Section 85.42 - Catastrophic health care expense program

85.42 Catastrophic health care expense program.

(a) The Expanded Health Care Coverage Act of 1988 (Chapter 703 of the Laws of 1988) establishes, under the jurisdiction of the New York State Department of Social Services, the Catastrophic Health Care Expense Program (CHCEP). The Department of Social Services will permit authorized counties to make available assistance with cost sharing to eligible county individuals and families for the purpose of assisting such individuals and families with catastrophic health care expenses. The CHCEP program requires participants eligible for cost sharing to receive such assistance in accordance with a schedule that sets forth the cost sharing shares between the participant and the program.

(b) The following schedule entitled "Cost Sharing Proportional Schedule" shall be used by the New York State Department of Social Services in determining a beneficiary's fiscal responsibility for catastrophic health care expenses covered under the CHCEP assistance with cost sharing program:
Cost Sharing Proportional Schedule

Category of Service Recipient Cost Share Responsibility

Hospital Emergency Room 75 percent

Selected Optional Services 50 percent

Podiatry

Clinical Psychology

Optometry/Eye Care Services

Transportation

Inpatient Hospitalization 30 percent

Physician, Dental & Clinic Services, 25 percent

Health Maintenance Organization, Home

Health Care

(freestanding and hospital-based)

including ordered diagnostic and

treatment services:

Pharmacy

Durable Medical Equipment

Laboratory

Radiology

Referred Ambulatory

Audiology (Hearing Aid)

Ambulatory Surgery and Outpatient Surgery 15 percent

Effective Date: 
Wednesday, May 2, 1990
Doc Status: 
Complete