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- VOLUME A-2 (Title 10)
- Part 95 - Discrimination In Physician Staff Appointments And Privileges Based On Participation In A Medical Group Practice Or Non-Profit Health Insurance Plan
- Title: Section 95.12 - Order of commissioner
Title: Section 95.12 - Order of commissioner
95.12 Order of commissioner.
If the hearing officer shall find that a respondent has engaged in an unlawful discriminatory practice as defined in section 206-a of the Public Health Law, the commissioner shall issue and cause to be served on the respondent an order requiring the respondent to cease and desist from the unlawful discriminatory practice. If the hearing officer shall find that a respondent has not engaged in an unlawful discriminatory practice, the commissioner shall issue and cause to be served on the complainant and respondent an order dismissing the complaint as to such respondent.
Volume
VOLUME A-2 (Title 10)
- VOLUME A-2 (Title 10)
- Part 86 - Reporting And Rate Certifications For Facilities
- SubPart 86-1 - Medical Facilities
- Section 86-1.1 - Definition
- Section 86-1.2 - Financial and statistical data required
- Section 86-1.3 - Uniform system of accounting and reporting
- Section 86-1.4 - Audits
- Section 86-1.5 - Effective period of reimbursement rates
- Section 86-1.6 - Allowable costs
- Section 86-1.7 - Recoveries of expense
- Section 86-1.8 - Research and educational activities
- Section 86-1.9 - Compensation of operators and relatives of operators
- Section 86-1.10 - Related organizations
- Section 86-1.11 - Termination of service
- Section 86-1.12 - Federal financial participation
- Section 86-1.13 - Certified home health agency rates
- Section 86-1.14 - Allowance for certified home health agencies providing a disproportionate share of bad debt and charity care
- Section 86-1.15 - Definitions
- Section 86-1.16 - Statewide base price
- Section 86-1.17 - Exclusion of outlier and transfer costs
- Section 86-1.18 - Service Intensity Weights (SIW) and average length-of-stay (LOS)
- Section 86-1.19 - Wage Equalization Factor (WEF)
- Section 86-1.20 - Add-ons to the case payment rate per discharge
- Section 86-1.21 - Outlier and transfer cases rates of payment
- Section 86-1.22 - Alternate level of care payments
- Section 86-1.23 - Exempt units and hospitals
- Section 86-1.24 - Trend factor
- Section 86-1.25 - Capital expense reimbursement
- Section 86-1.26 - Statewide Planning and Research Cooperative System (SPARCS)
- Section 86-1.27 - Federal upper limit compliance
- Section 86-1.28 - Adding or deleting hospital services or units
- Section 86-1.29 - New hospitals and hospitals on budgeted rates
- Section 86-1.30 - Swing bed reimbursement
- Section 86-1.31 - Mergers, acquisitions and consolidations
- Section 86-1.32 - Administrative rate appeals
- Section 86-1.33 - Out-of-state providers
- Section 86-1.34 - Supplemental indigent care distributions
- Section 86-1.35 - Disproportionate share limitations
- Section 86-1.36 - Hospital physician billing
- Section 86-1.37 - Readmissions
- Section 86-1.38 - Transition pool for 2010-2013 period
- Section 86-1.39 - Inpatient psychiatric services
- Section 86-1.41 - Hospital Quality Contribution
- Section 86-1.42 - Potentially preventable negative outcomes
- Section 86-1.43 - Certified home health care agency ceilings
- Section 86-1.44 - Episodic Payments for Certified Home Health Agency Services
- Section 86-1.45 - Reimbursement for language assistance services in hospital inpatient settings
- Section 86-1.46 - Empire Clinical Research Investigator Program (ECRIP)
- Section 86-1.47 - Hospital indigent care pool payments
- Section 86-1.50 Repealed
- Section 86-1.51 Repealed
- Section 86-1.52 Repealed
- Section 86-1.53 Repealed
- Section 86-1.54 Repealed
- Section 86-1.55 Repealed
- Section 86-1.57 Repealed
- Section 86-1.60 Repealed
- Section 86-1.61 Repealed
- Section 86-1.62 Repealed
- Section 86-1.63 Repealed
- Section 86-1.64 Repealed
- Section 86-1.65 Repealed
- Section 86-1.66 Repealed
- Section 86-1.70 Repealed
- Section 86-1.71 Repealed
- Section 86-1.74 Repealed
- Section 86-1.75 Repealed
- Section 86-1.80 Repealed
- Section 86-1.81 Repealed
- Section 86-1.82 Repealed
- Section 86-1.83 Repealed
- Section 86-1.84 Repealed
- Section 86-1.86 Repealed
- Section 86-1.88 Repealed
- Section 86-1.89 Repealed
- SubPart 86-2 - Residential Health Care Facilities
- Section 86-2.1 - Definitions
- Section 86-2.2 - Financial and statistical data required
- Section 86-2.3 - Uniform system of accounting and reporting
- Section 86-2.4 - Generally accepted accounting principles
- Section 86-2.5 - Accountant's certification
- Section 86-2.6 - Certification by operator or officer
- Section 86-2.7 - Audits
- Section 86-2.8 - Patient days
- Section 86-2.9 - Adult day health care in residential health care facilities
- Section 86-2.10 - Computation of basic rate
- Section 86-2.11 - Adjustments to direct component of the rate
- Section 86-2.12 - Adjustments to basic rate
- Section 86-2.13 - Adjustments to provisional rates based on errors
- Section 86-2.14 - Revisions in certified rates
- Section 86-2.15 - Rates for residential health care facilities without adequate cost experience
- Section 86-2.16 - Less expensive alternatives
- Section 86-2.17 - Allowable costs
- Section 86-2.18 - Recoveries of expense
- Section 86-2.19 - Depreciation for voluntary and public residential health care facilities
- Section 86-2.20 - Interest for all residential health care facilities
- Section 86-2.21 - Capital cost reimbursement for proprietary residential health care facilities
- Section 86-2.22 - Movable equipment
- Section 86-2.23 - Research
- Section 86-2.24 - Educational activities
- Section 86-2.25 - Compensation of operators or relatives of operators
- Section 86-2.26 - Related organizations
- Section 86-2.27 - Termination of service
- Section 86-2.28 - Return on investment
- Section 86-2.29 - Payments to receivers
- Section 86-2.30 - Residential health care facilities patient assessment for certified rates
- Section 86-2.31 - Recalibration
- Section 86-2.32 - Nurse aide competency exam
- Section 86-2.33 - Dementia pilot demonstration projects
- Section 86-2.34 - Affiliation changes
- Section 86-2.36 - Scheduled short term care
- Section 86-2.37 - Submission of resident assessments
- Section 86-2.38 - Nursing home incentive payment
- Section 86-2.39 - Closures, mergers, acquisitions, consolidations and restructurings
- Section 86-2.35 - Reserved
- Section 86-2.40 - Statewide prices for non-capital reimbursement.
- Section 86-2.41 - Sprinkler systems
- Section 86-2.42 - Residential health care facility quality pool
- SubPart 86-3 - Health Maintenance Organizations
- SubPart 86-4 - Free-standing Ambulatory Care Facilities
- Section 86-4.1 - Definitions
- Section 86-4.2 - Facility rates
- Section 86-4.3 - Recording and reporting of financial and statistical data
- Section 86-4.4 - Certification of reports
- Section 86-4.5 - Correction and supplementation of reports
- Section 86-4.6 - Audits
- Section 86-4.7 - Title XVIII (Medicare) certification
- Section 86-4.8 Reserved
- Section 86-4.9 - Units of service
- Section 86-4.10 - Minimum utilization standards
- Section 86-4.11 - Computation of basic rate for facilities other than licensed free-standing ambulatory surgery centers
- Section 86-4.12 - Allowance for diagnostic and/or treatment centers providing a disproportionate share of bad debt and charity care
- Section 86-4.13 - Groupings
- Section 86-4.14 - Ceilings on payments
- Section 86-4.15 - Calculation of trend factor
- Section 86-4.16 - Revisions in certified rates
- Section 86-4.17 - Appeal process
- Section 86-4.18 Reserved
- Section 86-4.19 - Rates for facilities without adequate cost experience
- Section 86-4.20 - Capital cost reimbursement
- Section 86-4.21 - Allowable costs
- Section 86-4.22 - Recoveries of expense
- Section 86-4.23 - Depreciation
- Section 86-4.24 - Interest
- Section 86-4.25 - Return on investment
- Section 86-4.26 - Sales, leases and realty transactions
- Section 86-4.27 - Compensation of operators and relatives of operators
- Section 86-4.28 - Related organizations
- Section 86-4.29 Reserved
- Section 86-4.30 Reserved
- Section 86-4.31 - Termination of service
- Section 86-4.32 Reserved
- Section 86-4.33 Reserved
- Section 86-4.34 - Pilot reimbursement projects
- Section 86-4.35 - Computation of basic rates for clinic services provided to Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) sero-positive patients by freestanding ambulatory care facilities and hospital clinic outpatient
- Section 86-4.36 REPEALED
- Section 86-4.37 - Computation of basic rates of payment for services provided to Medicaid patients by preferred primary care providers
- Section 86-4.38 - Computation of basic rates of payment for services provided to Medicaid patients by specialty clinics
- Section 86-4.39 - Computation of basic rates for methadone maintenance treatment services provided by freestanding ambulatory care facilities and hospital outpatient clinic services.
- Section 86-4.40 - Computation of case-based rates of payment for licensed free-standing ambulatory surgery centers and hospital based ambulatory surgery services
- Section 86-4.41 - Computation of basic rates for day health care services provided by freestanding ambulatory care facilities to patients with acquired immune deficiency syndrome (AIDS) and other human immunodeficiency (HIV) related illnesses
- SubPart 86-5 - Long-term Home Health Care Programs
- Section 86-5.1 - Definitions
- Section 86-5.2 - Financial and statistical data required
- Section 86-5.3 - Patient assessment
- Section 86-5.4 - Generally accepted accounting principles
- Section 86-5.5 - Accountant's certification
- Section 86-5.6 - Certification by operator or officer
- Section 86-5.7 - Audits
- Section 86-5.8 - Patient visits/hourly rate
- Section 86-5.9 - Determining patient eligibility
- Section 86-5.10 - Computation of average monthly nursing home rates
- Section 86-5.11 - Computation of individual hourly or per-visit service rate
- Section 86-5.12 - Cost guidelines for reimbursement purposes
- Section 86-5.13 - Adjustments to provisional rates based on errors
- Section 86-5.14 - Revisions in certified rates
- Section 86-5.15 - Rates for LTHHCP without adequate cost experience
- Section 86-5.16 - Less expensive alternatives
- Section 86-5.17 - Allowable costs
- Section 86-5.18 - Recoveries of expense
- Section 86-5.19 - Depreciation for voluntary and public LTHHCP
- Section 86-5.20 - Interest for all LTHHCPs
- Section 86-5.21 - Capital cost reimbursement for proprietary LTHHCPs
- Section 86-5.22 - Return on investment for proprietary LTHHCPs
- Section 86-5.23 - Movable equipment
- Section 86-5.24 - Research
- Section 86-5.25 - Education activities
- Section 86-5.26 - Termination of services
- Section 86-5.27 - AIDS home care programs
- Section 86-5.28 - Related organizations.
- SubPart 86-6 - Hospices
- Section 86-6.1 - Definitions
- Section 86-6.2 - Hospice rates of reimbursement
- Section 86-6.3 - Reimbursement for attending and consulting physician services
- Section 86-6.4 - Reporting requirements
- Section 86-6.5 - Trend factor
- Section 86-6.6 - Supplemental financial assistance program
- Section 86-6.7 - Hospice reimbursement for room and board provided to patients residing in a nursing facility
- SubPart 86-7 - Assisted Living Program
- SubPart 86-8 - Outpatient Services: Ambulatory Patient Group
- Section 86-8.1 - Scope
- Section 86-8.2 - Definitions
- Section 86-8.3 - Record keeping, reports and audits
- Section 86-8.4 - Capital reimbursement and rate add-ons
- Section 86-8.5 - Administrative rate appeals
- Section 86-8.6 - Rates for new facilities during the transition period
- Section 86-8.7 - APGs and relative weights
- Section 86-8.8 - Base rates
- Section 86-8.9 - Diagnostic coding and rate computation
- Section 86-8.10 - Exclusions from payment
- Section 86-8.11 - System updating and incorporation by reference
- Section 86-8.12 - Payments for extended hours of operation
- Section 86-8.13 - Out-of-state providers
- Section 86-8.14 - Non-APG payments
- Section 86-8.15 - Closures, mergers, acquisitions, consolidations, restructurings and inpatient bed de-certifications
- SubPart 86-9 - Limited Home Care Services Agencies
- SubPart 86-10 - Rates for Non-State Providers of Residential Habilitation in Community Residences, Including Individualized Residential Alternatives (IRAs) and for Non-State Providers of Day Habilitation
- Section 86-10.1 - Applicability
- Section 86-10.2 - Definitions
- Section 86-10.3 - Rates for residential habilitation services and for day habilitation services
- Section 86-10.4 - Reporting requirements
- Section 86-10.5 - Trend Factor, Increases to Compensation and Other Adjustments
- Section 86-10.6 - Transition periods and reimbursement
- Section 86-10.7 - Rate corrections
- Section 86-10.8 - Specialized template populations
- Section 86-10.9 - Severability
- SubPart 86-11 - Rate Setting for Non-State Providers: Intermediate Care Facilities for Persons with Developmental Disabilities
- Section 86-11.1 - Applicability
- Section 86-11.2 - Definitions
- Section 86-11.3 - Rates for providers of ICF/DD services
- Section 86-11.4 - Assessment
- Section 86-11.5 - Reporting requirements.
- Section 86-11.6 - Trend Factor, Increases to Compensation and Other Adjustments
- Section 86-11.7 - Transition to new methodology
- Section 86-11.8 - Rate corrections
- Section 86-11.9 - Specialized template populations
- Section 86-11.10 - Severability
- SubPart 86-12 - Outpatient Services Licensed Under the Mental Hygiene Law
- SubPart 86-13 - Rates for Non-State Providers of Prevocational Services (Site-based) and Respite (Hourly and Free-standing), and fees for Prevocational Services (Community-based), Residential Habilitation (Family Care) and Supported Employment
- Section 86-13.1 - Applicability
- Section 86-13.2 - Definitions
- Section 86-13.3 - Rates for prevocational services (site-based), respite (hourly and free-standing), prevocational services (community-based), supported employment, and residential habilitation (family care)
- Section 86-13.4 - Reporting requirements
- Section 86-13.5 - Trend Factor
- Section 86-13.6 - Transition periods and reimbursement
- Section 86-13.7 - Rate corrections for prevocational services (site-based) and respite (hourly and free-standing) rates
- Section 86-13.8 - Specialized template populations
- Section 86-13.9 - Severability
- Appendix 1 - Performance review of M/C faculty term appointments
- SubPart 86-1 - Medical Facilities
- Part 87 - Nursing Home Company And Hospital Mortgage Loans
- NURSING HOME COMPANIES
- Section 87.1 - General requirements
- Section 87.2 - Corporate organization
- Section 87.3 - Project development
- Section 87.4 - Project construction
- Section 87.5 - Development period records and reports
- Section 87.6 - Insurance
- Section 87.7 - Initial occupancy
- Section 87.8 - Operational period
- Section 87.9 - Real and personal tangible property
- Section 87.10 - Escrow funds
- Section 87.11 - Use of funds of the company
- Section 87.12 - Salaries or fees to officers or directors
- Section 87.13 - Purchases and contracts
- Section 87.14 - Default avoidance method
- MORTGAGE LOAN CHARGES
- HOSPITAL MORTGAGE LOANS
- Section 87.30 - General requirements
- Section 87.31 - Project development
- Section 87.32 - Project construction
- Section 87.33 - Development period records and reports
- Section 87.34 - Insurance
- Section 87.35 - Initial occupancy
- Section 87.36 - Operational period
- Section 87.37 - Personal tangible property
- Section 87.38 - Escrow funds
- Section 87.39 - Salaries or fees to officers or directors
- Section 87.40 - Purchases and contracts
- NURSING HOME COMPANIES
- Part 88 - Helen Hayes Hospital, New York State Veterans' Home and Roswell Park Memorial Institute
- SubPart 88-1 - Helen Hayes Hospital
- SubPart 88-2 - New York State Veterans' Homes
- SubPart 88-3 - Roswell Park Memorial Institute
- SubPart 88-4 - RESERVED
- SubPart 88-5 - Purchasing and Contracting
- Part 89 - Practice of Radiologic Technology
- Part 91 - Excess Liability Insurance Pool: Physicians And Dentists
- Section 91.1 - Required excess malpractice coverage
- Section 91.2 - Reporting requirements
- Section 91.3 - Determination of cost and reimbursement of excess medical malpractice coverage
- Section 91.4 - Pool administration
- SubChapter O - Physician's Assistants; Prohibited Discrimination in Hospital Staff Appointments and Privileges
- Part 92 - Infection Control Requirements
- SubPart 92-1 - Physician's, Registered Physician Assistants and Specialist Assistants: Required Course Work or Training in Infection Control and Barrier Precautions Every Four Years
- Section 92-1.1 - Course work or training
- Section 92-1.2 - Application
- Section 92-1.3 - Provider competency
- Section 92-1.4 - Approval period
- Section 92-1.5 - Denial or termination
- Section 92-1.6 - Certificate of completion
- Section 92-1.7 - Certificate of retention
- Section 92-1.8 - Submission of documentation to the department
- Section 92-1.9 - Exemptions
- Section 92-1.10 - Equivalencies
- SubPart 92-2 - Physicians, Registered Physician Assistants and Specialist Assistants Required Use of Infection Control Practices
- SubPart 92-1 - Physician's, Registered Physician Assistants and Specialist Assistants: Required Course Work or Training in Infection Control and Barrier Precautions Every Four Years
- Part 93 - Improper Practices in Hospital Staff Appointments and Extension of Professional Privileges
- Part 94 - Physician Assistants And Specialist Assistants
- Part 95 - Discrimination In Physician Staff Appointments And Privileges Based On Participation In A Medical Group Practice Or Non-Profit Health Insurance Plan
- Section 95.1 - Filing of complaint
- Section 95.2 - Contents of complaint
- Section 95.3 - Initial investigation
- Section 95.4 - Preliminary conference
- Section 95.5 - Notice of complaint
- Section 95.6 - Time for answer
- Section 95.7 - Pre-hearing procedures
- Section 95.8 - Subpoenas
- Section 95.9 - Conduct of the hearing
- Section 95.10 - Stenographic record
- Section 95.11 - Decision of hearing officer
- Section 95.12 - Order of commissioner
- SubChapter P - Licensure and Practice of Nursing Home Administration
- Part 96 - Licensure And Practice Of Nursing Home Administration
- Section 96.1 - Definitions
- Section 96.2 - Board of examiners; general powers
- Section 96.3 - Board of examiners; officers and duties
- Section 96.4 - Licenses and registrations
- Section 96.5 - Admission to the examination
- Section 96.6 - Grading of examination
- Section 96.7 - Petition for admission to examination
- Section 96.8 - Courses of study; standards for approval
- Section 96.9 - Approved courses of study; registration
- Section 96.10 - Training agencies; administration, organization and faculty
- Section 96.11 - Continuation education requirements
- Section 96.12 - Applicants holding an out-of-state nursing home administrators license.
- Section 96.13 - Notification of change of address or employment
- SubChapter Q - State Environmental Quality Review
- Part 97 - Regulations Implementing State Environmental Quality Review
- Section 97.1 - Authority, purpose and policy
- Section 97.2 - Definitions
- Section 97.3 - Applicability
- Section 97.4 - General rule
- Section 97.5 - Responsibilities of applicants
- Section 97.6 - Initial review of actions
- Section 97.7 - Designation of lead agency and determination of significance for type I actions
- Section 97.8 - Designation of lead agency and determination of significance for unlisted actions
- Section 97.9 - Environmental impact statement procedures
- Section 97.10 - Decisionmaking and findings requirements
- Section 97.11 - Notice and filing requirements
- Section 97.12 - Contents of environmental impact statements
- Section 97.13 - Criteria for determining what actions may have a significant effect on the environment
- Section 97.14 - Lists of department actions
- Section 97.15 - Actions involving a Federal agency
- Section 97.16 - Fees and costs
- Section 97.17 - Programmatic or generic environmental impact statements
- Section 97.18 - Confidentiality
- Section 97.19 - Effective date
- SubChapter R - Managed Care Organizations
- Part 98 - Managed Care Organizations
- SubPart 98-1 - Managed Care Organizations
- Section 98-1.1 - Applicability
- Section 98-1.2 - Managed Care Organizations
- Section 98-1.3 - RESERVED
- Section 98-1.4 - Certificate of incorporation or articles of organization
- Section 98-1.5 - Application for a certificate of authority
- Section 98-1.6 - Issuance of a certificate of authority
- Section 98-1.7 - Limitations of a certificate of authority
- Section 98-1.8 - Continuance of a certificate of authority
- Section 98-1.9 - Acquisition or retention of control of HMO's
- Section 98-1.10 - Transactions within a holding company system affecting controlled HMO's
- Section 98-1.11 - Operational and financial requirements for MCOs
- Section 98-1.12 - Quality management program
- Section 98-1.13 - Assurance of access to care
- Section 98-1.14 - Enrollee services and grievance procedures
- Section 98-1.15 - Employer requirements
- Section 98-1.16 - Audited Financial Statements for Managed Care Organizations
- Section 98-1.17 - Audits and examinations
- Section 98-1.18 - Relationship between an MCO and an IPA
- Section 98-1.19 - Marketing by MLTCPs
- Section 98-1.20 - Waived requirements for MLTCPs
- Section 98-1.21 - Fraud and abuse prevention plans and special investigation units
- Section 98-1.22 - Warning Statements
- SubChapter S - Land Acquisition
- SubPart 98-2 - External Appeals of Adverse Determinations
- Section 98-2.1 - Preamble
- Section 98-2.2 - Definitions
- Section 98-2.3 - Standard description of the external appeal process
- Section 98-2.4 - Certification of external appeal agents
- Section 98-2.5 - Certification requirements
- Section 98-2.6 - Conflict of interest
- Section 98-2.7 - Screening of requests for external appeal
- Section 98-2.8 - Random assignment of external appeals
- Section 98-2.9 - Responsibilities of health care plans
- Section 98-2.10 - Responsibilities of certified external appeal agents
- Section 98-2.11 - Enrollee rights and responsibilities
- Section 98-2.12 - Confidentiality
- Section 98-2.13 - Audits and examinations
- Subpart 98-3 - Audited Financial Statements for Managed Care Organizations
- Section 98-3.1 - Purpose
- Section 98-3.2 - Definitions
- Section 98-3.3 - General requirements related to filing of annual audited financial reports and audit committee appointment
- Section 98-3.4 - Contents of annual audited financial report
- Section 98-3.5 - Designation of CPA
- Section 98-3.6 - Qualifications of CPA
- Section 98-3.7 - Consolidated or combined audits
- Section 98-3.8 - Scope of audit and report of CPA
- Section 98-3.9 - Notification of adverse financial condition
- Section 98-3.10 - Communication of internal control related matters noted in an audit
- Section 98-3.11 - CPA’s letter of qualifications
- Section 98-3.12 - Availability and maintenance of CPA work papers
- Section 98-3.13 - Requirements for audit committees
- Section 98-3.14 - Conduct of MCO in connection with the preparation of required reports and documents
- Section 98-3.15 - Management’s report of internal control over financial reporting
- Section 98-3.16 - Effective date and special rules
- Subpart 98-4 - Mental Health and Substance Use Disorder Treatment Parity Compliance Program
- SubPart 98-1 - Managed Care Organizations
- Part 99 - Payments To An Owner Or Tenant Of Residential Property Or Commercial Property Upon Application For Allowance Of Moving Expenses In Vacating Property Acquired By The Department Of Health
- SubChapter N - Professional Medical and Dental Services
- Part 86 - Reporting And Rate Certifications For Facilities