§ 332-B — Disability program

§ 332-b. Disability program. 1. (a) Upon application and\nrecertification for public assistance benefits, or whenever a district\nhas reason to believe that a physical or mental impairment may prevent\nthe individual from fully engaging in work activities, the social\nservices district shall inquire whether the individual has any medical\ncondition which would limit the individual's ability to participate in\nwork activities pursuant to this title.\n (b) An individual who is eligible to receive comprehensive health\nservices through a special needs plan defined in paragraph (m) or (n) of\nsubdivision one of section three hundred sixty-four-j of this chapter,\nregardless of whether such a plan is operating in the individual's\nsocial services district of residence, shall be considered disabled and\nunable to engage in work activities or shall be considered work-limited.\n 2. (a) Under the circumstances set forth in subdivision one of this\nsection, notice shall be provided to the individual of the opportunity\nto provide, within ten calendar days, any relevant medical\ndocumentation, including but not limited to drug prescriptions and\nreports of the individual's treating health care practitioner, if any;\nsuch documentation must contain a specific diagnosis as evidenced by\nmedically appropriate tests or evaluations and must particularize any\nwork related limitations as a result of any such diagnosis.\n (b) If, prior to submitting his or her medical documentation, the\nindividual is referred to a health care practitioner certified by the\noffice of disability determinations of the office of temporary and\ndisability assistance or, if applicable, to the contracted agency or\ninstitution by or with which such health care practitioner is employed\nor affiliated for an examination pursuant to subdivision four of this\nsection, such individual shall make best efforts to bring such\ndocumentation to the examination, and in no case shall provide such\nrecords to the examining health care practitioner certified by the\noffice of disability determinations or, if applicable, to the contracted\nagency or institution by or with which such health care practitioner is\nemployed or affiliated later than four business days after such\nexamination; provided that the individual may demonstrate good cause as\ndefined in regulations, for failure to provide such records within the\nspecific time periods.\n 3. The district may in its sole discretion accept such documentation\nas sufficient evidence that the individual cannot fully engage in work\nactivities and in such case shall modify work assignments consistent\nwith the findings in such medical documents.\n 4. In instances where the district determines either that the\ndocumentation is insufficient to support an exemption from or limitation\non work activities or that further medical evaluation is appropriate,\nthe individual shall be referred to a health care practitioner certified\nby the Office of Disability Determinations of the Department of Social\nServices for an examination of such individual's medical condition.\n The health care practitioner who performs the examination of the\nindividual shall:\n (a) review and consider all records or information provided by the\nindividual or his or her treating health care practitioner that are\npertinent to the claimed medical condition;\n (b) make a specific diagnosis as evidenced by medically appropriate\ntests or evaluations in determination of the individual's claimed\ncondition;\n (c) render to the individual and the social services district, an\nopinion, particularizing the presence or absence of the alleged\ncondition; and\n (d) In the event that he or she identifies a condition, other than the\nalleged condition, that may interfere with the individual's ability to\nfully engage in work activities, the practitioner shall report such\ncondition; and\n (e) determine whether the individual is:\n (i) disabled and unable to engage in work activities pursuant to this\ntitle for a stated period of time, in which case the applicant shall be\nexempt in accordance with paragraph (a) of subdivision one of section\nthree hundred thirty-two of this title;\n (ii) for a stated period of time, not disabled, but work limited, and\nable to engage in work activities pursuant to this title, with stated\nlimitations, or\n (iii) neither disabled nor work limited.\n 4-a. If the practitioner to whom the individual is referred pursuant\nto subdivision four or paragraph (b) of subdivision two of this section\nissues an opinion that differs from the applicant's treating health care\npractitioner, the practitioner shall provide a written determination\nthat specifies why the practitioner disagrees with the applicant's\ntreating health care practitioner's disability determination and present\nevidence that supports the opinion.\n 5. When an applicant or recipient has requested or a social services\nofficial has directed a determination pursuant to this section, no\nassignment to work activities may be made until completion of such\ndetermination, unless the applicant or recipient agrees to a limited\nwork assignment not inconsistent with the medical condition alleged by\nsuch person.\n 6. When an applicant or recipient receives notification of the\nexamining medical professional's disability determination, he or she\nshall also be notified of his or her right to request a fair hearing\nwithin ten days of such notice. If such applicant timely requests a fair\nhearing, no assignment to work activities pursuant to this title may be\nmade pending such hearing and determination unless the applicant or\nrecipient agrees to a limited work assignment not inconsistent with the\nmedical condition alleged by such person. Provided, however, that if a\nsocial services district has reason to believe that such recipient or\napplicant does not actually suffer from a work limiting condition, the\ndistrict shall provide the applicant or recipient with notice of\npotential sanctions pursuant to subdivision three of section three\nhundred forty-two of this title, and provided further that recipients\nwill be subject to sanctions pursuant to subdivision three of section\nthree hundred forty-two of this title if the district determines, based\non clear medical evidence, that there is no basis for the individual's\nclaim that he or she is unable to fully engage in work activities, and\nthat the individual intentionally misrepresented his or her medical\ncondition.\n 7. Any applicant or recipient determined to be work limited pursuant\nto this section may be assigned to work activities only in accordance\nwith the limitations and protections set forth in paragraph (e) of\nsubdivision five of section three hundred thirty-five-b of this title.\n