New York Social Services Code § 367-B

Medical assistance information and payment system
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§ 367-b. Medical assistance information and payment system. 1. The\ndepartment shall design and implement a statewide medical assistance\ninformation and payments system for the purpose of providing individual\nand aggregate data to social services districts to assist them in making\nbasic management decisions, to the department and other state agencies\nto assist in the administration of the medical assistance program, and\nto the governor and the legislature as may be necessary to assist in\nmaking major administrative and policy decisions affecting such program.\nSuch system shall be designed so as to be capable of the following:\n  a. receiving and processing information relating to the eligibility of\neach person applying for medical assistance and of issuing a medical\nassistance identification card to persons determined by a social\nservices official to be eligible for such assistance;\n  b. receiving and processing information relating to each qualified\nprovider of medical assistance furnishing care, services or supplies for\nwhich claims for payment are made pursuant to this title;\n  c. receiving and processing, in a form and manner prescribed by the\ndepartment, all claims for medical care, services and supplies, and\nmaking payments for valid claims to providers of medical care, services\nand supplies on behalf of social services districts;\n  d. maintaining information necessary to allow the department,\nconsistent with the powers and duties of the department of health, to\nreview the appropriateness, scope and duration of medical care, services\nand supplies provided to any eligible person pursuant to this chapter;\nand\n  e. initiating implementation of such a system for the district\ncomprising the city of New York, in a manner compatible with expansion\nof such system to districts other than the district comprising the city\nof New York.\n  2. Consistent with the capabilities of the system established pursuant\nto subdivision one of this section, the department shall assume payment\nresponsibilities on behalf of social services districts by promulgation\nof regulations approved by the director of the budget. Such regulations\nshall specify the providers of medical assistance and the medical care,\nservices and/or supplies for the district or districts for which the\ndepartment will assume payment responsibilities and the date on which\nsuch responsibilities shall be assumed. Such regulations shall be\npublished for comment at least thirty days in advance of their\npromulgation and shall be filed with the secretary of state at least\nsixty days in advance of the date of assumption of responsibilities;\nprovided, however, that with respect to a particular district the\nrequirements for advance publications and/or filing may be waived, or\nthe time limits reduced, with the written consent of the district to\nsuch waiver or reduction. Providers of medical care and services shall\nsubmit claims to the social services district for all items of care,\nservices and supplies furnished prior to the date of state assumption of\npayment responsibilities and to the state for all such items furnished\nsubsequent to such date. Such regulations shall also specify a final\ntransition date after which any claiming submitted shall be enforceable\nby such provider only against the state and shall not be enforceable by\nsuch provider against the social services district; provided, however,\nthat the department and the district may enter into a written agreement\nby which the department agrees on the basis of eligibility information\nprovided by such district to pay claims submitted to such district prior\nto the final transition date.\n  3. Upon notice to a social services district in accordance with\nsubdivision two, that the department intends to assume payment\nresponsibilities on behalf of such district, (a) such district shall\npromptly submit to the department requested information regarding each\nperson who applies for or 

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