N.Y. Public Health Law § 3605-c: Authorization to enroll and provide medical assistance

§ 3605-c. Authorization to enroll and provide medical assistance. 1. A

licensed home care services agency (LHCSA) shall not enroll as a

provider in the medical assistance program operated pursuant to title

eleven of article five of the social services law or provide or claim

for services pursuant thereto, whether provided under the state plan, a

waiver thereto or through a managed care organization, without being

authorized to do so by contract with the department entered into

pursuant to this section. Authorization under this section shall not

substitute for or duplicate the requirements of licensure under this

article or the screening and enrollment process required for

participation in the medical assistance program.

2. Notwithstanding any inconsistent provision of section one hundred

sixty-three of the state finance law, or sections one hundred forty-two

and one hundred forty-three of the economic development law, the

commissioner shall enter into a sufficient number of contracts with

LHCSAs to ensure medical assistance recipients have access to care and

services, provided, however, that:

(a) the department shall post on its website for a period of no less

than thirty days:

(i) a description of the proposed services to be provided pursuant to

the contract or contracts;

(ii) the criteria for selection of LHCSA contractors, including but

not limited to: licensure under this article, the ability to

appropriately serve medical assistance recipients as determined by the

commissioner, a geographic distribution of LHCSAs to ensure access

statewide including in rural and underserved areas, demonstrated

cultural and language competencies specific to the population of

recipients and those of the available workforce, ability to provide

timely assistance to recipients, experience serving individuals with

disabilities, efficient and economic administration of LHCSA services,

and demonstrated compliance with all applicable federal and state laws

and regulations including, but not limited to, past compliance with

labor law and existing wage and labor standards, and compliance with

equal employment opportunity requirements and anti-discrimination laws;

(iii) the period of time during which a prospective contractor may

seek selection, which shall be no less than thirty days after such

information is first posted on the website; and

(iv) the manner by which a prospective contractor may submit a

proposal for selection, which may include submission by electronic

means;

(b) the commissioner shall review in a timely fashion all reasonable

and responsive submissions that are received from prospective

contractors;

(c) the commissioner shall select such contractors that, in the

commissioner's discretion, are best suited to efficiently and

economically administer medical assistance services;

(d) all decisions made and approaches taken pursuant to this section

shall be documented in a procurement record as defined in section one

hundred sixty-three of the state finance law;

(e) the commissioner may institute a continuous recruitment process

provided that the information required under paragraph (a) of this

subdivision remains on the department's website for the entire duration

of the recruitment process, until such date as the commissioner may

determine upon no less than ten days notice being posted on the website;

and

(f) the commissioner may reoffer contracts under the same terms of

this subdivision, if determined necessary by the commissioner, on a

statewide or regional basis.

3. (a) The department may terminate a LHCSA's contract under this

section or suspend or limit the LHCSA's rights and privileges under the

contract upon thirty day's written notice to the LHCSA if the

commissioner finds that the LHCSA has failed to comply with the

provisions of this section or any regulations promulgated hereunder. The

written notice shall include:

(i) a description of the conduct and the issues related thereto that

have been identified as failure of compliance; and

(ii) the time frame of the conduct that fails compliance.

(b) Notwithstanding paragraph (a) of this subdivision, upon

determining that a medical assistance recipient's health or safety would

be imminently endangered by the continued operation or actions of the

LHCSA, the commissioner may terminate the LHCSA's contract or suspend or

limit the LHCSA's rights and privileges under the contract immediately

upon written notice.

(c) All orders or determinations under this subdivision shall be

subject to review as provided in article seventy-eight of the civil

practice law and rules.

(d) Any procedural rights or privileges afforded pursuant to this

subdivision shall apply only to actions taken under this subdivision

with respect to compliance with the terms of the contract. Actions taken

under this subdivision shall not constitute and shall not be construed

to constitute an action with respect to a LHCSA's licensure or

enrollment in the medical assistance program, which the department may

undertake separately or in conjunction with an action pursuant to this

subdivision.

4. The provisions of this section shall not apply unless any and all

necessary approvals under federal law and regulation have been obtained

to receive federal financial participation in the costs of services that

would be provided by LHCSAs in accordance with the terms of contracts

entered into pursuant to this section.