100.00 3 or more 200.00

(15) Children's Camps. 100.00

(16) Frozen Desserts. (soft ice cream) 25.00

(f) Plan review fee (per project):

(1) Food Service Establishments, 75.00 Caterers, Commissaries, etc.

(2) Hotels, Motels, Bungalow Colonies, Cabins, Cottage Colonies.

Number of stories or structures 1 or 2 50.00 3 or more 200.00

(3) Campgrounds and Travel Trailer Parks. 100.00

(4) Mobile Home Parks. 100.00

(5) Migrant Labor Camps. 50.00

(6) Swimming Pools and Bathing Beaches.

100 - 5000 sq. ft. 100.00 5001 sq. ft. or more 150.00 Wavepools, slides, spa pools 150.00

(7) Realty Subdivisions (as prescribed by Public Health Law, section 1119) 25.00/lot

(8) Community and Noncommunity Water Supply.

Cost of Project Less than $10,000 50.00 10,000 - 100,000 100.00 More than 100,000 200.00

(9) Individual Sewage System. (alternative design) 50.00
 

Effective Date: 
Wednesday, January 25, 1989
Doc Status: 
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Section 40-4.2 - Applicability

40-4.2 Applicability. (a) It shall be the responsibility of each facility rendering to the public services covered by the fee schedule provided in section 40-4.1 of this Subpart to remit the annual fee in the form and by the date required by the department, except that no fee shall be charged in the case of a facility operated by a person, firm or corporation or association for charitable, philanthropic or religious purposes or by a municipality.
(b) Failure to pay the prescribed fee shall result in nonissuance of a permit to operate or summary suspension of any existing permit until such fee is paid.

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Part 41 - Grants For School Health Projects

PART 41
GRANTS FOR SCHOOL HEALTH PROJECTS
(Statutory authority: L. 1981, ch. 50)
Sec.
41.1 Applicability
41.2 Grant applications
41.3 Grant contracts
41.4 Waivers

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Section 41.1 - Applicability

Section 41.1 Applicability.

This Part shall apply to State grants paid for school health projects funded under chapter 50 of the Laws of 1981 or any subsequent State law providing funding through the State Department of Health for similar school health projects.
 

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Section 41.2 - Grant applications

41.2 Grant applications.

(a) State grants shall be based on the prior approval of specific school health project proposals after application by the governing authority of not-for-profit or publicly operated facilities licensed pursuant to article 28 of the Public Health Law. Review and approval of such applications shall be by the State Commissioner of Health with the consent of the State Commissioners of Education and Social Services.

(b) The submission of a memorandum of understanding and support between the governing authority of the school district serving the area in which the schools proposing to participate in the facility's project are located and the applicant-article 28 facility shall be a condition of eligibility for a grant under this Part. For those projects to be located in any nonpublic school, the submission of a memorandum of understanding and support between the governing authority of such nonpublic school and the applicant-article 28 facility shall also be a condition of eligibility for a grant under this Part. Services funded by these State grants shall be available to all pupils enrolled in participating schools regardless of ability to pay. Only article 28 facilities proposing projects based in schools located in cities exempt from the requirements of State mandated public school pupil medical inspections and examinations under article 19 of the Education Law will be eligible to receive grant funds. Grant funds received pursuant to this Part must be used solely for a school health project approved pursuant to this Part. Selection of applications for grants shall be based upon criteria which, at a minimum, shall include:

(1) the extent of need and high risk in the community to be served based upon health indicators relating to children;

(2) the degree of participation by, and the commitment of, the schools and school districts proposing to participate in the project;

(3) the quality, scope and feasibility of the project proposal; and

(4) the qualifications, experience and commitment to the proposal of the applicant.
 

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Section 41.3 - Grant contracts

41.3 Grant contracts. The Commissioner of Health shall, with the consent of the Commissioners of Education and Social Services, enter into contracts with the selected applicants with respect to the distribution and administration of grant funds, and the management, operation and evaluation of the school health projects. Such contracts shall contain provisions relating to, among other matters:

(a) those provisions of the Public Health Law and regulations that are waived;

(b) services to be provided;

(c) use of grant funds;

(d) staffing;

(e) submission of claims for grant funds and distribution of grant funds; and

(f) recordkeeping and reporting requirements.
 

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Section 41.4 - Waivers

41.4 Waivers.

The Commissioner of Health may waive any provision of the Public Health Law and regulations promulgated pursuant thereto in order to implement school health projects under this Part. Any such waivers shall only be effective for the duration of the grant contract entered into under this Part.
 

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Part 42 - State Aid For Public Health Laboratory Services: Counties And Cities

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Statutory Authority: 
Public Health Law, Section 620

GENERAL PROVISIONS

Section 42.1 - Application for State aid

GENERAL PROVISIONS

Section 42.1 Application for State aid.

(a) All counties and cities performing or contracting for laboratory tests related to the municipal health department's performance of eligible services described in this Part, must submit to the New York State Department of Health an application for State aid for laboratory services, on an annual basis, no later than on the date specified by the State Commissioner of Health.

(b) The application shall contain a detailed budget of proposed expenditures, estimated revenues, a copy of the latest schedule of laboratory fees, and other information that may be required by the Commissioner of Health.

(c) When a city or county contracts with a laboratory for public health laboratory services, in addition to the State aid application, a list of tests and the rate to be paid by the municipality for each test must be filed with the State Department of Health no later than on the date specified by the State Commissioner of Health.

Effective Date: 
Wednesday, July 7, 2010
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Section 42.2 - Approval of application

42.2 Approval of application.

Each application shall be reviewed by the State Department of Health. The application may be approved in whole or in part and the municipality shall be informed of the amount approved by the State Department of Health.
 

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Section 42.3 - Board of managers

42.3 Board of managers.

All laboratories shall be under the supervision, direction and control of either a board of managers or the board of health appointed in accordance with section 523 of the Public Health Law.
 

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Section 42.4 - Director of laboratories

42.4 Director of laboratories.

All laboratories shall have a director whose qualifications are in accordance with section 19.2 of this Title.
 

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Section 42.5 - Cost per laboratory test

42.5 Cost per laboratory test.

All laboratories must determine, at least every three years, the cost of each procedure done by the laboratory.
 

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STATE AID LIMITATIONS

Section 42.10 - Laboratory services eligible for reimbursement

STATE AID LIMITATIONS

42.10 Laboratory services eligible for reimbursement. State aid will be granted to a municipality performing or contracting for laboratory tests related to the municipal health department's performance of eligible services described in this Part for, the cost of laboratory services required for:

(a) the detection and control of disease as prescribed by the Public Health Law, the State Sanitary Code or the State Commissioner of Health;

(b) the maintenance of a safe and healthful environment; and

(c) the conduct of health research approved by the State Commissioner of Health.
 

Effective Date: 
Wednesday, July 7, 2010
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Section 42.11 - Laboratory Services ineligible for reimbursement

42.11 Laboratory services ineligible for reimbursement. State aid will not be provided on the cost of:

(a) laboratory services eligible for reimbursement by Medicaid, Medicare and other third-party payors; and laboratory services unrelated to the eligible services described in this Part; or those provided to private practitioners or others where the municipal laboratory is providing services available from a private, commercial laboratory;

(b) laboratory services of a blood bank;

(c) laboratory services of a medical examiner when the medical examiner's office is not eligible for State aid reimbursement;

(d) laboratory services not included within the scope of subdivision (a), (b) or (c) of section 42.10 of this Part;

(e) construction or purchase of a building;

(f) rental of space utilized by a laboratory if such rentals are payable to the same municipality as operates the laboratory. Expenditures for non-capital maintenance and operation of costs for space utilized by a laboratory may be included if such facility is owned by the same city or county as operates the laboratory;

(g) depreciation and interest on funding of the space utilized by a laboratory in a building owned by the same city or county as operates the laboratory;

(h) malpractice or personal liability insurance purchased by counties or cities for protection of laboratory employees;

(i) direct or apportioned cost of services provided by other agencies of the county or city to the laboratory;

(j) other costs that the State Commissioner of Health may deem inappropriate.
 

Effective Date: 
Wednesday, July 7, 2010
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Part 43 - State Aid For Tuberculosis and Uninsured Care Programs

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
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Statutory Authority: 
Public Health Law, Sections 2201, 2202(1), (2), (3), (4); Laws of 1981, ch. 623, Sec. 4

SubPart 43-1 - STATE AID FOR TUBERCULOSIS

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
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Statutory Authority: 
Public Health Law, sections 2201, 2202(1),(2), (3) and (4), section 4 of Chapter 623 of the Laws of 1981

STATE AID FOR TUBERCULOSIS

Section 43-1.1 - Definitions

Section 43-1.1 Definitions.

(a) A tuberculosis case shall mean a person diagnosed as having disease caused by M. tuberculosis determined by bacteriological evidence of tuberculous disease or a significant reaction to a mantoux tuberculin test and clinical or roentgenographic evidence of current disease.

(b) A person with tuberculosis infection shall mean a person diagnosed as having a significant reaction to the mantoux tuberculin test in the absence of clinical, roentgenographic or bacteriological evidence of tuberculous disease.

(c) A suspect shall mean a person suspected of having either tuberculosis infection or disease, (including a person who has been in close contact with a tuberculosis case) for whom diagnostic procedures have not been completed and who may or may not be receiving treatment. A person shall not be classified as a tuberculosis suspect for longer than 60 days.

(d) A tuberculosis contact shall mean a person who has been in close association with a suspect or tuberculosis case for a length of time sufficient to become infected with M. tuberculosis by breathing contaminated droplets.

(e) A provider shall mean any facility, agency or organization authorized to furnish tuberculosis health care services under Article 3, 28, 36 or 44 of the Public Health Law, or a licensed and registered physician.

(f) A tuberculosis patient shall mean a person who is a tuberculosis case; a tuberculosis suspect; or has a tuberculosis infection; and who has been accepted or admitted into care by a provider.

(g) Tuberculosis health care services shall mean diagnostic procedures, care, and treatment for tuberculosis patients furnished by a provider.

(h) Local health official shall mean the Commissioner of Health or public health administrator of a county or part county health district, the Commissioner of Health of the City of New York, the county health director or other appropriate health officer designated by the legislative body of each county or the corresponding authority of the City of New York to be responsible for providing or securing tuberculosis care and treatment, pursuant to section 2202 (1) of the Public Health Law.

(i) A state or local charge shall mean those persons defined as such in section 2200 (4) and (5) of the Public Health Law.

(j) Third-party payer shall mean Medicare, workers' compensation, medical assistance in accordance with the Social Services Law, the Veterans Administration, health and other insurers and indemnitors or other third parties by whom diagnosis, care and treatment hereunder is payable.
 

Effective Date: 
Wednesday, February 8, 1989
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Section 43-1.2 - Responsibility for tuberculosis care and treatment

43-1.2 Responsibility for tuberculosis care and treatment. The local health official, where a tuberculosis patient or contact resides or is found, shall provide or secure tuberculosis health care services needed by such person. Upon notification of a tuberculosis case or suspect, the appropriate local health official shall be responsible for immediately determining if other persons may have become infected with tuberculosis by the case or suspect, and shall perform those duties and responsibilities identified in Part 2 of the State Sanitary Code. The local health official shall provide or secure health care services needed for all cases or suspects found.

The local health official shall initiate preventive measures, to prevent the spread of infection or development of disease.

If a case or contact resides outside of the geographic jurisdiction of the local health official to which he or she has been reported, the local health official shall transfer copies of all materials concerning that case or contact to the local health official with jurisdiction.
 

Effective Date: 
Wednesday, February 8, 1989
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Complete

Section 43-1.3 - Nonresidents, aliens, refugees and staff members of legations

43-1.3 Nonresidents, aliens, refugees and staff members of legations.

(a) There shall be no discrimination against tuberculosis patients or contacts because of lack of United States citizenship or lack of New York State or local residence.

(b) Tuberculosis health care services for the following aliens are not eligible for payment by local health officials or the State or for payment of State aid reimbursement:

(1) officials, representatives or employees of foreign governments;

(2) officers and employees of international organizations;

(3) attendants, servants, personal employees of those listed in paragraphs (1) and (2) of this subdivision; or

(4) members of immediate families of those listed in paragraphs (1) through (3) of this subdivision.

Payment for tuberculosis health care services for these persons is the responsibility of the individual or foreign country through its appropriate representative in the United States.

(c) Refugees eligible for medical assistance in accordance with the Social Services Law and the rules and regulations thereunder shall also be eligible for tuberculosis health care services hereunder.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

REQUIREMENTS APPLYING TO PROVIDERS AS A CONDITION TO BEING ENTITLED TO PAYMENT FOR TUBERCULOSIS HEALTH CARE SERVICES

Section 43-1.4 - Standards for tuberculosis care and services

REQUIREMENTS APPLYING TO PROVIDERS AS A CONDITION TO BEING ENTITLED TO PAYMENT FOR TUBERCULOSIS HEALTH CARE SERVICES

43-1.4 Standards for tuberculosis care and services.

The care and treatment by providers of tuberculosis patients shall include health care services which meet prevailing standards of professional practice, including the following:

(a) a licensed and currently registered physician shall be responsible for the tuberculosis health care services furnished to a patient;

(b) tuberculosis suspects shall be confirmed as being or not being tuberculosis cases within 60 days from the date accepted into care by a provider. On or before the 60th day, the provider shall report findings in writing to the local health officials where the patient resides and where the provider is located;

(c) providers shall comply with applicable utilization review requirements.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.5 - Hospital inpatient admissions

43-1.5 Hospital inpatient admissions.

(a) Tuberculosis health care services provided in a hospital shall be based on prevailing standards of professional practice for the care of tuberculosis.

(b) An inpatient admission of a tuberculosis patient to a hospital for treatment of tuberculosis may be made when a person has severe symptoms attributed to tuberculosis, presents diagnostic problems or presents difficulties in drug treatment selection.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.6 - Reporting by providers

43-1.6 Reporting by providers.

(a) When a tuberculosis case or suspect is accepted for care by a provider, the provider shall notify by telephone within 24 hours the local health official where the provider is located, and also the local health official where the person resides. The provider shall then submit a written case report within 5 working days to the same local health official or officials. The written report shall include the person's name, date accepted for care, age, address, telephone number, name and address of employer, county of residence, diagnosis, clinical evidence of disease and diagnostic procedures completed. If the person has been admitted as an inpatient, a written statement shall also be submitted by the hospital indicating the reasons for inpatient admission, rather than ambulatory care.

(b) When a tuberculosis case or suspect accepted into care by a provider is or may be a local charge, as defined by Article 22, Section 2200 of the Public Health Law, the provider shall, within 5 working days, notify the local health official where the person resides of the person's name, address, potential status as a local charge, and the names and addresses of any third-party payers, along with all other information stated in part (a) of this section.

(c) When a tuberculosis case or suspect accepted for care by a provider is or may be a State charge, as defined by Article 22, Section 2200 of the Public Health Law, the provider shall, within 5 working days, notify the local health official where the provider is located of the person's name, address, potential status as a State charge, and the names and addresses of any third-party payers, along with all information stated in part (a) of this section. The health official will immediately inform the person designated by the State Health Commissioner for such purpose.

(d) A monthly patient status report on each person with tuberculosis disease shall be submitted by each provider to the local health officials where the person resides and where the provider is located, which shall include a medical and social history and, if applicable, a discharge summary. Reports shall be submitted within two weeks of the end of each month.

(e) Providers shall submit to such health official additional reports as the State Commissioner of Health may provide.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

AUTHORIZATION

Section 43-1.7 - Authorization of reimbursement for tuberculosis health care and services

AUTHORIZATION

43-1.7 Authorization of reimbursement for tuberculosis health care and services.

(a) Tuberculosis health care services shall be paid by the local health official with jurisdiction or the State only as authorized. Authorization for local charges shall be made by the local health official where the patient resides. Authorization for State charges shall be made by the designee of the State Health Commissioner.

(b) Providers shall be deemed authorized to collect reimbursement for tuberculosis health care services when they are so notified by the local health official or designee of the State Health Commissioner, if they comply with the requirements of this Subpart.

(c) Reimbursement for inpatient hospital services for a patient hospitalized for a period in excess of six weeks during a calendar year are not authorized unless approved in writing before expiration of the six weeks. Authorization for local charges may only be made by the local health official where the patient resides. If the patient is a potential State charge, the provider shall request authorization for care beyond six weeks by writing to the local health official where the patient resides. Such health official shall recommend whether such care is justified or not to the designee of the State Health Commissioner. Authorization for State charges may only be made by the designee of the State Health Commissioner.

(d) In determining which tuberculosis health care services to authorize for a tuberculosis patient, the local health official or designee of the State Health Commissioner shall consider available alternative tuberculosis health care services and determine the most appropriate source to meet the patient's needs.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

PROVIDER CLAIM FOR PAYMENT AND EFFORTS TO DETERMINE AVAILABILITY OF THIRD-PARTY PAYERS

Section 43-1.8 - Provider claim

PROVIDER CLAIM FOR PAYMENT AND EFFORTS TO DETERMINE AVAILABILITY OF THIRD-PARTY PAYERS

43-1.8 Provider claim.

(a) Providers of tuberculosis health care services may not claim payment from local health officials or the State for amounts which are eligible for payment from any other third-party payer or payers.

(b) For a tuberculosis patient who is a local charge, a provider shall submit to the local health official where the patient resides an itemized claim form for payment for tuberculosis health care services furnished to the patient who does not have full third-party coverage of the claim.

(c) For a State charge who does not have full third-party coverage, a provider shall submit an itemized claim form to the local health official where the patient resides. The health official shall verify the information on the claim form and shall forward the claim to the designee of the State Health Commissioner.

(d) The claim form shall show the charges for each of the services provided and shall deduct all amounts eligible for reimbursement or indemnification by the third-party payers.

(e) The claim form shall include the names of third-party payers or indemnitors who have paid, or are or may be responsible for making payments for part or all of the claim, and the amounts each has paid or is or may be responsible for paying.

(f) A form shall be submitted with a copy maintained by the provider, together with the claim form stating in detail the efforts made to determine whether there is third-party coverage or indemnification available for the claim. The form shall also state the efforts made to claim such reimbursements. If the provider's efforts to determine or obtain third-party reimbursement, as reported in the form are found unsatisfactory by the local health official, the provider shall make additional efforts and shall submit a supplemental form.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

RESPONSIBILITY FOR PAYMENT FOR SERVICES

Section 43-1.10 - No patient obligation to pay

43-1.10 No patient obligation to pay.

(a) No tuberculosis patient or his legally responsible relatives shall be requested or required by a provider, local health official, the State, or any other party to pay personally for any portion of tuberculosis health care services received, as provided in section 2202 of the Public Health Law.

(b) No provider, local health official, the State or any other person shall inquire into the financial ability of a tuberculosis patient or his legally responsible relatives to pay for tuberculosis health care services except to determine third-party coverage.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.9 - Extent of responsibility for payment

RESPONSIBILITY FOR PAYMENT FOR SERVICES

43-1.9 Extent of responsibility for payment.

(a) The local health official of the jurisdiction where a tuberculosis patient resides shall be responsible to pay providers for health care services rendered to a local charge tuberculosis patient when such services are authorized and provided in accordance with this Subpart, except:

(1) The maximum charges which the local health official shall be responsible for are the rates for the Medical Assistance Program established in accordance with the provisions of section 2807 of the Public Health Law and fees for services established in the State medical fee schedule for medical assistance.

(2) Amounts eligible for reimbursement or indemnification from any third-party payer shall not be paid by the local health official. Such amounts shall be deducted by the local health official from the charges billed by the provider or the established rates and/or fees in the State medical fee schedule for the health care services rendered, whichever are less.

(3) When a person has been admitted as an inpatient to a hospital for the treatment of a nontuberculous disease or condition and is subsequently found to have tuberculosis which requires inpatient care and treatment, a local health official has no responsibility to pay for care and treatment prior to the date of diagnosis of tuberculosis. If the person requires tuberculosis care and treatment, but hospitalization is not justified, the local health official shall not be responsible for hospitalization costs.

(4) If, upon review of a claim, the local health official determines that a tuberculosis patient had or was eligible for third-party coverage or indemnification and that the provider failed to make a good faith effort to determine whether there was such coverage or indemnification, the local health official may deny payment of claim.

(5) A person who volunteers to assume and pay for the cost of tuberculosis health care services hereunder shall be liable therefor.

(b) The State of New York shall be responsible to pay providers for health care services rendered to a State charge tuberculosis patient in accordance with the terms of this Subpart, with the same exceptions as described in subdivision (a) of this section.

(c) Subsequent to paying a provider for services, if a local health official or the State determines that a provider did not make a good faith effort to obtain third-party payer coverage or indemnification that was available, the local health official or the State shall require the provider to repay an amount equivalent to the amount of such third-party payer coverage or indemnification.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

REQUIREMENTS APPLYING TO LOCAL HEALTH OFFICIALS FOR RECEIVING STATE AID FOR TUBERCULOSIS HEALTH CARE SERVICES

Section 43-1.11 - State aid for tuberculosis

REQUIREMENTS APPLYING TO LOCAL HEALTH OFFICIALS FOR RECEIVING STATE AID FOR TUBERCULOSIS HEALTH CARE SERVICES

43-1.11 State aid for tuberculosis.

(a) Expenses incurred by a local health official for health care services rendered to tuberculosis patients in accordance with the terms of this Subpart shall be eligible for State aid reimbursement.

(b) Such aid shall be provided to local health officials through the same procedures and at the same rate as State aid for general public health work, pursuant to Part 40 of this Subchapter.
 

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete

Section 43-1.12 - Limitations on State aid

43-1.12 Limitations on State aid.

(a) No State aid is available to local health officials or providers for tuberculosis health care services which do not meet the terms of this Subpart or:

(1) if payment of a claim is available from any other third-party payer which equals or exceeds the per diem rate or fee for services;

(2) for tuberculosis health care services for persons listed in subdivision (b) of section 43-1.3 of this Subpart; or

(3) for services for which payment by a local health official is not required under this Subpart.

(b) If a local health official pays a provider more than it was responsible to pay under section 43-1.9 of this Subpart, State aid shall not exceed the amount that would have been due if the local health official had so limited payment in accordance with said section.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.13 - Audits by local health officials

43-1.13 Audits by local health officials.

Local health officials shall audit a sufficient number of provider reports, medical records, and if necessary, interview physicians and other personnel to determine whether a provider has furnished or is furnishing tuberculosis health care services in accordance with the requirements of this Subpart.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.14 - Recovery

43-1.14 Recovery.

Local health officials shall oversee all provider efforts to identify third-party coverage and to be able to demonstrate on audit that such third-party coverage was identified and fully utilized and that the providers adhered to the terms of this Subpart. Upon receipt of audit information by the State Health Department showing State aid overpayment, the Commissioner shall deduct from the next State aid voucher the amount previously overpaid.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

LOCAL HEALTH UNIT RECORDS AND REPORTS TO STATE HEALTH DEPARTMENT

Section 43-1.15 - Records and reports

LOCAL HEALTH OFFICIAL RECORDS AND REPORTS TO STATE HEALTH DEPARTMENT

43-1.15 Records and reports.

The local health officials shall submit all reports as required by the Department.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.16 - Return of a tuberculosis patient to location of residence

43-1.16 Return of a tuberculosis patient to location of residence.

(a) A New York State resident who is receiving tuberculosis health care services in another state and desires to return to New York State shall be referred to the local health official where the patient resides. The information requested of the other state by the local health official regarding the patient, shall include at least the following:

(1) medical history including sufficient clinical data to indicate need for further care and treatment of tuberculosis;

(2) a statement that the patient is physically able to travel without harm to himself or others, and arrangements have been made for his transfer to New York State;

(3) information for residence verification;

(4) a statement indicating the patient's willingness to return to New York State for further care and treatment of tuberculosis; and

(5) names and addresses of individuals who will assume responsibility for the patient.

(b) Once residence is established and the patient is able and willing to return, final arrangements for transfer shall be made by the local health official directly with the authorities of the other state.

(c) When a non-resident tuberculosis patient is willing and able to return to the political subdivision in which the patient resides in another state or country, the local health official where the patient's provider is located, or the Commissioner's designee, shall make arrangements with the health official of the political subdivision in which the patient resides so that the patient can be met on return and be provided the health care services needed. Copies of provider reports shall also be forwarded to said health official.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.17 - Commissioner's orders

43-1.17 Commissioner's orders.

If a local health official fails to provide or secure tuberculosis health care services or to pay providers for such services rendered under the terms of this Subpart, the State Health Commissioner upon notice and opportunity to be heard may order the local health official to provide or secure the services or to make such payment.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

Section 43-1.18 - Violations by a provider

43-1.18 Violations by a provider.

A violation of any provision of this Subpart as applied to a specific patient, shall be punishable by a denial of payment of State aid reimbursement to a local health official or a provider or the repayment thereof for tuberculosis health care services for such patient.
 

Effective Date: 
Wednesday, February 8, 1989
Doc Status: 
Complete

SubPart 43-2 - Uninsured Care Programs

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 201(1)(j), (q), 2776(1)(e)

Section 43-2.1 - Scope

Section 43-2.1 Scope.

These regulations govern the application and eligibility determination process for the Uninsured Care Programs and establish the rights and responsibilities of applicants, participants, providers, and contractors in that process.
 

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 201(1)(o), 201(1)(p) and 2776(1)(e)

Section 43-2.2 - Definitions

43-2.2 Definitions.

(a) An applicant is a person who has directly or by a representative, applied in writing to the New York State Department of Health.

(b) An application is the process by which a person indicates, in writing on a Department of Health-approved form, his/her desire to receive assistance.

(c) Resident means a person domiciled within the State.

(d) Authorized representative means any person authorized by an applicant or participant to act on his/her behalf.

(e) Period of coverage. Coverage for assistance for each individual program component is effective as specified in the individual's notification of eligibility. Coverage will terminate under the following circumstances:

(1) the applicant indicates in writing that they no longer need or desire assistance;

(2) the department determines that a change in the participant's circumstances or residence has affected their eligibility.

(3) the participant has died or cannot be located; and

(4) funding for the Uninsured Care Programs is exhausted.

(f) Program means the Uninsured Care Programs, as defined by the AIDS Institute, including the following service components:

(1) AIDS Drug Assistance Program, which provides coverage of medications;

(2) ADAP Plus, which provides coverage for ambulatory care services;

(3) ADAP Plus Insurance Continuation, which pays for insurance premiums for eligible individuals who have cost effective insurance policies; and

(4) the HIV Home Care Program, which provides coverage for home care services.

(g) Household. The applicant, persons legally responsible for the applicant, and persons for whom the applicant is legally responsible, shall be considered part of the household.

(h) Income means total gross income of the household. Income shall include: monetary compensation for services, including wages, salary, commissions or fees; net income from self-employment; unemployment insurance compensation; government civilian employee or military retirement or pension, including veterans' payments; pensions or annuities; alimony or child support payments; regular contributions from persons not living in the household; net royalties; social security benefits; dividends or interest on savings or bonds; income from estates or trusts; net rental income; public assistance or welfare payments; cash or any other income resource.

(i) Available household income means the applicant's household income after deducting the amount paid by the applicant under the Federal Insurance Contributions Act for Social Security and Medicare and the cost of health care coverage paid by the applicant.

(j) Provider means a medical provider, including a pharmacy, hospital, clinic, clinical practitioner, laboratory or home health care agency.

 

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete

Section 43-2.3 - Confidentiality

43-2.3 Confidentiality.

All information which may identify an applicant which is received by the program will be confidential and can only be used when necessary for supervision, monitoring or administration of the program. Information received by any contractor, his agents, employees, or by any other person or agency concerning applicants or participants in the program is confidential and may not be disclosed without the written approval of the Uninsured Care Program director, who shall approve disclosure only in conformance with Article 27-F of the Public Health Law and the federal standards with respect to the privacy and security of individually identifiable health information contained in Part 164 of Title 45 of the Code of Federal Regulations.
 

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete

Section 43-2.4 - Use of the application form

43-2.4 Use of the application form.

(a) The State-approved application form must be completed:

(1) for each applicant upon initial application and recertification, if required; and

(2) documentation may be required when there is a change in status affecting eligibility.

(b) The signature of the individual applying for assistance is required on the State-approved application form. In any case where the applicant is incapable of signing the application because of physical incapability, or mental incompetency, application shall be signed on behalf of such a person by his/her authorized representative.

(c) The State-approved form shall contain the following information, in addition to any other information which the Department of Health may require for the proper administration of the program:

(1) name, gender, date of birth, social security number, marital status, address and telephone number of the applicant;

(2) name and relationship to applicant for applicant's household members;

(3) income information for the applicant and members of the applicant's household; and

(4) information regarding any other health benefits or insurance coverage that is available to the applicant.
 

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 201(1)(o), 201(1)(p) and 2776(1)(e)

Section 43-2.5 - Eligibility for coverage

43-2.5 Eligibility for coverage.

(a) An applicant must be confirmed as medically eligible to participate in the program. The Department of Health will confirm medical eligibility based upon information received from the applicant and the applicant's clinical practitioner or their designee. The applicant's clinical practitioner or their designee will be required to submit information regarding an applicant's medical condition on a State-approved form consistent with their scope of practice.

(b) Financial eligibility will be based upon the available household income.

(1) In order to be eligible, an applicant's available household income must be equal to or less than 500% of the amount under the annual United States Department of Health and Human Services poverty guidelines for the applicant's family size. Federal poverty guidelines are published annually by the Department of Health and Human Services in the Federal Register.

(2) Applicants must provide income information for a reasonable period prior to application. Applicants who are self-employed must provide business records for the three months prior to application indicating type of business, gross income and net income.

(c) Full and proper use shall be made of existing public and private medical and health services and facilities for obtaining therapeutic drugs, medical services, and related supplies and equipment for the treatment or prevention of HIV or AIDS.

(d) An applicant or recipient of assistance may be required as a condition of eligibility or continued eligibility to assign any rights they may have for coverage benefits under any health insurance policy or group health plan to the department.

(e) In order to be eligible for ADAP Plus Insurance Continuation, an applicant must have:

(1) a health insurance policy that is determined to be cost effective by the department, based on the cost of premiums, limitations of coverage (i.e., deductible, caps, co-payments) and estimates of the monetary value of projected utilization and reimbursement under the insurance policy; and

(2) a premium cost that is more than 4% of the applicant's available household income, if the applicant's available household income is greater than 200% of the amount under the annual United States Department of Health and Human Services poverty guidelines for the applicant's family size. 

 

Effective Date: 
Wednesday, April 24, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 201(1)(o), 201(1)(p) and 2776(1)(e)

Section 43-2.6 - Decision on eligibility

43-2.6 Decision on eligibility.

(a) The department shall make one of the following decisions, based upon the application information:

(1) Accepted for coverage. This means that eligibility has been established through review and verification to the satisfaction of the department.

(2) Not accepted for coverage. Applications are denied when the information given by the applicant establishes that the applicant is ineligible, or when the applicant refuses to comply with any requirement essential to the determination of eligibility.

(b) No decision is required when:

(1) an application is withdrawn by the applicant; or

(2) the department documents that the applicant has died, cannot be located, or has left the State prior to the completion of the review and verification.
 

Effective Date: 
Friday, September 9, 1988
Doc Status: 
Complete

Section 43-2.7 - Responsibility for prompt determination of eligibility

43-2.7 Responsibility for prompt determination of eligibility.

The decision to accept or deny the application shall be made as soon as sufficient information to make a determination about eligibility is obtained.
 

Effective Date: 
Friday, September 9, 1988
Doc Status: 
Complete

Section 43-2.8 - Notification

43-2.8 Notification.

Written notification shall be given of the decision to accept or deny an application. Notification of denial shall clearly set forth the specific reason why the application was denied.
 

Effective Date: 
Friday, September 9, 1988
Doc Status: 
Complete

Section 43-2.9 - RESERVED

43-2.9 RESERVED

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Section 43-2.10 - Investigation

43-2.10 Investigation.

The department official shall review and verify information received on applications, as required. Documents, personal observation, personal and collateral interviews and contacts, reports, correspondence and conferences are means of verification of information supplied. When information is sought from collateral sources, other than public records or sources designated by the applicant on the application form, the department will inform the applicant/participant or his/her representative of what information is desired, why it is needed and how it will be used.
 

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Section 43-2.11 - Fraud and abuse

43-2.11 Fraud and abuse.

(a) The commissioner, his agents or designees, shall investigate and refer for prosecution any violations of State laws pertaining to fraud or abuse in the program.

(b) Where review indicates substantial evidence of abuse of the program, the participant may be removed from the program or restricted to a single provider.

(c) If the recipient did not provide accurate information regarding his income and expenses, the commissioner may summarily suspend an enrollee's participation in the program, and the department can recover the amount of assistance granted, to which the recipient is not entitled.
 

Effective Date: 
Wednesday, September 18, 1991
Doc Status: 
Complete

Section 43-2.12 - Appeals

43-2.12 Appeals.

(a) An applicant may request a reconsideration of an adverse decision within 60 days of a decision.

(b) The department shall review any additional submissions and issue a written decision within 30 days of an applicant's request and submission of additional documents.
 

Effective Date: 
Friday, September 9, 1988
Doc Status: 
Complete

Section 43-2.13 - Continuing eligibility

43-2.13 Continuing eligibility.

(a) Participants may be required to establish periodically that they remain eligible for the program.

(b) The applicant/participant must notify the department immediately of any changes in circumstances that may affect eligibility.
 

Effective Date: 
Friday, September 9, 1988
Doc Status: 
Complete

Section 43-2.14 - Enrollment of providers.

43-2.14 Enrollment of providers.

The department will contract with or enter into provider agreements with providers, including providers of related laboratory and ancillary services, which demonstrate that they are qualified to provide program services.
 

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Section 43-2.15 - Audit and claim review

43-2.15 Audit and review.

(a) Providers shall be subject to audit and reviews for quality assurance and proper utilization by the commissioner, his agents or designees. With respect to such audits and reviews, the provider may be required:

(1) to reimburse the department for overpayments discovered by audits; and

(2) to pay restitution for any direct or indirect monetary damage to the program resulting from their improperly or inappropriately furnishing covered drugs, services, supplies or equipment.

(b) The commissioner, his agents or designees, may conduct audits and reviews, and investigate potential fraud or abuse in a provider's conduct.

(c) The commissioner, his agents or designees, may pay or deny claims, or delay claims for audit review.

(d) When audit findings indicate that a provider has provided covered drugs, services, supplies or equipment in a manner which may be inconsistent with regulations governing the program, or with established standards for quality, or in an otherwise unauthorized manner, the commissioner may summarily suspend a provider's participation in the program and/or payment of all claims submitted and of all future claims may be delayed or suspended. When claims are delayed or suspended, a notice of the withholding payment or recoupment shall be sent to the provider by the department. This notice shall inform the provider that within 30 days he/she may request in writing an administrative review of the audit determination before a designee of the commissioner. The review must occur and a decision rendered within a reasonable time after a request for review. If the designee of the commissioner decides withholding or recoupment is warranted, or if no request for review is made by the provider within the 30 days provided, the department shall continue to recoup or withhold funds pursuant to the audit determination.

(e) Where investigation indicates evidence of abuse by a provider, the provider may be fined, suspended, restricted or terminated from the program.
 

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Section 43-2.16 - Audits and recovery of overpayments

43-2.16 Audits and recovery of overpayments.

(a) Recovery of overpayments shall be made only upon a determination by the commissioner, his agents or designees, that such overpayments have been made, and recovery shall be made of all money paid to the provider to which it has no lawful right or entitlement.

(b) Recovery of overpayments pursuant to this subject shall not preclude the commissioner or any other authorized governmental body or agency from taking any other action with respect to the provider, including auditing or reviewing other payments or claims for payment for the same or similar periods, imposing program sanctions, or taking any other action authorized by law.

(c) The commissioner may utilize any lawful means to recover overpayments, including civil lawsuit, participation in a proceeding in bankruptcy, common law set-off, or such other actions or proceedings authorized or recognized by law.

(d) All fiscal and statistical records and reports of providers and prescriptions filled or refilled which are used for the purpose of establishing the provider's right to payment under the program, and any underlying books, records and documentation which formed the basis for such fiscal and statistical records and reports, shall be subject to audit. All underlying books, records and documentation, including all prescriptions filled or refilled, shall be kept and maintained by the provider for a period of not less than three years from the date of completion of such reports, or the date upon which the fiscal and statistical records were required to be filed, whichever is later, or the date the prescription was filled or refilled.

(e) All claims made under the program shall be subject to audit by the commissioner, his agents or designees, for a period of six years from the date of their filing, or as required by state law, regulation or funding source. This limitation shall not apply to situations in which fraud may be involved or where the provider or an agent thereof prevents or obstructs the performance of an audit pursuant to this Part.
 

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Section 43-2.17 - Recoupment of overpayments

43-2.17 Recoupment of overpayments.

Overpayments determined to have been made pursuant to this section and section 43-2.16 of this Subpart shall be recovered by billing the provider for reimbursement, withholding the provider's current or withholding future payments on claims submitted or a percentage of payments otherwise payable on such claims, or such other remedies as may be available through a court of law.
 

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Section 43-2.18 - Claims submission

43-2.18 Claims submission.

(a) Providers shall submit claims for drugs or services within ninety days of the date of service in the manner and form proscribed by the program in order to receive reimbursement.

(b) The department will not be obligated to pay claims submitted more than ninety days after the date of service. Claims submitted later than 90 days with written justification may be considered for payment if funds are available.

Effective Date: 
Wednesday, June 2, 2010
Doc Status: 
Complete

Part 44 - State Aid For Approved Vector Surveillance And Control Programs

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 611 and 619

Section 44.10 - Purpose

44.10 Purpose.

Pursuant to Public Health Law, section 611, the New York State Department of Health (NYSDH) is authorized to pay State aid for approved vector surveillance and control programs. These rules and regulations are promulgated to define the conditions under which the NYSDH will approve vector surveillance and control activities for State aid.
 

Effective Date: 
Wednesday, August 19, 1992
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Section 44.20 - Definitions

44.20 Definitions.

For the purposes of these rules and regulations, the following definitions shall apply:

(a) Arthropod shall mean a member of the phylum Arthropoda, animals with jointed appendages.

(b) Presumptive human case shall mean the occurrence of one or more of the following:

(1) California Encephalitis: Central nervous system (CNS) symptoms plus serum titers consistent with the illness for example, HI >= 1:40, CF >= 1:8 or Neut >= 3 logs.

(2) Eastern Equine Encephalitis (EEE): CNS symptoms and single serum titers consistent with the illness, for example, HI >= 1:80, CF >= 1:16.

(3) Rocky Mountain Spotted Fever: headache, fever, rash, history of tick exposure and positive serologies.

(4) St. Louis Encephalitis: CNS symptoms plus single serum titers consistent with the illness, for example, HI >= 1:80, CF >= 1:16.

(c) Confirmed human case shall mean the occurrence of one or more of the following:

(1) California Encephalitis: virus isolation and/or CNS symptoms plus four-fold or greater rise or fall in antibody titers.

(2) Eastern Equine Encephalitis (EEE): virus isolation and/or four-fold or greater rise or fall in antibody titers or 1.3 log rise or fall in neutralization index.

(3) Rocky Mountain Spotted Fever: Rickettsial isolation and/or four-fold or greater rise in antibody titers.

(4) St. Louis Encephalitis: virus isolation and/or CNS symptoms plus four-fold or greater rise or fall in antibody titers.

(d) Clustering shall mean multiple human cases of disease which may be considered related to each other by proximity, source or simultaneity of occurrence.

(e) Control shall mean any measure taken to reduce or eliminate a vector arthropod species or related disease threat. Control measures may include water management, use of biological agents, chemical ground application, chemical air application, or any other method used to reduce or eliminate vector arthropods.

(f) Endemic shall mean the continued presence of a disease in an area, or the cyclic reintroduction of a disease into the same area.

(g) Epidemic shall mean the occurrence of recognizable disease or illness in the human or animal host outside the endemic area or an excess incidence of the disease beyond that usual in an endemic area.

(h) Etiologic agent shall mean the pathogen responsible for causing a disease or illness.

(i) Host shall mean a man or other living animal, including birds and arthropods, which affords subsistence or lodgement to an infectious agent under natural conditions.

(j) Reservoir shall mean a human, animal or arthropod in which an infectious agent normally lives and multiplies and on which it depends primarily for survival and serves as a source of infection for a susceptible host.

(k) Response protocols shall mean the procedure followed by the NYSDH in response to a documented public health threat or emergency.

(l) Surveillance shall mean the epidemiologic study of a disease as a dynamic process involving the ecology of the infectious agent, the host, the reservoirs and the vectors as well as the complex mechanisms concerned in the spread of infections and the extent to which this spread occurs.

(m) Vector shall mean an arthropod species capable of carrying and transmitting a disease agent.

(n) Vector surveillance program shall mean the activities of any agency designed to accomplish any or all of the following:

(1) location of vector breeding areas;

(2) collection and identification of vector species;

(3) determination of vector population densities;

(4) determination of vector species distribution;

(5) determination of physiologic or chronologic age composition of vector population;

(6) submission of site specific groups of vector species for etiologic agent isolation attempts;

(7) assessment of the vector population to determine the effectiveness of control measures; and

(8) compilation of data generated by any or all of the above.

(o) Commissioner shall mean the Commissioner of the New York State Department of Health.
 

Effective Date: 
Wednesday, August 19, 1992
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Section 44.30 - Eligibility for State aid

44.30 Eligibility for State aid.

State aid shall be paid for approved vector surveillance and vector surveillance and control programs that:

(a) have been approved in advance of implementation by the commissioner or his designee and operated in accordance with that approval;

(b) have been conducted by county or part-county departments of health or county boards of health or municipal agencies which have been designated by the county or part-county health department or county board of health for vector surveillance or vector surveillance and control programs;

(c) have operated vector surveillance programs only or have had vector surveillance and vector control activities concurrently; and

(d) have been the subject of a determination of significance pursuant to the State Environmental Quality Review Act, Article 8 of the Environmental Conservation Law and the implementing regultions issued thereunder.
 

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Section 44.40 - Procedure for applying for State aid

44.40 Procedure for applying for State aid.

Applications for State aid for vector surveillance and vector control activities shall be on a form prescribed by the commissioner and shall be accompanied by a detailed, proposed plan of activity which shall include the following:

(a) an historical and chronological review of arthropod-borne disease activity in the area with evidence of any substantive endemic disease which has occurred during the past decade and to include the number of human cases (confirmed and presumptive), clustering of human cases; and/or isolations of the agents from vector species as well as the presence of vectors with a potential risk to human health;

(b) a detailed description of the geographic area where vector populations have occurred previously or where they could occur; a map of the county identifying these risk areas must be included; and

(c) methods by which vector populations or areas will be monitored.
 

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Section 44.41 - Additional requirements for localities applying for State aid

44.41 Additional requirements for localities applying for State aid.

(a) Nonchemical control measures. Localities applying for nonchemical control of insect vectors must include in the plan a discussion of methods of habitat modification and biological control in terms of feasibility, manpower, equipment and target species in conjunction with a comprehensive delineation of the target area and anticipated short and long-term benefits.

(b) Chemical control measures. Localities which anticipate a need for chemical control measures must submit detailed plans for such measures. Plans for pesticide application must discuss the target vector, its anticipated geographic location, manpower/equipment required, chemicals/application procedures, and pertinent safeguards which will be followed.

(c) Miscellaneous responsibilities. (1) Localities anticipating the submission of vector surveillance or vector surveillance and control activities should review the response protocols available from the New York State Department of Health.

(2) Approval of a vector control program for the purpose of State aid shall not relieve any locality of its obligation to comply with all applicable laws or regulations, including Article 8 of the Environmental Conservation Law and implementing regulations. Each application for State aid for vector control shall include a statement indicating the applicant's acknowledgement of the obligation.

(3) Counties shall submit proposals directly to the New York State Department of Health. Other municipalities shall submit plans through their respective counties. Plans must be submitted to the Department of Health by January 15th of the calendar year for which State aid will be requested. Exceptions to this deadline may be allowed by the State Department of Health if a public health threat occurs and/or in other compelling unanticipated circumstances.
 

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Section 44.50 - Public health threat; determination

44.50 Public health threat; determination.

(a) Public health threat of an arthropod vector-borne disease based on historical risk shall be determined by the documentation of a public health threat as described in subdivision (b) of this section, once in the previous three years, or two or more times in the previous ten years, and by a finding, based upon the risk assessment considerations set forth in section 44.51 of this Part, that current conditions pose a substantial risk to human health.

(b) A public health threat of an arthropod vector-borne disease based on current activity shall be determined by the presence of human vector-borne disease or the presence of disease-specific etiologic agents in a known or suspected vector as specified below, and substantiated by information required by the risk assessment activities described in section 44.51.

(1) The presence of human vector-borne disease includes, but is not limited to:

(i) a single human or equine case of EEE;

(ii) a single human case of St. Louis Encephalitis (SLE); or

(iii) epidemiologic evidence of clustering of human cases of:

(a) California Encephalitis (CE);

(b) Rocky Mountain Spotted Fever (RMSF);

(c) Lyme disease;

(d) Babesiosis; or

(e) The occurrence of indigenous cases of other arthropod-borne etiologic agents which include, but are not limited to:

(1) dog heartworm;

(2) malaria;

(3) tularemia;

(4) powassan; or

(5) dengue.

(2) The presence of disease specific etiologic agents in a known or suspected vector includes, but is not limited to:

(i) isolation of EEE virus or SLE virus from mosquitoes or an avian host;

(ii) demonstration of vector infectivity rates in excess of 5% in known or suspected tick vectors of the rickettsia of the spotted fever group, or in excess of 30% in known or suspected tick vectors of the Lyme disease spirochete in association with documented human cases;

(iii) site specific, multiple isolations of the related alpha virus, the Highlands J (HJ) virus, from known or suspected mosquito vectors, indicative of potential EEE virus activity;

(iv) demonstration of an imminent potential for the transfer of the etiologic agent from the endemic cycle to the epidemic disease cycle, including but not limited to:

(a) the demonstration of a significant rise in antibody levels or significant IgM antibody levels in avian hosts of EEE virus or SLE virus during the recognized period of disease activity; or

(b) the demonstration of high levels of parasitemia (>20%) in the mammalian reservoirs for human babesia; or

(c) in the case of established clustering of human cases of dog heartworm, malaria, powassan, dengue or tularemia, the demonstration of infective forms or etiologic agent isolation from known or suspected arthropod vectors.
 

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Section 44.51 - Public health threat; risk assessment and declaration

44.51 Public health threat; risk assessment and declaration.

(a) In evaluating the existence of a public health threat, the commissioner shall assess the risk to human health by taking into account the etiologic agent, the vector species, the size of the specific and secondary vector populations, the vectors' physiological age, density and proximity of human population, the time of year and weather conditions.

(b) When a locality believes that an arthropod-borne disease should be designated as a public health threat, localities should document the information and immediately notify the county health commissioner or responsible regional health director who shall information the commissioner. The person notifying the Commissioner of Health shall also send a copy of the notification to the Commissioner of Environmental Conservation.

(c) Only the commissioner may make a declaration of public health threat for state aid eligibility.
 

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Section 44.60 - Standards for review and approval

44.60 Standards for review and approval.

(a) State aid applications for vector control activities in the absence of a concurrent arthropod vector surveillance program shall not be approved. However, there will be State aid for vector surveillance programs in the absence of control activities where the surveillance activities are directed to the detection of arthropod vector-borne diseases which may constitute a public health threat.

(b) Plans for surveillance activities must be described within the State aid application for vector surveillance (form DOH 0627-2377) and be approved in advance by the designee of the commissioner.

(c) Localities implementing nonchemical control measures should take steps that do not create any risks to public health, that minimize any risks to the environment, that can be accomplished in a cost effective manner, and produce long-term benefits to the community by permanent vector control. Each control effort must be approved by the designee of the commissioner.

(d) Requests for state aid reimbursement for pesticide spray application for vector control shall meet the following requirements:

(1) Pesticide spray applications conducted by the municipality must be in response to a public health threat determined pursuant to section 44.50 of this Part.

(2) Reserved.

(3) When pesticide control measures are found necessary, ground application of pesticides shall be the preferred method of control. No aerial pesticide application shall be approved for State aid reimbursement except under conditions involving specific arboviruses such as Eastern Equine Encephalitis or St. Louis Encephalitis and the commissioner concludes, because of the inaccessibility of the target areas by land, that aerial spraying is the only practical way in which vector control activities can be carried out. The department, in its review of each application, will consider physiography, accessibility to the area where the vector is located, rapidity of response required as determined by the seriousness of the public health threat, and the likelihood that vectors in nearby areas not subject to control measures will migrate from the area if not subject to control.

(4) If a public health threat warranting control measures is found to exist, control measures must be limited to the immediate area where the vector population has been determined to exist through vector surveillance and may include adjacent areas considered at risk for imminent disease transmissions as documented through vector surveillance activities.

(5) The pesticides to be applied and the manner of application must be approved on a timely basis in advance of use by the department and must be conditionally approved by the Department of Environmental Conservation subject to a further timely review and opportunity, pursuant to paragraph (8) of subdivision (d) of this section, for the Department of Environmental Conservation to request a modification of an order of the Commissioner of Health declaring a public health threat. Such approval will be based upon, among other things, an assessment of effectiveness of the proposed pesticides applied to control the vector in the target area including pesticide type and timing in the vector's life cycle, the potential impact of the pesticide on people and the potential adverse ecosystem effects on any proposed pesticide based on its toxicity, persistence and target organism specificity, and potential for no-target impacts.

(6) Sources for public water supplies will not be subjected to direct pesticide applications nor to the drift of such activities. Surface water shall not be subjected to mosquito larvicide application without a NYSDEC aquatic pesticide permit, when required, and any such application shall comply with the label restrictions of the pesticide used.

(7) Under conditions of a current public health threat as declared by the commissioner, the applicant shall announce to the general public, via the print and broadcast news media, the use of vector control activities in the target area at least 24 hours in advance of such use. The time period for advance notice may be shortened by the commissioner or designee in the event that 24-hour advance notice is not possible or that delay would endanger the public health. Vector control activities taken under conditions supported only by historical evidence shall be announced similarly to the general public at least 72 hours in advance of such activities.

(8) The Commissioner of Environmental Conservation shall have an opportunity to consult with the Commissioner of Health and request such modification of orders declaring public health threats as are deemed necessary to implement the purposes of the Environmental Conservation Law.
 

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Section 44.61 - State aid reimbursement; vector surveillance and control

44.61 State aid reimbursement; vector surveillance and control.

The municipality must document within the state aid application, as a precondition for reimbursable vector surveillance and control (form DOH-0627-2378), conditions supporting a public health threat.
 

Effective Date: 
Wednesday, August 19, 1992
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Section 44.70 - Monitoring

44.70 Monitoring.

(a) Localities receiving State aid for vector surveillance and/or control will be subject to unannounced, onsite monitoring by New York State Department of Health personnel. Localities applying pesticide will be monitored more actively than those areas only engaging in surveillance.

(b) Localities conducting vector control activities shall provide to the department information used to monitor and evaluate the effectiveness of each control activity. Such information shall be submitted to the department as part of the locality's monthly report in the format described in the response protocols.
 

Effective Date: 
Wednesday, August 19, 1992
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Section 44.80 - Claiming State aid

44.80 Claiming State aid.

Counties with State aid applications approved in advance of implementation shall submit vouchers for vector surveillance and/or vector control activities through the same procedure and at the same rate as State aid for general public health work, pursuant to Part 40 of this Title.
 

Effective Date: 
Wednesday, December 31, 2014
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Section 44.90 - State aid reimbursement amounts

44.90 State aid reimbursement amounts.

Under emergency situations, the department shall reimburse counties or municipalities for 50 percent of the cost for emergency vector control measures as approved by the department. Emergency funds will only be available after the county or municipality has expended all other forms of State aid for vector surveillance and vector control programs.
 

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Part 45 - Cystic Fibrosis Health Care Program Adult Cystic Fibrosis Assistance Program

Doc Status: 
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Statutory Authority: 
Public Health Law, art. 27-G

Section 45.1 - Medical care and/or insurance premium reimbursement

Section 45.1 Medical care and/or insurance premium reimbursement.

Reimbursement for medical care for the treatment of cystic fibrosis patients and/or medical insurance premiums for cystic fibrosis patients will be made on behalf of patients enrolled in the Adult Cystic Fibrosis Assistance Program.
 

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Section 45.2 - Definitions

45.2 Definitions.

(a) Medical care for cystic fibrosis means such diagnostic, therapeutic and rehabilitative care by medical and paramedical personnel, including hospital and related care, drugs, prostheses, appliances, procedures, equipment and devices, as necessary for the treatment of cystic fibrosis and any conditions demonstrated to result from the progress or treatment of cystic fibrosis.

(b) Net annual income means gross income of the patient and/or patient's spouse, less State, local and Federal income taxes, and social security deductions.
 

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Section 45.3 - Eligibility criteria

45.3 Eligibility criteria.

(a) To be eligible for medical care reimbursement for cystic fibrosis and/or medical insurance premium payment through this program, such individual:

(1) shall be at least 21 years old;

(2) shall have been diagnosed as having cystic fibrosis;

(3) shall have resided in New York State for a minimum of 12 continuous months immediately prior to application for services from the Adult Cystic Fibrosis Assistance Program;

(4) shall not be eligible for medical benefits under any group or individual health insurance policy;

(5) shall not be eligible for medical assistance (Medicaid) pursuant to title 11 of article five of the Social Services Law solely due to earned income;

(6) shall submit an application and provide such other information, including documentation of net annual income, as required by the commissioner; and

(7) shall pay annually seven percent of his or her net annual income toward the cost of medical care related to cystic fibrosis and/or the cost of annual health insurance premiums at such intervals as are agreed upon by an authorized representative of the commissioner.

(b) To be a partially eligible individual for whom medical care reimbursement for cystic fibrosis and/or medical insurance premium payment will be provided through this program on a supplemental basis, such individual shall meet all criteria of a fully eligible individual except that a partially eligible individual shall have medical care reimbursement benefits available under a group or individual health insurance policy which does not provide full coverage for the care and treatment of cystic fibrosis.
 

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Section 45.4 - Qualified consultants

45.4 Qualified consultants.

Professional services rendered by medical 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 45.8 of this Part.
 

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Section 45.5 - Hospital and related medical care

45.5 Hospital and related medical care.

Reimbursement for inpatient and outpatient care rendered by hospitals and other facilities established pursuant to article 28 shall be made at rates not to exceed those established for patients eligible for medical assistance (Medicaid).
 

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Section 45.6 - Payment for outpatient and related medical care

45.6 Payment for outpatient and related medical care.

Fees for outpatient and related medical care may not exceed those established pursuant to title 11 of article five (Medicaid) of the Social Services Law.
 

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Section 45.7 - Out-of-state care

45.7 Out-of-state care.

Out-of-state care will not be approved for State aid reimbursement unless specific exception is made by an authorized representative of the commissioner for just cause.
 

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Section 45.8 - Accredited hospital

45.8 Accredited hospital.

Payment for care in hospitals will be made only if the hospital possesses a valid operating certificate from the commissioner if it is located within the State or appears on the Joint Commission on Accreditation of Hospitals list of approved hospitals if it is located out-of-state.
 

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Section 45.10 - Confidentiality

45.10 Confidentiality.

Medical, financial and personal information provided to the Adult Cystic Fibrosis Assistance Program to establish and maintain eligibility shall be kept confidential in accordance with Public Health Law, section 206(1)(j).

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Section 45.11 - Payor of last resort

45.11 Payor of last resort.

In all cases, the Adult Cystic Fibrosis Assistance Program shall be the payor of last resort.
 

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Section 45.9 - Foreign diplomatic personnel

45.9 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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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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Part 47 - New York State Health Service Corps/Obstetric And Pediatric Practitioner Incentive Demonstration Program

Effective Date: 
Wednesday, October 13, 1993
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Statutory Authority: 
Public Health Law, Secs. 231, 232, 233 2506

SubPart 47-1 - New York State Health Service Corps

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
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Statutory Authority: 
Public Health Law, Secs. 231, 232, 233

Section 47-1.1 - Definitions

Section 47-1.1 Definitions

(a) State Health Service Corps professional shall mean a health professional in any one of the professions listed below or any other health professional, excluding physician or dentist, determined by the Commissioner of Health, in consultation with the State Health Service Corps advisory committee to be needed in designated facilities or agencies:

(1) A registered professional nurse;

(2) A registered physician's assistant;

(3) A dental hygienist;

(4) An occupational therapist;

(5) A physical therapist;

(6) A speech-language pathologist;

(7) An audiologist;

(8) A pharmacist;

(9) A midwife; and

(10) Any other health profession identified by participating agencies as being difficult to recruit. Scholarships in these occupations will be offered on a limited basis for no more than two years.

(b) State Health Service Corps advisory committee shall mean a committee composed of the Commissioners of the Departments of Health, Education and Correctional Services, the Commissioners of the Office of Mental Health and the Office of Mental Retardation and Developmental Disabilities and the Presidents of the Civil Service Commission and the Higher Education Services Corporation or their designees, established to advise the Commissioner of Health on issues related to the State Health Service Corps.

(c) Designated facility or agency shall mean a facility or institution designated by the Commissioner of Health, in consultation with the State Health Service Corps advisory committee that is:

(1) operated by:

(i) the Office of Mental Health;

(ii) the Office of Mental Retardation and Developmental Disabilities;

(iii) the Department of Correctional Services; or

(2) not-for-profit and licensed by the Office of Mental Retardation and Developmental Disabilities or the Office of Mental Health or under contract with the Commission for the Blind and Visually Handicapped;

(3) a not-for-profit diagnostic and treatment center, with an operating certificate issued pursuant to section 401.1 of this title, which has a critical shortage of health personnel, as determined by the commissioner, and which serves the medically indigent and Medicaid- eligible persons;

(4) a health care facility or non-profit or public agency which provides care or treatment to persons infected with the human immunodeficiency virus or who have acquired immunodeficiency syndrome and which are currently experiencing a shortage of health personnel to specifically serve such persons, or

(5) in the case of midwives, a not-for-profit facility with an operating certificate issued pursuant to section 401.1 of this title, which serves the medically indigent and Medicaid-eligible women.

(d) Licensure shall mean possession of a license, registration or certificate to practice in one of the professions listed in subsection (a) of this section issued by the appropriate governing agency.

(e) Academic year shall mean the period between July 1 and June 30 of the following year.

(f) Full-time enrollment shall mean matriculation as a college or university student taking at least 12 credits or their equivalent, except that in the final semester of study in which the student must take sufficient credits or their equivalent in order to complete training, but not fewer than six credits.

(g) Scholarship or fellowship award shall mean the sum of the State Health Service Corps funds paid to or on behalf of a State Health Service Corps recipient during one academic year. The award shall not exceed the cost of attendance which shall mean tuition, required fees, books, transportation, and room and board.

(h) Effective date of award shall mean the beginning date of the first semester for which the scholarship or fellowship recipient has received a State Health Service Corps award.

(i) Service obligation shall mean the period of time a State Health Service Corps scholarship or fellowship recipient is required to work a basic work-week as an employee of a designated facility or agency.

(j) Alternative service shall mean working a basic work week as a paraprofessional or in a profession other than the one for which the award was given in fulfillment of the service obligation.

(k) State Health Service Corps recipient shall mean an individual who has signed a service agreement to receive a scholarship or fellowship award under the State Health Service Corps program in return for a service obligation.

(l) Service agreement shall mean the written agreement to be signed by a State Health Service Corps recipient specifying the terms of the award and the service obligation required prior to issuance of an award.

(m) Reporting date shall mean the date upon which a State Health Service Corps recipient is required to begin employment in fulfillment of his/her service obligation.

(n) Rescission shall mean the withdrawal of an award after the signing of the service agreement but before full payment for an award is made to an educational institution. (o) Waiver shall mean full or partial release by the Commissioner of Health, of the service obligation and/or any financial obligation for repayment of scholarship or fellowship award monies incurred by a State Health Service Corps award recipient.

(p) Deferral shall mean a delay or temporary suspension of the award payment and/or service obligation and/or any financial obligation for repayment of award monies incurred by the State Health Service Corps award recipient, with no resulting reduction in service or financial obligation.

(q) Default shall mean the failure to complete program of study, or the failure to begin the service obligation on the reporting date, or the failure of a State Health Service Corps recipient to complete his/her service obligation within the time prescribed by the Commissioner of Health.
 

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Wednesday, October 13, 1993
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Section 47-1.2 - Eligibility for an award

47-1.2 Eligibility for an award.

(a) To be eligible for a State Health Service Corps award, an individual must:

(1) show evidence of enrollment or acceptance for full-time study in a professional study program in an institution approved by the Board of Regents. The Commissioner of Health may permit individuals who are not enrolled or who have not been accepted for enrollment to apply for an award, but an award will not be made until the individual provides evidence of acceptance into an institution approved by the Department of Health pursuant to standards established in this Title, or the Board of Regents. The Commissioner of Health may permit individuals who submit satisfactory medical statements substantiating a serious illness or disability that precludes full-time attendance to attend part-time;

(2) be pursuing a program of continuous undergraduate or graduate education in a health care profession as defined in section 47.1(a) of this Part;

(3) be within 24 months of completing the program of study and being eligible to apply for licensure, registration or certification in the profession of study;

(4) be a United States citizen or resident alien who is holding a valid I-551 card or a valid I-151 card issued by the U.S. Immigration and Naturalization Service;

(5) meet the character and moral standards required for licensure under section 6524, subsection 7 of the State Education Law; and

(6) complete, sign and file an application using prescribed forms which must be filed within specified time frames. All required supplementary documents must be filed as directed. Incomplete, illegible or vague applications may be rejected. Applications filed after the deadlines specified may be rejected.

(b) An individual may be determined to be ineligible to receive a State Health Service Corps scholarship or fellowship award if:

(1) the individual is already receiving any other scholarship or fellowship award that requires the fulfillment of a service obligation;

(2) the individual is employed by the State of New York and is granted educational leave with pay from the position held except in the instance of extreme hardship as determined by the Commissioner of Health;

(3) the individual is identified by Higher Education Services Corporation as having defaulted on the repayment of a guaranteed student loan; or

(4) the individual is not a resident of New York State and plans to attend or attends an educational institution located out of state.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.3 - Selection of award recipients

47-1.3 Selection of award recipients.

(a) Process. The Commissioner of Health in consultation with the State Health Service Corps advisory committee shall select award recipients based on the criteria and preferences described in subdivisions (b) and (c) of this section; however, no award shall be given to an applicant unless a designated facility or agency has expressed a willingness to employ the applicant upon completion of the applicant's education.

(b) Preference. Preference shall be given to persons in the following categories, in the order of priority stated:

(1) holders of a prior State Health Service Corps award who have maintained an acceptable academic performance, provided they meet all requirements of chapter 355 of the Laws of 1985 and regulations of the Commissioner of Health. Recipients are limited to one award annually and are eligible for annual awards for two consecutive academic years. Holders of awards may be required to submit such supplemental data as required by the department;

(2) a New York State resident attending or planning to attend a New York State educational institution;

(3) a New York State resident attending or planning to attend an educational institution located out of state; and

(4) persons who are not residents of New York State attending or planning to attend a New York State educational institution.

(c) Selection criteria. All eligible applications will be reviewed competitively using the following criteria:

(1) the need, as determined the Commissioner of Health and the State Health Service Corps advisory committee, for the profession for which a scholarship is being sought in the designated facilities or agencies and region(s) where the applicant is willing to work;

(2) academic performance and academic awards or honors;

(3) special training and education relevant to the needs of the population to be served;

(4) work experience in the chosen health profession;

(5) work or volunteer experience with the population to be served;

(6) demonstrated commitment to working with the population to be served;

(7) civic or community awards and honors; and

(8) special skills or abilities or background or experience which will facilitate working with the population to be served.

(d) Number of awards. The Commissioner of Health shall make as many awards as permitted by statute and for which there is available funding. The Commissioner of Health may make fewer awards than permitted by statute if, in consultation with the State Health Service Corps advisory committee, it is determined that no eligible applicants meet minimum qualifications, based on such criteria as those listed in the selection criteria in subdivision (c) of this section.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.4 - Maintaining eligibility for awards

47-1.4 Maintaining eligibility for awards.

(a) Full-time continuous enrollment. Award recipients must be enrolled full-time except as permitted by section 47.2 (a)(1) and in good standing in accordance with the standards and regulations established by the New York State Higher Education Services Corporation and the institution where the award recipient is receiving training. The recipient who receives awards for completing two years of education must do so in two consecutive academic years.

(b) Transfers. An award recipient may receive permission from the Commissioner of Health to transfer to another institution provided:

(1) the recipient continues training in the profession for which the award was granted;

(2) the transfer does not increase the total period of training; and

(3) the school to which the recipient transfers has a program approved by the New York State Department of Health pursuant to standards established in this Title, or the New York State Board of Regents.

(c) Reporting requirements. Award recipients must report semiannually to the Department of Health and the Higher Education Services Corporation on forms and at such times as required by these agencies.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.5 - Award rescission and deferrals

47-1.5 Award rescission and deferrals.

(a) Award rescission. An award may be rescinded by the Commissioner of Health if:

(1) the recipient fails to execute a student payment application (form HE8030) with the Higher Education Services Corporation or fails to follow the Higher Education Services Corporation or Department of Health reporting requirements;

(2) the recipient withdraws from school or otherwise fails to maintain full-time enrollment;

(3) the recipient is convicted of any felony;

(4) the recipient fails to maintain good academic standing; or

(5) the recipient is found to have provided fraudulent or willfully misrepresented information in the application or supporting documents.

(b) Award deferral. An award may be postponed or deferred temporarily by the Commissioner of Health because of one or more of the conditions described in subdivision (a) of this section if it is determined that the condition will be corrected in a reasonable time or if the circumstances warrant a deferral rather than a rescission.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.6 - Service obligation

47-1.6 Service obligation.

(a) Service obligation. A State Health Service Corps award recipient is required to work full-time in a designated facility or agency for 18 months in the profession he/she has received an award. A recipient will be required to complete his/her service obligation by working from the reporting date to completion of his/her service obligation without interruption.

(b) Reporting date. A State Health Service Corps recipient is required to begin his/her service obligation within 60 days of either completing the education for which he/she has received a State Health Service Corps award, or receiving a license in that profession whichever comes later, except that the reporting date shall not exceed:

(1) 30 months from the effective date of the first scholarship award if the recipient has received two awards; and

(2) 18 months if the recipient has received one award.

(i) In the case of a recipient whose award has been deferred, the period of time of the approved deferral shall not be included in the calculation of the reporting date described in this section.

(ii) If no appropriate position exists in any designated facilities or agencies for the recipient, the reporting date shall be extended until such a position becomes available.

(c) Alternative service. In the event a recipient fails to qualify for licensure or is unable to fulfill the service obligation in the profession for which the State Health Service Corps scholarship award is given, the Commissioner of Health, in consultation with the State Health Service Corps advisory committee, may permit the individual to provide alternative service which would meet the intent of the public service obligation.

(d) Service performance. Each recipient while employed in a designated facility or agency shall abide by all of the performance rules or requirements of that agency. Loss of employment due to unsatisfactory performance will result in default.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.7 - Service obligation: deferrals and waivers

47-1.7 Service obligation: deferrals and waivers.

(a) Service deferral. The Commissioner of Health may delay or defer the reporting date, the service obligation or the repayment obligation incurred by a State Health Service Corps recipient due to extreme hardship. Extreme hardship includes, but is not limited to: serious illness or injury of the recipient or an immediate family member and other circumstances beyond the control of the recipient that would make it difficult or impossible for the recipient to fulfill the service obligation or repay the State of New York.

(b) Waiver. The Commissioner of Health may waive all or part of the service obligation and/or any repayment obligation incurred by an award recipient for reasons described in subdivision (a) of this section.

(c) Evidence of hardship. The recipient must submit, in writing, ample evidence of hardship when requesting a deferral or waiver. Applications for deferral or waiver shall be submitted on forms prescribed by the Department of Health and may include sworn statements and appropriate documentation of the recipient's claim.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.8 - Default

47-1.8 Default.

(a) A recipient of an award will be considered in default if the recipient has not been granted a waiver or deferral by the Commissioner of Health and:

(1) the scholarship award is rescinded after disbursal of scholarship monies on the recipient's behalf; or

(2) the recipient is not available to fulfill his/her service obligation on the reporting date; or

(3) the recipient fails to complete a training program; or

(4) the recipient resigns, is dismissed from employment or otherwise fails, refuses or is unable to fulfill the service obligation.

(b) An individual found to be in default will be required to pay the State, within five years from the date of default, all monies received, plus interest, plus liquidated damages as determined by the following formula:

A = 2B (T-S) ________

T

"A" is the amount the State is entitled to recover; "B" is the sum of all payments made to the recipient and the interest on such amount which would be payable if at the time such awards were paid they were loans bearing interest at the maximum prevailing rate determined by the Higher Education Services Corporation; "T" is the total number of months in the recipient's period of obligated service; and "S" is the number of months of service actually rendered by the recipient.

(c) Department of Health shall advise the Higher Education Services Corporation of any default, and the Higher Education Services Corporation shall collect repayments and, where indicated, initiate action for prosecution to recover monies owed the State.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-1.9 - Administration

47-1.9 Administration.

(a) Acceptance and service agreement. Prior to being certified for payment, successful applicants must sign a written acceptance of the award and a service agreement describing the conditions of the award, the service obligation, and the terms of repayment.

(b) Disbursements and collections. The Higher Education Services Corporation will be responsible for disbursements to or on behalf of the scholarship recipient. A State Health Service Corps recipient is required to comply with all administrative and reporting requirements established by the Higher Education Services Corporation.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

SubPart 47-2 - Obstetric and Pediatric Practitioner Incentive Demonstration Program

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Secs. 231, 232, 233, 2506

Section 47-2.1 - Definitions.

Section 47-2.1 Definitions.

(a) "Program" means the Obstetric and Pediatric Practitioner Incentive Demonstration Program, also known as the Obstetric and Pediatric Malpractice Insurance Subsidy Program, as administered by the New York State Department of Health.

(b) "Obstetric practitioner" means:

(1) a New York State licensed physician who is board certified or an active candidate for board certification in obstetrics;

(2) a New York State licensed physician who is board certified or eligible for board certification in family practice and who provides obstetrical services;

(3) a New York State Education Department licensed midwife or person certified to practice midwifery by the Department of Health; or

(4) a licensed registered nurse certified as an obstetric nurse practitioner by the New York State Education Department.

(c) "Pediatric practitioner" means:

(1) a New York State licensed physician who is board certified or eligible for board certification in Pediatrics; or

(2) a licensed registered nurse certified as a pediatric nurse practitioner by the New York State Education Department.

(d) "Obstetric Group Practice" means an obstetric practitioner with an arrangement to practice with one or more other obstetric practitioners whether by partnership agreement or by forming a professional corporation.

(e) "Covered services" means prenatal, delivery and post-partum services provided by an obstetric practitioner or pediatric services provided by a pediatric practitioner for children under the age of one in a private individual or group practice, or in a comprehensive diagnostic and treatment center (1) through the Prenatal Care Assistance Program, or the Medical Assistance Program under the Social Services Law; or (2) to women and children who are not covered for obstetric or pediatric services by the programs set forth in paragraph (1) of this subdivision, or by private health insurance; or (3) through a program approved by the commissioner pursuant to section 2506(4) of the Public Health Law, under which the services are provided as part of a program provided by a general hospital or a city or a county health department and without remuneration to the practitioner.

(f) "Target population" means pregnant women and children up to the age of one who (1) are eligible for the Prenatal Care Assistance Program or the Medical Assistance Program under the Social Services Law; or (2) are not covered for obstetric or pediatric services by the programs set forth in paragraph (1) of this subdivision or by private health insurance; or (3) are eligible for a program approved by the commissioner pursuant to Section 2506(4) of the Public Health Law under which the services are provided as part of a program provided by a general hospital or a city or a county health department and without remuneration to the practitioner.

(g) "Malpractice insurance premium" means the cost of professional liability insurance coverage for the contract period.

(h) "Contractor" means an eligible obstetric or pediatric practitioner or group practice who has contracted with the Department of Health for a subsidy.

(i) "Subsidy" means the amount of remuneration a contractor may receive through this Program for his/her malpractice insurance premium.

(j) "Designated pediatric area" means a Federally designated Health Professional Shortage Area or an area designated by New York State Board of Regents as a Regents Physician Loan Forgiveness Area.

(k) "New pediatric practitioner" means a pediatric practitioner who is proposing to begin practice, or began practice, six months before or after filing an application for a subsidy, in a designated pediatric area.

(l) "Additional service obstetric practitioner" means an obstetric practitioner or obstetric group practice that agrees to increase the number of the target population provided covered services.

(m) "Disproportionate share obstetric practitioner" means an obstetric practitioner or obstetric group practice that has in the past provided and agrees to continue to provide covered services to a high number of the target population.

(n) "High-number" means 1/3 the average number of deliveries performed per year per obstetrician, family practitioner, or nurse midwife, as determined by the Department of Health.

(o) "Full-time pediatric practice" means providing patient care services at least 37.5 hours per week during at least 46 weeks per year in a designated pediatric area. Up to 8 hours per week providing services to residents from the designated pediatric area in a hospital located outside the designated area may be counted towards those hours.

(p) "General pediatric services" means ambulatory health care services provided to children under the age of one.

(q) "Comprehensive obstetrical services" means prenatal, delivery and post-partum services.

(r) "Application" means an application for a contract submitted by an obstetric practitioner, obstetric group practice, or pediatric practitioner on forms prescribed by the Department. (s) "Average obstetrical malpractice premium (AOMP)" means the amount determined by the commissioner to reflect the average malpractice insurance premium per delivery for obstetricians in a geographic region.
 

Doc Status: 
Complete

Section 47-2.2 - Practice requirements/eligibility

47-2.2 Practice requirements/eligibility.

(a) A new pediatric practitioner may be eligible to contract with the Program if the practitioner:

(1) agrees to provide pediatric services full-time in a designated pediatric area;

(2) agrees that the ratio of the practice's target patient population to the total patient population will be equal to or greater than the ratio of the target population in the designated area to the total population in that designated area;

(3) agrees to provide medical care in accordance with accepted medical standards (for example, standards accepted by the American College of Pediatricians);

(4) has the education, training and access to health care facilities to provide pediatric services to the eligible population (or, for a pediatric nurse practitioner, a practice arrangement with a pediatric practitioner who meets such requirements) including:

(i) hospital admitting privileges;

(ii) arrangements for twenty-four hour backup coverage; and

(iii) has purchased medical malpractice insurance from a medical liability insurer; and

(5) is responsible for paying his/her own malpractice insurance premiums or is a member of a partnership or professional corporation which is responsible for paying his/her malpractice insurance premiums.

(b) An additional service obstetric practitioner may be eligible to contract with the Program if the practitioner:

(1) agrees to increase the number of the target population provided comprehensive obstetrical services over the number served preceding the application;

(2) agrees to provide medical care in accordance with accepted medical standards (for example, standards accepted by the American College of Obstetricians and Gynecologists, the American Academy of Family Practitioners, or the American College of Nurse- Midwives);

(3) has the education, training and access to health care facilities to provide obstetric services to the eligible population (or, for obstetric nurse practitioners, a practice arrangement with an obstetric practitioner who meets such requirements) including:

(i) hospital admitting and delivery privileges in a hospital with maternity services or practice privileges in a birth center; and

(ii) arrangements for twenty-four hour backup coverage; and

(iii) has purchased medical malpractice insurance from a medical liability insurer; and

(4) is responsible for paying his/her/their own malpractice insurance premiums or is a member of a partnership or professional corporation which is responsible for paying his/her malpractice insurance premiums.

(c) A disproportionate share obstetric practitioner may be eligible to contract with the Program if the practitioner:

(1) agrees to maintain his/her/their current high number of the target population provided comprehensive obstetrical services: the number of deliveries required to be performed to be considered a group providing a disproportionate share of services is the sum of those required for each individual to be a disproportionate share provider;

(2) agrees to provide medical care in accordance with accepted medical standards (for example, standards accepted by the American College of Obstetricians and Gynecologists, the American Academy of Family Practitioners, or the American College of Nurse- Midwives);

(3) has the education, training and access to health care facilities to provide obstetric services to the eligible population (or for obstetric nurse practitioners, a practice arrangement with an obstetric practitioner who meets such requirements) including:

(i) hospital admitting and delivery privileges in a hospital with maternity services or practice privileges in a birth center;

(ii) arrangements for twenty-four hour backup coverage; and

(iii) has purchased medical malpractice insurance from a medical liability insurer; and

(4) is responsible for paying his/her/their own malpractice insurance premiums or is a member of a partnership or professional corporation which is responsible for paying his/her/their malpractice insurance premiums.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-2.3 - Amount of subsidy

47-2.3 Amount of subsidy.

(a) A new pediatric practitioner may receive a subsidy in an amount equal to his/her malpractice insurance premium for the contract period up to a maximum of $10,000.

(b) An additional service obstetric practitioner may receive a subsidy equal to the AOMP for each delivery to a member of the target population during the contract period above the number of deliveries of the target population performed during the calendar year prior to the date of original application, proportioned to the contract period. A maximum of $30,000 per year is allowed per obstetric practitioner in a solo or group practice who qualifies under section 47-2.2(b) which will be prorated for shorter contract periods. The number of deliveries performed by a group practice will be based on the total number performed by all practitioners in the group.

(c) A disproportionate share obstetric practitioner may receive a subsidy equal to the AOMP for each member of the target population delivered during the contract period over the minimum number of deliveries of the target population considered a disproportionate share, proportioned to the contract period. A maximum subsidy of $10,000 per year will be allowed per obstetric practitioner in a solo or group practice who qualifies under section 47-1.2(c) which will be prorated for shorter contract periods. The number of deliveries performed by a group practice will be based on the total number performed by all practitioners in the group.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-2.4 - Payment of subsidy

47-2.4 Payment of subsidy.

If a practitioner is a solo practitioner responsible for payment of his/her malpractice insurance premium, such subsidy will be paid directly to the practitioner. If the practitioner is a member of a partnership or professional corporation which is responsible for payment of his/her malpractice insurance premiums, such subsidy will be paid to the partnership or professional corporation.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-2.5 - Selection of contractors

47-2.5 Selection of contractors.

(a) Process. Contractors shall be selected based on the criteria described in subdivisions (b) and (c) of this section to the extent funds are available for contracts; however, a practitioner who is not eligible to enroll in the medical assistance program as a Medicaid provider or who is under suspension, exclusion or involuntary withdrawal from participation in the medical assistance program shall not be eligible for a contract under this Part.

(b) Preference. Preference shall be given to practitioners in the following categories in the order of listing:

(1) An additional service obstetric practitioner who has had a contract, satisfactorily met the contract's terms and conditions, and is requesting a second contract.

(2) A new pediatric practitioner who has a new pediatric practitioner contract, satisfactorily met the contract's terms and conditions, and is requesting a second contract.

(3) An additional service obstetric practitioner applying for an initial contract.

(4) A new pediatric practitioner applying for an initial contract.

(5) A disproportionate share obstetric practitioner applying for an initial or additional contract.

(c) Selection criteria. If funds available for the program are not sufficient to cover all eligible applicants within a category listed in subdivision (b) above, then applicants within that category shall be reviewed competitively using the following criteria:

(1) the extent of the practitioner's potential contribution towards increasing covered services available to the target population;

(2) the need for covered services to the target population in the designated area or location;

(3) in the case of an obstetric practitioner, the extent of participation in the New York State Department of Health Prenatal Care Assistance Program;

(4) the extent of participation in a Medicaid managed care program if there is a New York State Department of Social Services approved program in the social services district; and

(5) the demonstrated commitment of the applicant to serve the target population and the education, training or other experience of the applicant to provide obstetric or pediatric services to the target population.
 

Doc Status: 
Complete

Section 47-2.6 - Program administration and process.

47-2.6 Program administration and process.

(a) Applicants shall apply to the New York State Department of Health on such forms and provide such information as the Department determines is necessary to administer the program.

(b) Applicants who are practitioners in an obstetric group practice must submit an application as a group.

(c) To obtain a subsidy, applicants who are selected and approved must enter into a contract with the Department. The contract will include the minimum level of services to be provided, recording requirements, payment schedule and other requirements.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

SubPart 47-3 - DESIGNATION OF UNDERSERVED AREAS

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, sections 901, 903 and 904

Section 47-3.1 - Underserved areas

Section 47-3.1 Underserved areas.

For purposes of Section 903(2)(a) of the Public Health Law, the Resident Loan Repayment Program; Section 903(2)(b) of the Public Health Law, the Physician Loan Repayment Program; and, Section 904 of the Public Health Law, the Primary Care Practitioner Scholarship Program, underserved areas shall be located in New York State and shall include the following:

(a) areas designated by the federal government as a Health Professional Shortage Area;

(b) not-for-profit diagnostic and treatment centers, with an operating certificate issued pursuant to section 401.1 of this Title which serve the medically indigent and Medicaid-eligible persons;

(c) facilities participating in state-supported rural health networks;

(d) programs receiving federal Title 10 funding;

(e) Department of Health approved Prenatal Care Assistance Programs;

(f) facilities or programs supported by the Department of Health Primary Care Services Grant program, pursuant to Section 2807 of the Public Health Law;

(g) school-based clinics providing primary care services;

(h) Department of Health designated AIDS service sites;

(i) state operated facilities;

(j) facilities and service sites operated by county health departments;

(k) sites serving the homeless or Native Americans;

(l) facilities licensed by the Office of Alcoholism and Substance Abuse Services;

(m) managed care plans approved by the Commissioner;

(n) other sites, areas and facilities determined by the Commissioner to have a significant need for additional primary care physicians and primary care practitioners.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

SubPart 47-4 - Resident Loan Repayment Program.

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 901 and 903

Section 47-4.1 - Definitions

Section 47-4.1 Definitions.

(a) "Council" shall mean the New York State Council on Graduate Medical Education.

(b) "Primary Care Medical Training Program" or "Primary Care Residency Program" shall mean a residency program approved by the Council for up weighting of 1.5 under Section 2807-c of the Public Health Law.

(c) "Resident Loan Repayment Recipient" and "Recipient" shall mean an individual who has signed a service agreement to receive a loan repayment award under this Subpart.

(d) "Service Agreement" shall mean the written agreement prepared by the Department of Health and signed by the Resident Loan Repayment Recipient prior to the issuance of an award specifying the terms of the award and the service obligation required.

(e) "Award" shall mean the funds provided under this Subpart during one residency year, for the purpose of repaying some or all of the qualifying debt of the Resident Loan Repayment Recipient.

(f) "Qualifying debt" shall mean any outstanding, unpaid debt incurred by the recipient from loans to cover tuition and other related educational expenses made by, or guaranteed by, the federal or state government, or made by a lending or educational institution approved under Title IV of the Federal Higher Education Act.

(g) "Underserved Area" shall mean a site, area, or facility designated pursuant to section 47-3.1 of this Part.

(h) "License" shall mean a license to practice medicine in New York State issued by the State Education Department.

(i) "Residency year" shall mean the period between July 1 and June 30 of the following year.

(j) "Service Obligation" shall mean the period of time a Resident Loan Repayment Recipient must practice primary care in an underserved area after completion of his/her residency training.

(k) "Service Obligation Start Date" shall mean the date upon which a Resident Loan Repayment Recipient is required to begin practicing primary care in fulfillment of his/her service obligation.

(l) "Rescission" shall mean the withdrawal, cancellation or revocation of an award in accordance with the provisions of section 47-4.4 of this Subpart, after the signing of the service agreement.

(m) "Waiver" shall mean full or partial release by the commissioner of the service obligation and/or financial obligation for repayment of an award incurred or owed by a recipient.

(n) "Deferral" shall mean a delay or temporary suspension of an award payment, service obligation, or any financial obligation for repayment of an award by the recipient, which is granted by the commissioner with no resulting reduction in service or financial obligation.

(o) "Default" shall occur if a recipient has not obtained an approved waiver or deferral and the recipient fails to complete the primary care residency program on which the award is based, or the recipient fails to begin or complete the service obligation within the timeframes prescribed by this Subpart, or an award is rescinded after payment of award monies to the recipient.

(p) "Program Default Rate" shall be equal to the number of residents that have completed residency training in a specific program and have defaulted on their service obligation divided by the total number of recipients that completed training in that program.

(q) "President" shall mean the president of the New York State Higher Education Services Corporation.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.2 - Eligibility for an award

47-4.2 Eligibility for an award.

(a) To be eligible to receive a Resident Loan Repayment Program award, an individual must:

(1) be a resident in good standing in the second or third year of residency training in a program that is designated as a Primary Care Residency Program by the Council and which was so designated prior to July 1 of the year in which the individual began such residency training;

(2) have begun his/her Primary Care Residency Program as a first or second year student after January 1, 1994;

(3) be eligible to apply for licensure upon satisfactory completion of his/her residency training, and meet the character and moral standards required for licensure as a physician;

(4) agree to seek licensure in New York State at least four months prior to the anticipated completion of his/her Primary Care Residency Program;

(5) agree to practice primary care in an underserved area for one year for each annual award received;

(6) agree to apply award monies toward repaying all or part of a recipient's qualifying debt; and,

(7) complete, sign, and file an application with the Department of Health on forms specified by the department at least six months prior to the beginning of the residency year for which an award is requested or by a later date specified by the commissioner. All required supplementary documentation shall be filed as directed. Incomplete or illegible applications may be rejected.

(b) An individual will be ineligible to become a Resident Loan Repayment Recipient if:

(1) the individual has received a scholarship or loan for his/her medical education which includes a service obligation that may require service outside of New York State;

(2) the individual is identified by the New York State Higher Education Services Corporation as being in default on the repayment of a guaranteed student loan or as being in default under the terms of any other governmentally administered scholarship or financial aid program and the individual refuses to allow the New York State Higher Education Services Corporation to directly apply the award to the defaulted account(s); or

(3) the individual is in a residency program with a program default rate higher than five percent. However, the Commissioner may waive this provision if less than 30 recipients have completed their training in the program.

(c) To maintain eligibility for an award, the Resident Loan Repayment Recipient must:

(1) be a participant in good standing in the Primary Care Residency Program;

(2) report to the Department of Health and the Higher Education Services Corporation annually and as may be necessary to implement the program on such forms and at such times as required by the Commissioner and the President; and,

(3) provide required documentation regarding qualifying debt.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.3 - Awards

47-4.3 Awards.

(a) Award Schedule. Awards shall be made during the second and third year of residency training in a Primary Care Residency Program.

(b) Award. The award shall be up to $15,000 per residency year.

(c) Award payments. Awards shall be paid directly to the recipients who will be required to apply the funding to reduce their qualifying debt.

(d) Payment of awards. Payment of awards shall be subject to the availability of funds.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.4 - Award rescissions and deferrals

47-4.4 Award rescissions and deferrals.

(a) An award may be rescinded by the commissioner if:

(1) prior to the full payment of an award, the recipient withdraws from or fails to continue in his/her primary care residency program;

(2) the recipient is convicted of a felony or a lesser offense related to professional activity;

(3) the recipient is found to have provided fraudulent or willfully misrepresented information in the application or supporting documents; or

(4) the recipient fails to apply award monies received toward repayment of all or part of a recipient's qualifying debt.

(b) An award may be postponed or deferred temporarily by the commissioner because of one or more of the conditions described in subdivision (a) of this section if the commissioner determines that the condition will be corrected within a reasonable time or that the circumstances warrant a deferral rather than a rescission.

(c) The commissioner will notify the President of any award rescissions or deferrals.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.5 - Service obligation

47-4.5 Service obligation.

(a) Service obligation start date. A recipient is required to begin providing primary care in an underserved area in New York State no later than 60 days after completion of his/her Primary Care Residency Program or obtaining his/her medical license, which ever is later, except that such date shall not exceed four months from completion of residency training.

(b) Practice requirements. A recipient must provide at least 35 hours per week of primary care services for at least 48 weeks per year for each annual award received. If the recipient receives two awards under this Subpart, the service obligations shall run consecutively.

(c) Alternate service. If a recipient fails to satisfactory complete the Primary Care Residency Program or fails to obtain a New York State license to practice medicine, the commissioner may permit the recipient to provide alternate service which involves the provision of health or human services in an underserved area and which is consistent with the intent of the Resident Loan Repayment Program.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.6 - Deferral and waiver

47-4.6 Deferral and waiver.

(a) Deferrals. The commissioner may delay or defer the service obligation start date, the service obligation and/or the repayment obligation of a recipient due to extreme hardship, or to permit the recipient to continue training in primary care specifically approved by the commissioner. Extreme hardship includes, but is not limited to, serious illness or injury of the recipient or a member of the recipient s immediate family or other circumstances beyond the control of the recipient that would make it extremely difficult or impossible for the recipient to fulfill the service obligation or repayment requirements.

(b) Waiver. The commissioner may waive all or part of the service obligation and/or any repayment obligation incurred by a recipient due to extreme hardship.

(c) Evidence of hardship. A request for a deferral or waiver of a service or repayment obligation must be submitted in writing on forms prescribed by the Commissioner. The commissioner may request sworn statements and appropriate documentation to support the recipient's request.

(d) Notice. The commissioner will notify the President of any service or repayment obligation deferrals or waivers.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.7 - Default

47-4.7 Default.

(a) A recipient shall be placed in default if he/she has not been granted a deferral or waiver by the Commissioner, and:

(1) the recipient fails to complete the primary care residency program, or

(2) the recipient is not available to fulfill his or her service obligation on the service obligation start date; or

(3) the recipient resigns, is dismissed from employment, or otherwise fails, refuses, or is unable to fulfill the service obligation; or

(4) an award is rescinded after dispersal of monies to a recipient.

(b) Calculation of financial obligation. A recipient found to be in default will be required to pay the President, within five years from the date of default, all monies received, plus interest, plus liquidated damages, as determined by the following formula:

A = 2B (T-S) _______ T

where "A" is the amount the President is entitled to receive; "B" is the sum of all payments made to the recipient and the interest on such amount which would be payable if, at the time such awards were paid, they were loans bearing interest at the maximum prevailing rate determined by the Higher Education Services Corporation; "T" is the total number of months in the recipient's period of obligated service; and "S" is the number of months of service actually rendered by the recipient. The total number of months in the recipient's period of obligated service is calculated by multiplying by twelve the number of annual awards received by the recipient.

(c) The Department of Health shall advise the Higher Education Services Corporation of any default, and the Higher Education Services Corporation shall collect repayments and, where indicated, initiate action for prosecution to recover monies owed the State.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-4.8 - Administration

47-4.8 Administration.

(a) Acceptance and service agreement. Prior to being certified for payment, a recipient must sign a written acceptance of the award and a service agreement describing the conditions of the award, the service obligation, and the terms of repayment in the event of rescission or default.

(b) A recipient is required to comply with all administrative and reporting requirements of the Department of Health and the Higher Education Services Corporation.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

SubPart 47-5 - Physican Loan Repayment Program

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 901 and 903

Section 47-5.1 - Definitions

Section 47-5.1 Definitions.

(a) "Underserved area" shall mean a site, area or facility designated under section 47-3.1 of this Part.

(b) "Recipient" shall mean a physician who has signed a service agreement pursuant to this Subpart agreeing to practice medicine in an underserved area.

(c) "Service agreement" shall mean the written agreement prepared by the Department of Health and signed by a recipient specifying the terms of the award and service obligation. Each agreement will require a minimum two-year service obligation.

(d) "Award" shall mean the funds, provided under this Subpart on an annual basis, for the purpose of repaying some or all of the qualifying debt of the recipient.

(e) "Qualifying debt" shall mean any outstanding, unpaid debt incurred by the recipient for loans to cover tuition and other related educational expenses made by, or guaranteed by, the federal or state government, or made by a lending or educational institution approved under Title IV of the federal higher education act;

(f) "License" shall mean a license to practice medicine in New York State issued by the State Education Department.

(g) "Service obligation" shall mean the period of time a recipient must practice in an underserved area.

(h) "Rescission" shall mean the withdrawal, cancellation or revocation of an award in accordance with the provisions of section 47-5.4 of this Subpart, after the signing of a service agreement.

(i) "Waiver" shall mean full or partial release by the Commissioner of the service obligation and/or financial obligation for repayment of an award incurred or owed by a recipient;

(j) "Deferral" shall mean a delay or temporary suspension granted by the Commissioner of an award payment, service obligation, or any financial obligation for repayment of an award by the recipient, with no resulting reduction in service or financial obligation;

(k) "Default" shall occur if the recipient has not received an approved deferral or waiver and the recipient is not available to fulfill his/her service obligation on the start date, the recipient fails to complete the service obligation, or the award is rescinded after payment of monies to the recipient.

(l) "President" shall mean the President of the New York State Higher Education Services Corporation.

(m) "Primary care physician" means a physician specialist in the field of family practice, general pediatrics, primary care internal medicine, or primary care obstetrics and gynecology who provides or arranges for coordinated primary care services.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.2 - Physician eligibility

47-5.2 Physician eligibility.

(a) Eligibility. To be eligible to receive a Physician Loan Repayment Program award, a physician must:

(1) be a primary care physician, emergency medicine physician or other physician specialist determined by the Commissioner to be in short supply;

(2) be licensed in New York;

(3) agree to practice in an underserved area for a minimum of two years;

(4) agree to apply award monies received toward repaying all or part of recipient's qualifying debt; and,

(5) complete, sign, and file an application with the Department on such forms and within such timeframes specified by the Department. All required supplementary documentation shall be filed as directed. Incomplete or illegible applications may be rejected.

(b) A physician may be eligible for a maximum of four annual awards.

(c) Ineligibility. A physician will be ineligible for an award if:

(1) the physician has a service obligation to the federal government or other entity which could require service outside of New York State;

(2) the physician is fulfilling a service obligation under the Regents Physician Loan Forgiveness Program or a federally-funded loan repayment program for the period for which a Physician Loan Repayment Program Award is requested; or

(3) the physician is in default on the repayment of a guaranteed student loan or in default under the terms of any other governmentally administered scholarship or financial aid program and the individual refuses to allow the New York State Higher Education Services Corporation to directly apply the award to the defaulted account(s).

(d) Selection criteria. The Department of Health shall consider the following factors in selecting recipients:

(1) the need for a physician specializing in the same specialty as the applicant in the underserved area where the applicant proposes to fulfil his/her service obligation;

(2) prior experience in serving the medically indigent or other underserved populations; and

(3) appropriateness of the applicant s education and training to meet the needs of the underserved area in which the applicant proposes to fulfil his/her service obligation.

(e) Number. The Department of Health shall award up to 100 new awards per year.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.3 - Awards

47-5.3 Awards.

(a) Award Amount. Physicians who agree to practice in an underserved area for two years and meet the other eligibility requirements under this Subpart shall be eligible for awards of up to $15,000 per year during their first and second year of practice in such area. Recipients who agree to practice in an underserved area for an additional two years and meet the other eligibility requirements under this Subpart shall be eligible for awards of up to $20,000 per year in their third and fourth years of practice in such area.

(b) Award Payments. Awards shall be paid directly to the recipient who will be required to apply the funds to pay off qualifying debt.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.4 - Award rescissions and deferrals

47-5.4 Award rescissions and deferrals.

(a) An award may be rescinded by the Commissioner if:

(1) prior to payment of an award, the recipient withdraws from the program or fails to begin his/her service obligation in an underserved area;

(2) the recipient is convicted of a felony or a lesser offense related to professional activity;

(3) the recipient is found to have provided fraudulent or willfully misrepresented information in the application or supporting documents; or

(4) the recipient fails to apply award monies received toward repayment of all or part of his/her qualifying debt.

(b) An award may be postponed or deferred temporarily by the Commissioner because of one or more of the conditions described in subdivision (a) of this section if the Commissioner determines that the condition will be corrected within a reasonable time or that the circumstances warrant a deferral rather that a rescission.

(c) The Commissioner will notify the President of any award rescissions or deferrals.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.5 - Service obligation

47-5.5 Service obligation.

(a) Period. A recipient shall agree to practice for a minimum of two consecutive years in an underserved area. A recipient shall provide at least 40 hours of service per week for at least 48 weeks per year.

(b) Start date. A recipient is required to begin practice in an underserved area within 90 days of signing a service agreement.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.6 - Deferrals and waivers

47-5.6 Deferrals and waivers.

(a) Deferral. The Commissioner may delay or defer the service obligation start date, the service obligation, and/or the repayment obligation of a recipient due to extreme hardship. Extreme hardship includes, but is not limited to, serious illness or injury of the recipient or a member of the recipient s immediate family or other circumstances beyond the control of the recipient that would make it extremely difficult or impossible for the recipient to fulfill the service obligation or repayment requirements.

(b) Waiver. The Commissioner may waive all or part of the service obligation and/or any repayment obligation incurred by a recipient due to extreme hardship.

(c) Prescribed forms. A request for a deferral or waiver of a service obligation and/or repayment obligation must be submitted in writing on forms prescribed by the Commissioner. The commissioner may request sworn statements andappropriate documentation to support the recipient's request.

(d) The commissioner shall notify the President of any service and/or repayment obligation deferrals or waivers.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.7 - Default

47-5.7 Default.

(a) Default. A recipient shall be placed in default if he/she has not been granted a waiver or deferral by the Commissioner and:

(1) the recipient is not available to fulfill his/her service obligation on the start date; or

(2) the recipient fails, refuses or is unable to fulfill his/her service obligation; or

(3) an award is rescinded after dispersal of award monies to the recipient.

(b) Dismissal. A recipient who is dismissed from employment or discontinues practice at the location of his/her service obligation, shall contact the Department of Health within 30 days of dismissal or discontinuance. The Commissioner may reassign the recipient to an alternate underserved area. A recipient who is reassigned shall resume his/her service obligation at the alternate location within 90 days of the dismissal or discontinuance. A recipient who is reassigned and who fails to resume his/her service obligation at the alternate location within 90 days of dismissal or discontinuance shall be placed in default.

(c) Calculation of financial obligation. An individual found to be in default will be required to pay the President, within five years from the date of default, all monies received, plus interest, plus liquidated damages, as determined by the following formula:

A =2B (T-S) ________ T

where "A" is the amount the President is entitled to receive; "B" is the sum of all payments made to the recipient and the interest on such amount which would be payable if at the time such awards were paid they were loans bearing interest at the maximum prevailing rate determined by the Higher Education Services Corporation; "T" is the total number of months in the recipient's period of obligated service; and "S" is the number of months of service actually rendered by the recipient. The minimum number of months in the recipient's period of obligated service shall be 24 months.

(d) The Department of Health shall advise the Higher Education Services Corporation of any default, and the Higher Education Services Corporation shall collect repayments and, where indicated, initiate action for prosecution to recover monies owed the State.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-5.8 - Administration

47-5.8 Administration.

(a) Prior to being certified for an award payment, a recipient must sign a written acceptance of the award and a service agreement describing the conditions of the award, the service obligation, and the terms of repayment in the event of rescission or default.

(b) A recipient is required to comply with all administrative and reporting requirements of the Department of Health and the Higher Education Services Corporation.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

SubPart 47-6 - Primary Care Practitioner Scholarship Program

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 901 and 904

Section 47-6.1 - Definitions

Section 47-6.1 Definitions.

(a) "Primary Care Practitioner Scholarship Program" shall be known as the Primary Care Service Corps.

(b) "Primary care practitioner" shall mean a midwife, nurse practitioner, or physician assistant who is licensed, registered or certified by the appropriate governing agency to practice in New York State and who provides or arranges for coordinated primary care services.

(c) "Underserved area" shall mean an area, site or facility designated pursuant to section 47-3.1 of this Subpart.

(d) "Primary care practitioner program" shall mean a full or part-time graduate, undergraduate or certificate course of study, approved or registered by the regents or a program registered by the Department of Education or determined by the Department of Education to be equivalent, and which an individual is required to complete in order to become licensed, registered, or certified as a primary care practitioner.

(e) "Academic year" shall mean the period between July 1 and June 30 of the following year.

(f) "Full-time enrollment" shall mean matriculation as a student taking at least 12 credits or their equivalent, except that in the final semester of study the student must take sufficient credits or their equivalent in order to complete training, but not fewer than six credits.

(g) "Part-time enrollment" shall mean matriculation as a student taking at least six credits but fewer than twelve or their equivalent per semester, except if the student is enrolled full time and in the final semester.

(h) "Recipient" shall mean an individual who has signed a service agreement to receive a scholarship award under the Primary Care Service Corps program in return for a service obligation.

(i) "Service agreement" shall mean the written agreement prepared by the Department of Health to be signed by a recipient, prior to issuance of an award, specifying the terms of the award and the service obligation required.

(j) "Scholarship award" shall mean the sum of the Primary Care Service Corps funds paid to, or on behalf of, a recipient under this Subpart during one academic year. An award shall not exceed the cost of attendance which shall mean tuition, required fees, books, transportation, and room and board; nor shall it exceed $15,000 for full-time study or $7,500 for part-time study; nor shall any combination exceed $15,000 annually.

(k) "Effective date" shall mean the beginning date of the first semester for which the recipient has received a Primary Care Service Corps scholarship.

(l) "Service obligation" shall mean the period of time a Recipient is required to provide primary care in an underserved area designated pursuant to section 47-3.1 of this Subpart.

(m) "Alternative service" shall mean work in a health facility in an underserved area as a paraprofessional or in a profession other than the one for which the award was given in fulfillment of the service obligation.

(n) "Reporting date" shall mean the date upon which a recipient is required to begin employment in fulfillment of the service obligation.

(o) "Rescission" shall mean the withdrawal, cancellation or revocation of an award in accordance with the provisions of section 47-6.5 of this Subpart, after the signing of the service agreement.

(p) "Waiver" shall mean full or partial release granted by the Commissioner of Health of the service obligation and/or any financial obligation for repayment of scholarship award monies incurred or owed by a recipient.

(q) "Deferral" shall mean a delay or temporary suspension granted by the Commissioner of an award payment and/or a service obligation and/or any financial obligation for repayment of award monies incurred by a recipient, with no resulting reduction in service obligation or financial obligation.

(r) "Default" shall occur if a recipient has not received a waiver or deferral from the Commissioner and the recipient fails to complete the program of study, the recipient is not available to fulfill his/her service obligation on the reporting date, the recipient fails to complete his/her service obligation within the time prescribed by the Commissioner of Health, or a scholarship award is rescinded pursuant to section 47-6.5(a) of this Subpart, after dispersal of scholarship monies to, or on behalf of, the recipient.

(s) "President" shall mean the president of the New York State Higher Education Services Corporation.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.2 - Eligibility for an award

47-6.2 Eligibility for an award.

(a) To be eligible for Primary Care Service Corps scholarship award, an individual must:

(1) show evidence of enrollment or acceptance for full- time study or part-time study in a primary care practitioner program. The Commissioner of Health may permit individuals who are not enrolled or who have not been accepted for enrollment to apply for an award, but an award will not be made until the individual provides evidence of enrollment or acceptance into a primary care practitioner program.

(2) be within 24 months of completing the program of study on a full-time basis or be within 48 months of completing the program of study on a part-time basis;

(3) be eligible to apply for licensure, registration or certification, as appropriate, in the profession of study after completion of the primary care practitioner program;

(4) be a United States citizen or resident alien who is holding a valid I-551 card or a valid I-151 card issued by the U.S. Immigration and Naturalization Service;

(5) be a New York State resident;

(6) meet the character and moral standards required for licensure registration or certification, as appropriate; and

(7) complete, sign and file an application with the Department of Health on such forms as are specified by the Department at least 90 days prior to the beginning of the semester for which an award is sought or by a later date specified by the Commissioner. All required supplementary documentation shall be filed as directed. Incomplete, illegible or vague applications may be rejected. Applications filed after the deadlines specified may be rejected.

(b) An individual may be determined to be ineligible to receive a Primary Care Service Corps scholarship award if:

(1) the individual is already receiving any other scholarship or fellowship award that requires the fulfillment of a service obligation;

(2) the individual is identified by Higher Education Services Corporation as having defaulted on the repayment of a guaranteed student loan or as being in default under the terms of any other governmentally administered scholarship or financial aid program.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.3 - Selection of recipients

47-6.3 Selection of recipients.

(a) Process. The Commissioner of Health shall select recipients based on the criteria and preferences described in subdivisions (b) and of this section.

(b) Preference. Preference shall be given to persons in the following categories, in the order of priority stated:

(1) holders of a prior Primary Care Service Corps scholarship award who have maintained an acceptable academic performance;

(2) a New York State resident attending or planning to attend a New York State primary care practitioner program;

(3) a New York State resident attending or planning to attend a primary care practitioner program located out- of-state.

(c) Selection criteria. All eligible applications will be reviewed competitively using the following criteria:

(1) the need, as determined the Commissioner of Health, for an individual(s) qualified to practice the profession for which a scholarship is being sought in the underserved areas of the region(s) where the applicant is willing to work;

(2) academic performance and academic awards or honors;

(3) special training and education relevant to the needs of underserved populations;

(4) work experience relevant to the chosen health profession;

(5) work or volunteer experience with underserved populations or in underserved areas;

(6) demonstrated interest or commitment to working with underserved populations or in underserved areas;

(7) civic or community awards and honors; and

(8) special skills or abilities, background or experience which will facilitate working with underserved populations or in underserved areas.

(d) Number of awards. The Commissioner of Health shall make as many awards as available funding permits. The Commissioner of Health may make fewer awards than available funding permits if it is determined that there are not a sufficient number of eligible applicants who meet minimum qualifications, based on such criteria as those listed in subdivision (c) of this section.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.4 - Maintaining eligibility for an award

47-6.4 Maintaining eligibility for an award.

(a) Continuous enrollment. Award recipients must be continuously enrolled either part-time or full-time in consecutive academic years and be in good standing in accordance with the standards and regulations established by the New York State Higher Education Services Corporation and the institution where the award recipient is receiving training.

(b) Transfers. An award recipient who transfers to another primary care practitioner program may continue to be eligible for an award if:

(1) the recipient notifies the Commissioner prior to the transfer;

(2) the recipient continues training in a primary care practitioner program in the profession for which the award was granted; and

(3) the transfer does not increase the total period of training beyond that which is allowed by this Subpart.

(c) Reporting requirements. Award recipients must report to the Department of Health and the Higher Education Services Corporation at least annually and as may be necessary to implement the program on such forms and at such times as required by the Commissioner and the President.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.5 - Award rescission and deferrals

47-6.5 Award rescission and deferrals.

(a) Award rescission. An award may be rescinded by the Commissioner if:

(1) prior to full payment of an award, the recipient withdraws from the primary care practitioner program or otherwise fails to maintain enrollment;

(2) prior to full payment of an award, the recipient fails to maintain good academic standing;

(3) the recipient is convicted of any felony or a lesser offense related to professional activity; or

(4) the recipient is found to have provided fraudulent or willfully misrepresented information in the application or supporting documents.

(b) If, prior to full payment of an award, the recipient fails to complete and return a payment application and any required supplementary documentation as required by the Higher Education Services Corporation or fails to report to the Higher Education Services Corporation and the Department of Health at least annually and as may be necessary to implement the program on such forms and at such times as required by the President and the Commissioner, the Commissioner may deny full or partial payment of an award.

(c) Award deferral. An award may be postponed or deferred temporarily by the Commissioner because of one or more of the conditions described in subdivisions (a) and (b) of this section if the Commissioner determines that the condition will be corrected within a reasonable time or that the circumstances warrant a deferral rather than a rescission.

(d) The Commissioner will notify the President of any award rescissions or deferrals.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.6 - Service obligation

47-6.6 Service obligation.

(a) Service obligation. A recipient is required to practice in an underserved area in the profession for which he/she received an award for a period of 18 months for each annual award received for full-time study. A recipient is required to practice in an underserved area in the profession for which he/she received an award for a period of 9 months for each annual award received for part-time study. However, in no case shall the total number of months of service be less than 18. If a recipient receives more than one award, the service obligations for such awards shall run consecutively.

(b) Practice requirements. A recipient must agree to the following practice requirements:

(1) provide primary care services in an underserved area;

(2) work in a practice site that accepts payment on behalf of beneficiaries of Title XVIII of the federal Social Security Act (Medicare) and individuals eligible for medical assistance pursuant to Title 11 of article five of the Social Services law; and

(3) provide thirty-five hours per week of direct patient care in the underserved area.

(c) Reporting date. A recipient is required to begin his/her service obligation within 60 days of either completing the education for which he/she has received a Primary Care Service Corps scholarship award, or receiving a license or becoming registered or certified, as appropriate, in that profession, whichever occurs later, except that the reporting date shall not exceed:

The number of months from the effective date as determined by the following formula:

M = (Y x 12) + 6

where "M" is the maximum number of months from the effective date of the award by which a recipient must begin the service obligation; "Y" is the number of years in which funding is received.

(1) In the case of a recipient whose award has been deferred, the period of time of the approved deferral shall not be included in the calculation of the reporting date described in this section.

(d) Alternative service. In the event a recipient fails to qualify for licensure, registration or certification, as appropriate, or is unable to fulfill the service obligation in the profession for which the Primary Care Service Corps scholarship award is given, the Commissioner may permit the individual to provide alternative service which would meet the intent of the public service obligation.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.7 - Service obligation: deferrals and waivers

47-6.7 Service obligation: deferrals and waivers.

(a) Service deferral. The Commissioner may delay or defer the reporting date, the service obligation and/or the repayment obligation incurred by a recipient due to extreme hardship, or the Commissioner may defer the reporting date for a recipient who is unavailable because the recipient is completing the program of study for which a scholarship award was given. Extreme hardship includes, but is not limited to: serious illness or injury of the recipient or a member of the recipient s immediate family and other circumstances beyond the control of the recipient that would make it extremely difficult or impossible for the recipient to fulfill the service obligation or repayment requirements.

(b) Waiver. The Commissioner may waive all or part of the service obligation and/or any repayment obligation incurred by a recipient because of extreme hardship.

(c) Evidence of hardship. A request for deferral or waiver shall be submitted on forms prescribed by the Department of Health. The Commissioner may require that sworn statements and appropriate documentation be submitted to support the recipient's claim.

(d) The Commissioner will notify the President of any service and/or repayment obligation deferrals or waivers.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.8 - Default

47-6.8 Default.

(a) Causes. A recipient of an award will be placed in default if the recipient has not been granted a waiver or deferral by the Commissioner and:

(1) the recipient fails to complete a primary care practitioner program;

(2) the recipient is not available to begin the service obligation on the reporting date;

(3) the recipient resigns, is dismissed from employment, or otherwise fails, refuses or is unable to fulfill the service obligation; or,

(4) the scholarship award is rescinded pursuant to section 47-6.5(a) of this Subpart, after dispersal of scholarship monies to, or on behalf of, the recipient.

(b) Calculation of financial obligation. An individual found to be in default will be required to pay the President, within five years from the date of default, all monies received, plus interest, plus liquidated damages, as determined by the following formula:

A = 2B (T-S) _______ T

where "A" is the amount the President is entitled to recover; "B" is the sum of all payments made to, or on behalf of, the recipient and the interest on such amount which would be payable if, at the time such awards were paid, they were loans bearing interest at the maximum prevailing rate determined by the Higher Education Services Corporation; "T" is the total number of months in the recipient's period of obligated service; and "S" is the number of months of service actually rendered by the recipient.

(c) The Department of Health shall advise the Higher Education Services Corporation of any default, and the Higher Education Services Corporation shall collect repayments and, where indicated, initiate action for prosecution to recover monies owed the State.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Section 47-6.9 - Administration

47-6.9 Administration.

(a) Acceptance and service agreement. Prior to being certified for payment, successful applicants must sign a written acceptance of the award and a service agreement describing the conditions of the award, the service obligation, and the terms of repayment in the event of rescission or default.

(b) A recipient is required to comply with all administrative and reporting requirements established by the Department of Health and the Higher Education Services Corporation.
 

Effective Date: 
Wednesday, October 22, 1997
Doc Status: 
Complete

Part 48 - Palliative Care Certified Medical Schools and Residency Programs

Effective Date: 
Wednesday, June 23, 2010
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2807-n

Section 48.10 - Definitions

48.10 Definitions

(a)
Palliative careshall mean the active, interdisciplinary care of patients with serious, life-threatening, advanced, or life limiting illness, focusing on relief of distressing physical and psychosocial symptoms and meeting spiritual needs. Its goal is achievement of the best quality of life for patients and families.

(b)
Palliative care certified medical schoolshall be a Liaison Committee on Medical Education (LCME) or American Osteopathic Association (AOA) accredited medical school in New York State which is an institution granting a degree of doctor of medicine or of osteopathic medicine in accordance with regulations by the Commissioner of Education under subdivision two of section sixty-five hundred twenty-four of the education law, and which meets the following criteria:

(1) one or more faculty does clinical work or teaching relevant to palliative care; and/or

(2) contains an element of the preclinical or clinical curriculum relevant to palliative care; and

(3) is certified by the Commissioner or his or her designee in conformance with Subdivision (a) of Section 48.20 of this Part.

Relevant work, teaching, or curriculum may include, but is not limited to, didactic coursework or training related to one of the following eight domains of quality palliative care relating to populations with serious or life-threatening illnesses: (1) structure and process of care, (2) physical aspects of care, (3) psychological and psychiatric aspects of care, (4) social aspects of care, (5) spiritual, religious, and existential aspects of care, (6) cultural aspects of care, (7) care of the imminently dying patient, and (8) ethical and legal aspects of care.

(c)
Palliative care certified residency programshall be a graduate medical education program in New York State accredited and in good standing by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA), and which meets the following criteria:

(1) is sponsored by one of the following specialties that have incorporated Hospice and Palliative Medicine (HPM) as a subspecialty:

(i) anesthesiology;
(ii) emergency medicine;
(iii) family medicine;
(iv) internal medicine;
(v) pediatrics;
(vi) physical medicine and rehabilitation;
(vii) psychiatry and neurology;
(viii) radiology;
(ix) surgery; or
(x) obstetrics and gynecology; and

(2) contains an element of the teaching curriculum is identified as relevant to palliative care; and

(3) is certified by the Commissioner or his or her designee in conformance with Subdivision (b) of Section 48.20 of this Part.

Relevant work, teaching, or curriculum may include, but is not limited to, didactic coursework or training related to one of the following eight domains of quality palliative care, relating to populations with serious or life-threatening illnesses: (1) structure and process of care, (2) physical aspects of care, (3) psychological and psychiatric aspects of care, (4) social aspects of care, (5) spiritual, religious, and existential aspects of care, (6) cultural aspects of care, (7) care of the imminently dying patient, and (8) ethical and legal aspects of care.

Effective Date: 
Wednesday, June 23, 2010
Doc Status: 
Complete

Section 48.20 - Certification

48.20 Certification

(a) Any medical school which has submitted an application with documentation acceptable to the department and which has been determined by the Commissioner or his or her designee to have met the definition of a palliative care certified medical school as set forth in subdivision (b) of Section 48.10 of this Part shall be certified until such time as the medical school receives written notice of termination from the Commissioner of Health, who, in his/she sole discretion, may terminate when continuation of such certification no longer benefits public health or satisfies the definitional requirements. Medical schools are eligible during the period of certification to apply for grants for undergraduate medical education in palliative care within amounts appropriated for such purpose to enhance the study of palliative care, increase the opportunities for undergraduate medical education in palliative care and encourage the education of physicians in palliative care.

(b) Any residency program which has submitted an application with documentation acceptable to the department and which has been determined by the Commissioner or his or her designee to have met the definition of a palliative care certified residency program as set forth in subdivision (c) of Section 48.10 shall be certified until such time as the residency program receives written notice of termination from the Commissioner of Health, who, in his/she sole discretion, may terminate when continuation of such certification no longer benefits public health or satisfies the definitional requirements. Residency programs are eligible during the period of certification to apply for grants for graduate medical education in palliative care, within amounts appropriated for such purpose.

Effective Date: 
Wednesday, June 23, 2010
Doc Status: 
Complete

Part 49 - Funding For Family Practice Residency Training Programs

Effective Date: 
Wednesday, December 27, 1989
Doc Status: 
Complete
Statutory Authority: 
L. 1988, ch.482

Section 49.1 - Purpose

Section 49.1 Purpose.

Funds allocated will be for the continuation and expansion of approved family practice residency training programs and will not be paid directly to individual family practice residents.
 

Effective Date: 
Wednesday, December 27, 1989
Doc Status: 
Complete

Section 49.2 - Definitions

49.2 Definitions. As used in this Part, the following terms shall have the meanings indicated:

(a) "Family practice residency training program" means a family practice residency program accredited by the Liaison Committee on Graduate Medical Education (LCGME) for three years of postgraduate medical education (PGY-1, PGY-2, PGY-3) in the specialty of family practice, or accredited by the American Osteopathic Association for two years of postgraduate training in family practice (PGY-2, PGY-3).

(b) "Resident" means a physician employed in a training position in a family practice residency training program.

(c) "Commissioner" means the State Commissioner of Health.

(d) "Approved plan" means a funding application submitted by the director of a family practice residency training program, providing the information specified in section 49.3 of this Part and approved by the commissioner.

(e) "Program" means family practice residency training program.
 

Effective Date: 
Wednesday, December 27, 1989
Doc Status: 
Complete

Section 49.3 - Funding application

49.3 Funding application.

A plan submitted to the commissioner by the program director for approval shall consist of the following:

(a) A copy of the application for program approval which was submitted to the Residency Review Committee of the American Medical Association or the American Osteopathic Association.

(b) A copy of the current program review report and letter of approval received from the Liaison Committee on Graduate Medical Education or the American Osteopathic Association.

(c) The budget for operation of the program for the current 12-month period, showing:

(1) with respect to the total cost of the program:

(i) compensation of each of the following personnel categories, both full-time and part-time: physician (excluding residents), other professional and administrative-clerical;

(ii) total salaries paid residents in the program;

(iii) fringe benefits of all personnel including residents;

(iv) rent;

(v) equipment;

(vi) medical and other supplies;

(vii) all other expense items.

(2) with respect to total revenues of the program, receipts or other financial support from the following resources:

(i) hospital(s);

(ii) third-party payors;

(iii) self-pay patients;

(iv) grants and contracts;

(v) gifts and endowments;

(vi) other.

(3) the proposed allocation of State funding to continuation of the program and to current or future expansion thereof.

(d) An acknowledgement that funding is contingent upon the residents' practicing medicine in New York State for at least two years following completion of their residency.

(e) With respect to all residents in the program:

(1) the salary paid a resident in each year of the program;

(2) a list of residents indicating name, medical school or osteopathic college of graduation, year in residency program, New York State medical license or limited permit number, or ECFMG number, and Social Security number ;

(3) (i) a copy of the agreement between the program and resident wherein the resident agrees to practice medicine in New York State for at least two years following completion of the residency (hereafter the "two year service obligation agreement".)

(ii) Such written agreement shall state whether the resident agrees to practice medicine in the State of New York for at least two years immediately following the completion of the family practice residency training program or immediately following completion of another medical training program or immediately following some other service obligation which the resident is legally committed to undertake. If such a commitment prevents the resident from fulfilling the two year service obligation immediately following the completion of the family practice residency training program, the agreement shall specify the date the resident expects to satisfy that commitment.
 

Effective Date: 
Wednesday, December 27, 1989
Doc Status: 
Complete

Section 49.4 - Utilization of funds

49.4 Utilization of funds.

Funds received by a program may be used to pay the costs necessary to the conduct and operation of a program, including its expansion, provided that State funds allocated to a program shall not be used to pay capital construction costs taken into consideration in the determination and certification of rates by the commissioner pursuant to section 2807 of the Public Health Law.
 

Doc Status: 
Complete

Section 49.5 - Funding

49.5 Funding.

(a) Funds will be distributed among eligible programs in the same ratio as the number of full-time residents who have two year service obligation agreements on file with the commissioner in each program is to the total number of residents in all programs who have two year service agreements on file with the commissioner. Funds allocated shall not exceed fifteen thousand dollars per family practice resident.

(b) Funds will be recouped for any residents who have not complied with their two year service obligation agreement.

(c) Distributed funds which must be recouped because former residents have not complied with their two year service obligation agreement shall be recouped by withholding funds from future distributions to the program.

(d) The amount recouped from the amount originally funded shall be in the same ratio as the time left unfulfilled to the two year service obligation.
 

Effective Date: 
Wednesday, December 27, 1989
Doc Status: 
Complete

Section 49.6 - Records and reports

49.6 Records and reports.

The director of the program shall maintain such records and submit such reports, including an annual report, as may be required by the commissioner. The annual report shall include the status of all former residents who have not complied with their two year service obligation agreement.
 

Effective Date: 
Wednesday, December 27, 1989
Doc Status: 
Complete