Section 69-4.24 - Proceedings involving the approval of an individual or agency

69-4.24 Proceedings involving the approval of an individual or agency.

(a) An agency's or individual's approval to deliver evaluations, service coordination services and Early Intervention Program services may be revoked, suspended, limited or annulled by the commissioner upon a finding that the agency or individual provider:

(1) has failed to comply with the provisions of title II-A of article twenty five of the public health law or rules and regulations promulgated thereunder;

(2) no longer meets one of the criteria for approval or reapproval as set forth in section 69-4.5 of this subpart;

(3) does not have current licensure, registration or certification to deliver services in the early intervention program;

(4) for agency providers, use of personnel, whether by contract or under employment, to deliver evaluations, service coordination services or early intervention program service who did not hold a license, registration or certification to provide such service;

(5) falsely represented or omitted material fact in an application submitted to the Department for approval or re-approval;

(6) is, or ever has been, excluded or suspended as a provider under Medicaid, Medicare, or any governmental or private medical insurance program;

(7) has been the subject of one or more actions taken against the provider by another State agency which approves, licenses, certifies, or registers the applicant for any purpose;

(8) has been convicted of an offense in an administrative or criminal proceeding;

(9) has failed to provide unobstructed access to and examination of facilities, child records, or any other documents relevant to Early Intervention Program services as requested and within the timeframes required by the Department or a municipality, or an agent of any of these entities, for purpose of monitoring, auditing, or investigating the provider's participation in the Early Intervention Program;

(10) has failed to submit required corrective action plans or other information or documents requested by the Department, or a municipality to address findings of noncompliance identified through monitoring, systems complaint investigations, audits, or other early intervention program oversight activities, or to correct non-compliance within one year of any finding of non-compliance;

(11) has failed to pay recoupment due, or to implement any actions required, on the basis of a State or municipal audit within the timeframes specified in such audit report;

(12) has failed to pay any fines or penalties assessed against the applicant or provider within timeframes specified by the Department;

(13) through action, or act of omission, has placed children, parents, or staff in danger, or otherwise violated early intervention program health and safety standards issued by the Department;

(14) has submitted improper or fraudulent claims to a third party payor or the municipality for payment, including but not limited to submission of claims for services not rendered;

(b) No approval shall be revoked, suspended, limited or annulled without first providing the individual or agency an opportunity to be heard. The Department shall notify the individual or agency in writing of the proposed action and shall afford the individual or agency an opportunity to be heard.

(c) Approval may be temporarily suspended or limited, prior to granting an opportunity to be heard, for a period not exceeding 120 days upon written notice to the provider following a finding by the Department that the health or safety of a child, parents or staff of the agency or municipality is in imminent risk of danger or there exists any condition or practice or a continuing pattern of conditions or practices which poses imminent danger to the health or safety of such children, parents or staff of the agency or municipality. Upon such a finding and notice the Department may also:

(1) prohibit or limit the assignment of children to the provider;

(2) remove or cause to be removed some or all of the children the provider currently serves; and

(3) suspend or limit or cause to be suspended or limited payment for services to the provider.

(d) The provider shall be afforded an opportunity to be heard to contest the Department's findings.

Effective Date: 
Wednesday, December 5, 2018
Doc Status: 
Complete