§ 3605-C — Authorization to enroll and provide medical assistance

New York § 3605-C

• Jurisdiction: New York
• Law PBH: Public Health
• Art. 36: Home Care Services

Text

§ 3605-c. Authorization to enroll and provide medical assistance. 1. A\nlicensed home care services agency (LHCSA) shall not enroll as a\nprovider in the medical assistance program operated pursuant to title\neleven of article five of the social services law or provide or claim\nfor services pursuant thereto, whether provided under the state plan, a\nwaiver thereto or through a managed care organization, without being\nauthorized to do so by contract with the department entered into\npursuant to this section. Authorization under this section shall not\nsubstitute for or duplicate the requirements of licensure under this\narticle or the screening and enrollment process required for\nparticipation in the medical assistance program.\n 2. Notwithstanding any inconsistent provision of section one hundred\nsixty-three of the state finance law, or sections one hundred forty-two\nand one hundred forty-three of the economic development law, the\ncommissioner shall enter into a sufficient number of contracts with\nLHCSAs to ensure medical assistance recipients have access to care and\nservices, provided, however, that:\n (a) the department shall post on its website for a period of no less\nthan thirty days:\n (i) a description of the proposed services to be provided pursuant to\nthe contract or contracts;\n (ii) the criteria for selection of LHCSA contractors, including but\nnot limited to: licensure under this article, the ability to\nappropriately serve medical assistance recipients as determined by the\ncommissioner, a geographic distribution of LHCSAs to ensure access\nstatewide including in rural and underserved areas, demonstrated\ncultural and language competencies specific to the population of\nrecipients and those of the available workforce, ability to provide\ntimely assistance to recipients, experience serving individuals with\ndisabilities, efficient and economic administration of LHCSA services,\nand demonstrated compliance with all applicable federal and state laws\nand regulations including, but not limited to, past compliance with\nlabor law and existing wage and labor standards, and compliance with\nequal employment opportunity requirements and anti-discrimination laws;\n (iii) the period of time during which a prospective contractor may\nseek selection, which shall be no less than thirty days after such\ninformation is first posted on the website; and\n (iv) the manner by which a prospective contractor may submit a\nproposal for selection, which may include submission by electronic\nmeans;\n (b) the commissioner shall review in a timely fashion all reasonable\nand responsive submissions that are received from prospective\ncontractors;\n (c) the commissioner shall select such contractors that, in the\ncommissioner's discretion, are best suited to efficiently and\neconomically administer medical assistance services;\n (d) all decisions made and approaches taken pursuant to this section\nshall be documented in a procurement record as defined in section one\nhundred sixty-three of the state finance law;\n (e) the commissioner may institute a continuous recruitment process\nprovided that the information required under paragraph (a) of this\nsubdivision remains on the department's website for the entire duration\nof the recruitment process, until such date as the commissioner may\ndetermine upon no less than ten days notice being posted on the website;\nand\n (f) the commissioner may reoffer contracts under the same terms of\nthis subdivision, if determined necessary by the commissioner, on a\nstatewide or regional basis.\n 3. (a) The department may terminate a LHCSA's contract under this\nsection or suspend or limit the LHCSA's rights and privileges under the\ncontract upon thirty day's written notice to the LHCSA if the\ncommissioner finds that the LHCSA has failed to comply with the\nprovisions of this section or any regulations promulgated hereunder. The\nwritten notice shall include:\n (i) a description of the conduct and the issues related thereto that\nhave been identified as failure of compliance; and\n (ii) the time frame of the conduct that fails compliance.\n (b) Notwithstanding paragraph (a) of this subdivision, upon\ndetermining that a medical assistance recipient's health or safety would\nbe imminently endangered by the continued operation or actions of the\nLHCSA, the commissioner may terminate the LHCSA's contract or suspend or\nlimit the LHCSA's rights and privileges under the contract immediately\nupon written notice.\n (c) All orders or determinations under this subdivision shall be\nsubject to review as provided in article seventy-eight of the civil\npractice law and rules.\n (d) Any procedural rights or privileges afforded pursuant to this\nsubdivision shall apply only to actions taken under this subdivision\nwith respect to compliance with the terms of the contract. Actions taken\nunder this subdivision shall not constitute and shall not be construed\nto constitute an action with respect to a LHCSA's licensure or\nenrollment in the medical assistance program, which the department may\nundertake separately or in conjunction with an action pursuant to this\nsubdivision.\n 4. The provisions of this section shall not apply unless any and all\nnecessary approvals under federal law and regulation have been obtained\nto receive federal financial participation in the costs of services that\nwould be provided by LHCSAs in accordance with the terms of contracts\nentered into pursuant to this section.\n