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- VOLUME C (Title 18)
- SubChapter F - Finance; Claims for Reimbursement by Social Services Districts
- Article 1 - Reimbursement and Claims
- Title: Part 609 - CONDITIONS AND STANDARDS FOR REIMBURSEMENT CLAIMING
Title: Part 609 - CONDITIONS AND STANDARDS FOR REIMBURSEMENT CLAIMING
Statutory Authority
Social Services Law, Sections 20, 34, 62, 65, 80, 81, 82, 83, 84, 85, 87, 88, 90, 92, 93, 94, 95, 153, 363-a
Volume
VOLUME C (Title 18)
- VOLUME C (Title 18)
- SubChapter E - Medical Care
- Article 1 - General
- Article 2 - Program Administration
- Part 501 - MEDICAL CARE-DEPARTMENT POLICY
- Part 502 - DISCLOSURE OF INFORMATION BY PROVIDERS AND FISCAL AGENTS
- Section 502.1 - General requirements.
- Section 502.2 - Definitions.
- Section 502.3 - Determination of ownership or control percentages.
- Section 502.4 - Disclosure by providers and fiscal agents; information on owner
- Section 502.5 - Time and manner of disclosure.
- Section 502.6 - Disclosure by providers; information related to business trans
- Section 502.7 - Disclosure by providers; information on persons convicted of
- Section 502.8 - Additional time requirements for submission of requested infor
- Part 503 (Reserved)
- Part 504 - MEDICAL CARE - ENROLLMENT OF PROVIDERS
- Section 504.1 - Policy and scope.
- Section 504.2 - Application for participation.
- Section 504.3 - Duties of the provider.
- Section 504.4 - Duties of the department.
- Section 504.5 - Denial of an application.
- Section 504.6 - Acceptance of an application.
- Section 504.7 - Continued enrollment termination.
- Section 504.8 - Audit and claim review.
- Section 504.9 - Service bureaus, billing services and electronic media billers.
- Section 504.10 - New enrollments; previously enrolled providers.
- Section 504.11 - Financial security.
- Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
- Part 505 - MEDICAL CARE
- Section 505.1 - Scope of medical assistance.
- Section 505.2 - Physicians' services.
- Section 505.3 - Drugs
- Section 505.4 - Hospital services.
- Section 505.5 - Durable medical equipment; medical/surgical supplies; orthotic and prosthetic appliances; orthopedic footwear
- Section 505.6 - Ophthalmic services.
- Section 505.7 - Laboratory Services.
- Section 505.8 - Nursing service.
- Section 505.9 - Residential health care.
- Section 505.10 - Transportation for medical care and services.
- Section 505.11 - Rehabilitation services.
- Section 505.12 - Podiatry services.
- Section 505.13 - Family planning.
- Section 505.14 - Personal care services
- Section 505.15 - Psychiatric care.
- Section 505.16 - Case management.
- Section 505.17 - Radiology services.
- Section 505.18 - Clinical psychological services.
- Section 505.19 - Standards for services rendered by physicians' assistants and specialist's assistants
- Section 505.20 - Alternate care.
- Section 505.21 - Long term home health care programs; AIDS home care programs.
- Section 505.22 - Shared health facilities.
- Section 505.23 - Home health services.
- Section 505.24 - Blood, plasma or related products.
- Section 505.25 - Ambulatory care for recipients with mental illness.
- Section 505.26 - Chemical Dependence Outpatient Medically Supervised Withdrawal Services
- Section 505.27 - Chemical Dependence Outpatient Services
- Section 505.28 - Consumer directed personal assistance program
- Section 505.29 - Foster family care demonstration programs.
- Section 505.30 - Chronic hemodialysis services in the home.
- Section 505.31 - Audiology, hearing aid services and products.
- Section 505.32 - Nurse practitioner services.
- Section 505.33 - Personal emergency response services (PERS).
- Section 505.34 - Chronic care management demonstration programs.
- Section 505.35 - Assisted living programs.
- Section 505.37 - Collateral services.
- Section 505.38 - Children’s Behavioral Health and Health Services.
- Section 505.39 - Applied Behavior Analysis
- Part 506 - DENTAL CARE
- Part 507 - HEALTH SUPERVISION AND MEDICAL CARE FOR CHILDREN
- Section 507.1 - General responsibilities for health supervision and
- Section 507.2 - Special assessments, examinations and tests required for children
- Section 507.3 - Payment for health supervision and care.
- Section 507.4 - Medical rehabilitation and mental health.
- Section 507.5 - Emergency medical treatment for children in foster care.
- Part 508 - CHILD/TEEN HEALTH PLAN (C/THP)
- Section 508.0 - Scope.
- Section 508.1 - Definitions.
- Section 508.2 - General policy.
- Section 508.3 - Identification of persons eligible for C/THP services.
- Section 508.4 - Informing persons eligible for C/THP services about C/THP.
- Section 508.5 - Provision of C/THP services.
- Section 508.6 - Identification of available providers.
- Section 508.7 - Agreements with providers.
- Section 508.8 - Standards and periodicity.
- Section 508.9 - Coordination with related programs.
- Section 508.10 - Forms and reports.
- Section 508.11 - Payment.
- Section 508.12 - Continuing care providers.
- Part 509 - TUBERCULOSIS CARE
- Part 510 - CHIROPRACTIC SERVICES
- Part 511 - MEDICAL CARE - UTILIZATION REVIEW
- Section 511.1 - Utilization review.
- Section 511.2 - Excluded services.
- Section 511.3 - REPEALED
- Section 511.4 - REPEALED
- Section 511.5 - REPEALED
- Section 511.6 - REPEALED
- Section 511.7 - REPEALED
- Section 511.8 - REPEALED
- Section 511.9 - REPEALED
- Section 511.10 - REPEALED
- Section 511.11 - REPEALED
- Section 511.12 - REPEALED
- Section 511.13 - REPEALED
- Section 511.14 - REPEALED
- Part 512 - DRUG UTILIZATION REVIEW
- Part 513 - PRIOR APPROVAL OF MEDICAL, DENTAL AND REMEDIAL CARE
- Section 513.0 - Policy, purpose and scope.
- Section 513.1 - Definitions.
- Section 513.2 - Procedure for obtaining prior approval.
- Section 513.3 - Obligations and responsibilities of recipients.
- Section 513.4 - Obligations and responsibilities of the ordering practitioner and potential provider
- Section 513.5 - Obligations and responsibilities of the Department of Health.
- Section 513.6 - Evaluation of requests.
- Section 513.7 - Determinations.
- Section 513.8 - Fair hearings.
- Part 514 - PROVIDER VERIFICATION OF RECIPIENT ELIGIBILITY AND ORDERS FOR SERVICE
- Section 514.1 - Policy.
- Section 514.2 - Introduction.
- Section 514.3 - Electronic eligibility verification system.
- Section 514.4 - Medicaid eligibility terminal (MET).
- Section 514.5 - Card swipe.
- Section 514.6 - Posting of orders for care, services or supplies.
- Section 514.7 - Clearing of orders for care, services or supplies.
- Part 515 - PROVIDER SANCTIONS
- Section 515.1 - Scope and definitions.
- Section 515.2 - Unacceptable practices under the medical assistance program.
- Section 515.3 - Authority to sanction.
- Section 515.4 - Guidelines for sanctions.
- Section 515.5 - Sanctions; effect.
- Section 515.6 - Notification.
- Section 515.7 - Immediate sanctions.
- Section 515.8 - Mandatory exclusions.
- Section 515.9 - Overpayments.
- Section 515.10 - Reinstatement.
- Part 516 - MONETARY PENALTIES
- Part 517 - PROVIDER AUDITS
- Part 518 - RECOVERY AND WITHHOLDING OF PAYMENTS OR OVERPAYMENTS
- Section 518.1 - Scope.
- Section 518.2 - Definitions.
- Section 518.3 - Liability for overpayments.
- Section 518.4 - Interest.
- Section 518.5 - Recovery of overpayments; procedure.
- Section 518.6 - Recoupment of overpayments.
- Section 518.7 - Withholding of payments.
- Section 518.8 - Recovery of overpayments pending a hearing.
- Section 518.9 - Incorporation by reference
- Part 519 - PROVIDER HEARINGS
- Section 519.1 - Scope.
- Section 519.2 - General.
- Section 519.3 - Definitions.
- Section 519.4 - Right to a hearing.
- Section 519.5 - Notice.
- Section 519.6 - Information concerning the right to a hearing.
- Section 519.7 - Request for a hearing.
- Section 519.8 - Hearing rights.
- Section 519.9 - Authorization of representative.
- Section 519.10 - Notice of hearing.
- Section 519.11 - Scheduling and adjourning the hearing.
- Section 519.12 - Withdrawal or abandonment of a request for hearing.
- Section 519.13 - Examination of file before hearing.
- Section 519.14 - Prehearing conference.
- Section 519.15 - Hearing officer.
- Section 519.16 - Who may be present at the hearing.
- Section 519.17 - Responsibilities at the hearing.
- Section 519.18 - Hearing procedure.
- Section 519.19 - Witnesses.
- Section 519.20 - Hearing record.
- Section 519.21 - Examination of the record after the hearing.
- Section 519.22 - Decision after hearing.
- Section 519.23 - Decision without hearing.
- Section 519.24 - Correction of errors.
- Section 519.25 - Compliance with decision.
- Part 520 - Tax Refund Offset for Overpayments of Medical Assistance
- Part 521 - Provider Compliance Programs
- Part 522 - PAYMENT FOR PRE-SCHOOL CHILDREN WITH HANDICAPPING CONDITIONS
- Part 527 - STATE REIMBURSEMENT FOR PAYMENT TO OUT-OF-STATE PROVIDERS OF MEDICAL CARE AND SERVICES
- Part 530 - HOSPITAL RATES
- Part 531 - REIMBURSEMENT FOR MA PROVIDED TO PRESUMPTIVELY ELIGIBLE APPLICANTS
- Part 532 - PAYMENT TO PHYSICIANS
- Part 533 - STATE REIMBURSEMENT FOR PAYMENT TO PHYSICIANS
- Section 533.1 - Payment for physician's services to hospitalized
- Section 533.2 - Definitions.
- Section 533.3 - State reimbursement.
- Section 533.4 - Medicine.
- Section 533.5 - Anesthesia and surgery.
- Section 533.6 - Radiology.
- Section 533.7 - Preferred Physicians and Children Program.
- Section 533.8 - Human immunodeficiency virus enhanced fees for physicians
- Part 535 - STATE REIMBURSEMENT FOR PAYMENT TO DENTISTS
- Part 537 - STATE REIMBURSEMENT FOR OPTOMETRIC SERVICES
- Part 538 - STATE REIMBURSEMENT FOR TELEHEALTH SERVICES
- Part 505 - MEDICAL CARE
- Article 4 - Fees and Reimbursement
- Article 5 - Procedures and Forms
- Part 540 - AUTHORIZATION OF MEDICAL CARE
- Section 540.1 - Authorization as basis for payment for medical assist
- Section 540.2 - Limitations on nonmedical assistance emergency hospital care.
- Section 540.3 - Drug prescriptions.
- Section 540.4 - Notification to public welfare official for medical services.
- Section 540.5 - Authorization by public welfare officials.
- Section 540.6 - Billing for medical assistance.
- Section 540.7 - Requirements for billing.
- Section 540.8 - Verification, payment and recording of medical bills.
- Section 540.9 - Filing of authorizations, bills and related documents.
- Section 540.10 - Claims for State aid.
- Section 540.11 - Internal administrative safeguards over medical care expendi
- Section 540.12 - Advance payments to hospitals.
- Section 540.13 - Concurrent payments to hospitals.
- Part 541 - PATIENT'S MEDICAL RECORD
- Part 542 - SUBROGATED CLAIMS TO LIABLE THIRD PARTIES
- Part 540 - AUTHORIZATION OF MEDICAL CARE
- SubChapter F - Finance; Claims for Reimbursement by Social Services Districts
- Article 1 - Reimbursement and Claims
- Part 600 - PRINCIPLES OF REIMBURSEMENT CLAIMING
- Part 601 - PROCEDURES OF REIMBURSEMENT CLAIMING
- Part 602 - COST ALLOCATION FOR REIMBURSEMENT CLAIMING
- Part 603 - REDISTRIBUTION ADJUSTMENT PROCESS FOR REIMBURSEMENT CLAIMING
- Part 608 - RETRIEVAL AND CREDIT ADJUSTMENTS FOR REIMBURSEMENT CLAIMING
- Part 609 - CONDITIONS AND STANDARDS FOR REIMBURSEMENT CLAIMING
- Article 2 - Redistributable and Interim Claiming Classification
- Article 3 - Maintenance Assistance Reimbursement Claiming
- Part 620 - PUBLIC ASSISTANCE AND CARE REIMBURSEMENT CLAIMING
- Part 621 - HOME RELIEF REIMBURSEMENT CLAIMING OTDA
- Part 625 - ASSISTANCE FOR DEPENDENT CHILDREN REIMBURSEMENT CLAIMING - OTDA
- Part 626 - FEDERALLY REIMBURSED AID TO DEPENDENT CHILDREN REIMBURSEMENT CLAIMING - OTDA
- Part 627 - CHILD SUPPORT ENFORCEMENT REIMBURSEMENT CLAIMING - OTDA
- Part 628 - CHILD CARE AND FOSTER CARE REIMBURSEMENT CLAIMING - OTDA
- Part 629 - JOBS OPPORTUNITIES AND BASIC SKILLS TRAINING REIMBURSEMENT CLAIMING - OTDA
- Article 4 - Supplementary Assistance Reimbursement Claiming
- Part 633 - SERVICES FOR RECIPIENTS AND OTHERS; REIMBURSEMENT CLAIMING - OTDA
- Part 634 - SUPPLEMENTARY SECURITY INCOME AND ASSISTANCE FOR THE AGED, BLIND AND DISABLED REIMBURSEMENT CLAIMING
- Part 635 - MEDICAL ASSISTANCE REIMBURSEMENT CLAIMING
- Part 637 - FOOD STAMPS REIMBURSEMENT CLAIMING - OTDA
- Part 638 - ENERGY ASSISTANCE REIMBURSEMENT CLAIMING - OTDA
- Part 639 - OTHER ASSISTANCE REIMBURSEMENT CLAIMING - OTDA
- Article 1 - Reimbursement and Claims
- SubChapter G - Statistics
- Part 650 - REPORTS OF PRIVATE INSTITUTIONS AND AGENCIES
- Section 650.3 - Child-caring agencies and institutions (annual financial reports).
- Section 650.4 - Hospitals or sanatoria (annual reports).
- Section 650.5 - Private homes for the aged.
- Section 650.6 - Institutions providing temporary or special care (annual statistical reports).
- Section 650.7 - Medical convalescent or nursing homes which are incorporated
- Part 651 - PUBLIC ASSISTANCE REPORTS - OTDA
- Part 653 - PERSONNEL REPORTS
- Part 655 - WELFARE MANAGEMENT SYSTEM
- Part 650 - REPORTS OF PRIVATE INSTITUTIONS AND AGENCIES
- SubChapter H - Personnel
- Part 674 - GENERAL PROVISIONS
- Part 675 - DUTIES AND RESPONSIBILITIES WITH RESPECT TO REIMBURSEMENT ON PERSONNEL
- Part 676 - PERSONAL HISTORY SUMMARY
- Part 677 - MAINTENANCE OF PERSONNEL INFORMATION
- Part 678 - PERSONNEL POLICIES
- Part 679 - SPECIFICATIONS FOR LOCAL SOCIAL SERVICES COMMISSIONER AND DEPUTY SOCIAL SERVICES COMMISSIONER
- Section 679.1 - Definitions.
- Section 679.2 - Groups of social services districts.
- Section 679.3 - Commissioners of districts in Group I: minimum qualifications
- Section 679.4 - Commissioners of districts in Group II: minimum qualifications
- Section 679.5 - Commissioners of districts in Group III: minimum qualifications
- Section 679.6 - Commissioners of districts in Group IV: minimum qualifications
- Section 679.7 - Appointment of qualified persons.
- Section 679.8 - Submission of qualifications.
- Section 679.9 - Notice of qualification.
- Section 679.10 - Deputy social services commissioner.
- Part 680 - SPECIFICATIONS FOR LOCAL SOCIAL SERVICES POSITIONS
- SubChapter I - Acquisition of Real Property for Department Purposes
- SubChapter J - Commission for the Visually Handicapped - OTDA
- Part 725 - PENSION PLAN FOR BLIND VENDING STAND OPERATORS - OTDA
- Part 726 - APPLICATION FOR AUTHORIZATION TO REPRESENT GOODS AND ARTICLES AS BLIND MADE OR PROCESSED PRODUCTS PURSUANT TO SECTIONS 396-f AND 396-g OF THE GENERAL BUSINESS LAW - OTDA
- Part 727 - CONFIDENTIAL NATURE OF RECORDS OF THE COMMISSION FOR THE VISUALLY HANDICAPPED - OTDA
- Part 728 - THE EQUIPMENT LOAN FUND FOR THE DISABLED - OTDA
- SubChapter K - Standards for Office Space and Facilities
- SubChapter L - Homeless Housing and Assistance Program
- Part 800 - HOMELESS HOUSING AND ASSISTANCE PROGRAM
- Section 800.1 - General.
- Section 800.2 - Definitions.
- Section 800.3 - Applicant eligibility.
- Section 800.4 - Community eligibility.
- Section 800.5 - Project eligibility.
- Section 800.6 - Funding limitations.
- Section 800.7 - Funding criteria and award of contracts.
- Section 800.8 - Other than project costs.
- Section 800.9 - Contract provisions and performance.
- Section 800.10 - Conflict of interests.
- Part 801 - PROMPT PAYMENT POLICY OF THE NEW YORK STATE HOMELESS HOUSING AND ASSISTANCE CORPORATION - OTDA & OCFS
- Part 900 - SHELTER FOR FAMILIES - OCFS
- Part 800 - HOMELESS HOUSING AND ASSISTANCE PROGRAM
- Chapter XX - Youth Facilities Project Guarantee Fund - OTDA & OCFS
- SubChapter E - Medical Care