Section 364. Responsibility for standards  


Latest version.
  • To assure that the medical care
      and services rendered pursuant to this title are of the highest  quality
      and  are  available  to  all  who  are  in  need, the responsibility for
      establishing and maintaining standards for medical care and  eligibility
      shall be as follows:
        1. The department of social services shall be responsible for
        (a)  determining  eligibility  for  care and services pursuant to this
      title and consistent with standards established by the  commissioner  of
      the  department  of  health and, as authorized by such commissioner, for
      hearing  appeals  and  making  findings  and  recommendations   relating
      thereto;
        (b)  auditing  payments  to  providers  of care, services and supplies
      under the medical assistance program; and
        (c) publishing and distributing to the public, from time to  time  and
      in  consultation  with the department of health, information relating to
      the medical assistance program, to promote maximum public  awareness  of
      the availability of, and the procedure for obtaining, such assistance.
        2. The department of health shall be responsible for
        (a)  establishing  and  maintaining  standards  for  all  hospital and
      related services pursuant to article twenty-eight of the  public  health
      law,  and  for all medical care and services furnished in an institution
      operated by the department of health pursuant to other provisions of the
      public health law;
        (b) establishing and maintaining standards for  all  non-institutional
      health  care and services rendered pursuant to this title, including but
      not  limited  to  procedural  standards  relating  to  the   revocation,
      suspension,  limitation  or annulment of qualification for participation
      as a provider of care and services, on a determination that the provider
      is an incompetent provider of  specific  services  or  has  exhibited  a
      course  of  conduct  which is either inconsistent with program standards
      and  regulations  or  which  exhibits  an  unwillingness  to  meet  such
      standards and regulations, or is a potential threat to the public health
      or safety pursuant to section two hundred six of the public health law;
        (c) reviewing and approving local social services medical plans;
        (d)  establishing  by  regulation requirements for a uniform system of
      reports relating to the quality of medical care and  services  furnished
      pursuant to this title;
        (e)  reviewing  the  quality  and  availability  of  medical  care and
      services furnished under local social services medical plans, to  assure
      that the quality of medical care and services is in the best interest of
      the recipients;
        (f)  providing consultative services to hospitals, nursing homes, home
      health agencies, clinics, laboratories, and such other  institutions  as
      the secretary of the federal department of health and human services may
      specify  in  order  to  assist  them:  to qualify for payments under the
      provisions of this title and title XIX of the  federal  social  security
      act;  in  providing  information  needed  to determine such payments; in
      establishing and maintaining such fiscal records as may be necessary for
      the proper and efficient administration of medical assistance;
        (g) establishing standards  of  eligibility  for  medical  assistance,
      consistent with the provisions of this title; and
        (h)  making  policy, rules and regulations for maintaining a system of
      hearings for applicants and recipients of medical  assistance  adversely
      affected  by  the  actions of the department or social service districts
      and for making final administrative  determinations  and  issuing  final
      decisions concerning such matters.
        3.  Each  office  within  the  department  of  mental hygiene shall be
      responsible for establishing and maintaining standards for medical  care
    
      and  services  received in institutions operated by it or subject to its
      supervision pursuant to the mental hygiene law.
        4. The public health council shall be responsible for establishing and
      maintaining  qualifications  for  persons  employed  by  social services
      districts as professional directors.