§ 364 — Responsibility for standards

§ 364. Responsibility for standards. To assure that the medical care\nand services rendered pursuant to this title are of the highest quality\nand are available to all who are in need, the responsibility for\nestablishing and maintaining standards for medical care and eligibility\nshall be as follows:\n 1. The department of social services shall be responsible for\n (a) determining eligibility for care and services pursuant to this\ntitle and consistent with standards established by the commissioner of\nthe department of health and, as authorized by such commissioner, for\nhearing appeals and making findings and recommendations relating\nthereto;\n (b) auditing payments to providers of care, services and supplies\nunder the medical assistance program; and\n (c) publishing and distributing to the public, from time to time and\nin consultation with the department of health, information relating to\nthe medical assistance program, to promote maximum public awareness of\nthe availability of, and the procedure for obtaining, such assistance.\n 2. The department of health shall be responsible for\n (a) establishing and maintaining standards for all hospital and\nrelated services pursuant to article twenty-eight of the public health\nlaw, and for all medical care and services furnished in an institution\noperated by the department of health pursuant to other provisions of the\npublic health law;\n (b) establishing and maintaining standards for all non-institutional\nhealth care and services rendered pursuant to this title, including but\nnot limited to procedural standards relating to the revocation,\nsuspension, limitation or annulment of qualification for participation\nas a provider of care and services, on a determination that the provider\nis an incompetent provider of specific services or has exhibited a\ncourse of conduct which is either inconsistent with program standards\nand regulations or which exhibits an unwillingness to meet such\nstandards and regulations, or is a potential threat to the public health\nor safety pursuant to section two hundred six of the public health law;\n (c) reviewing and approving local social services medical plans;\n (d) establishing by regulation requirements for a uniform system of\nreports relating to the quality of medical care and services furnished\npursuant to this title;\n (e) reviewing the quality and availability of medical care and\nservices furnished under local social services medical plans, to assure\nthat the quality of medical care and services is in the best interest of\nthe recipients;\n (f) providing consultative services to hospitals, nursing homes, home\nhealth agencies, clinics, laboratories, and such other institutions as\nthe secretary of the federal department of health and human services may\nspecify in order to assist them: to qualify for payments under the\nprovisions of this title and title XIX of the federal social security\nact; in providing information needed to determine such payments; in\nestablishing and maintaining such fiscal records as may be necessary for\nthe proper and efficient administration of medical assistance;\n (g) establishing standards of eligibility for medical assistance,\nconsistent with the provisions of this title; and\n (h) making policy, rules and regulations for maintaining a system of\nhearings for applicants and recipients of medical assistance adversely\naffected by the actions of the department or social service districts\nand for making final administrative determinations and issuing final\ndecisions concerning such matters.\n 3. Each office within the department of mental hygiene shall be\nresponsible for establishing and maintaining standards for medical care\nand services received in institutions operated by it or subject to its\nsupervision pursuant to the mental hygiene law.\n 4. The public health and health planning council shall be responsible\nfor establishing and maintaining qualifications for persons employed by\nsocial services districts as professional directors.\n