§ 365-a. Character and adequacy of assistance. The amount, nature and\nmanner of providing medical assistance for needy persons shall be\ndetermined by the public welfare official with the advice of a physician\nand in accordance with the local medical plan, this title, and the\nregulations of the department.\n 1. "Benchmark coverage" shall mean payment of part or all of the cost\nof medically necessary medical, dental, and remedial care, services, and\nsupplies described in subdivision two of this section, and to the extent\nnot included therein, any essential benefits as defined in 42 U.S.C.\n18022(b), with the exception of institutional long term care services;\nsuch care, services and supplies shall be provided consistent with the\nmanaged care program described in section three hundred sixty-four-j of\nthis title.\n 2. "Standard coverage" shall mean payment of part or all of the cost\nof medically necessary medical, dental and remedial care, services and\nsupplies, as authorized in this title or the regulations of the\ndepartment, which are necessary to prevent, diagnose, correct or cure\nconditions in the person that cause acute suffering, endanger life,\nresult in illness or infirmity, interfere with such person's capacity\nfor normal activity, or threaten some significant handicap and which are\nfurnished an eligible person in accordance with this title and the\nregulations of the department. Such care, services and supplies shall\ninclude the following medical care, services and supplies, together with\nsuch medical care, services and supplies provided for in subdivisions\nthree, four and five of this section, and such medical care, services\nand supplies as are authorized in the regulations of the department:\n (a) services of qualified physicians, dentists, nurses, and private\nduty nursing services shall be further subject to the provisions of\nsection three hundred sixty-seven-o of this chapter, optometrists, and\nother related professional personnel;\n (b) care, treatment, maintenance and nursing services in hospitals,\nnursing homes that qualify as providers in the medicare program pursuant\nto title XVIII of the federal social security act, infirmaries or other\neligible medical institutions, and health-related care and services in\nintermediate care facilities, while operated in compliance with\napplicable provisions of this chapter, the public health law, the mental\nhygiene law and other laws, including any provision thereof requiring an\noperating certificate or license, or where such facilities are not\nconveniently accessible, in hospitals located without the state;\nprovided, however, that care, treatment, maintenance and nursing\nservices in nursing homes or in intermediate care facilities, including\nthose operated by the state department of mental hygiene or any other\nstate department or agency, shall, for persons who are receiving or who\nare eligible for medical assistance under provisions of subparagraph\nfour of paragraph (a) of subdivision one of section three hundred\nsixty-six of this chapter, be limited to such periods of time as may be\ndetermined necessary in accordance with a utilization review procedure\nestablished by the state commissioner of health providing for a review\nof medical necessity, in the case of skilled nursing care, every thirty\ndays for the first ninety days and every ninety days thereafter, and in\nthe case of care in an intermediate care facility, at least every six\nmonths, or more frequently if indicated at the time of the last review,\nconsistent with federal utilization review requirements; provided,\nfurther, that in-patient care, services and supplies in a general\nhospital shall not exceed such standards as the commissioner of health\nshall promulgate but in no case greater than twenty days per spell of\nillness during which all or any part of the cost of such care, services\nand supplies are claimed as an item of medical assistance, unless it\nshall have b
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.