N.Y. Social Services Law § 332-b: Disability program

§ 332-b. Disability program. 1. (a) Upon application and

recertification for public assistance benefits, or whenever a district

has reason to believe that a physical or mental impairment may prevent

the individual from fully engaging in work activities, the social

services district shall inquire whether the individual has any medical

condition which would limit the individual's ability to participate in

work activities pursuant to this title.

(b) An individual who is eligible to receive comprehensive health

services through a special needs plan defined in paragraph (m) or (n) of

subdivision one of section three hundred sixty-four-j of this chapter,

regardless of whether such a plan is operating in the individual's

social services district of residence, shall be considered disabled and

unable to engage in work activities or shall be considered work-limited.

2. (a) Under the circumstances set forth in subdivision one of this

section, notice shall be provided to the individual of the opportunity

to provide, within ten calendar days, any relevant medical

documentation, including but not limited to drug prescriptions and

reports of the individual's treating health care practitioner, if any;

such documentation must contain a specific diagnosis as evidenced by

medically appropriate tests or evaluations and must particularize any

work related limitations as a result of any such diagnosis.

(b) If, prior to submitting his or her medical documentation, the

individual is referred to a health care practitioner certified by the

office of disability determinations of the office of temporary and

disability assistance or, if applicable, to the contracted agency or

institution by or with which such health care practitioner is employed

or affiliated for an examination pursuant to subdivision four of this

section, such individual shall make best efforts to bring such

documentation to the examination, and in no case shall provide such

records to the examining health care practitioner certified by the

office of disability determinations or, if applicable, to the contracted

agency or institution by or with which such health care practitioner is

employed or affiliated later than four business days after such

examination; provided that the individual may demonstrate good cause as

defined in regulations, for failure to provide such records within the

specific time periods.

3. The district may in its sole discretion accept such documentation

as sufficient evidence that the individual cannot fully engage in work

activities and in such case shall modify work assignments consistent

with the findings in such medical documents.

4. In instances where the district determines either that the

documentation is insufficient to support an exemption from or limitation

on work activities or that further medical evaluation is appropriate,

the individual shall be referred to a health care practitioner certified

by the Office of Disability Determinations of the Department of Social

Services for an examination of such individual's medical condition.

The health care practitioner who performs the examination of the

individual shall:

(a) review and consider all records or information provided by the

individual or his or her treating health care practitioner that are

pertinent to the claimed medical condition;

(b) make a specific diagnosis as evidenced by medically appropriate

tests or evaluations in determination of the individual's claimed

condition;

(c) render to the individual and the social services district, an

opinion, particularizing the presence or absence of the alleged

condition; and

(d) In the event that he or she identifies a condition, other than the

alleged condition, that may interfere with the individual's ability to

fully engage in work activities, the practitioner shall report such

condition; and

(e) determine whether the individual is:

(i) disabled and unable to engage in work activities pursuant to this

title for a stated period of time, in which case the applicant shall be

exempt in accordance with paragraph (a) of subdivision one of section

three hundred thirty-two of this title;

(ii) for a stated period of time, not disabled, but work limited, and

able to engage in work activities pursuant to this title, with stated

limitations, or

(iii) neither disabled nor work limited.

4-a. If the practitioner to whom the individual is referred pursuant

to subdivision four or paragraph (b) of subdivision two of this section

issues an opinion that differs from the applicant's treating health care

practitioner, the practitioner shall provide a written determination

that specifies why the practitioner disagrees with the applicant's

treating health care practitioner's disability determination and present

evidence that supports the opinion.

5. When an applicant or recipient has requested or a social services

official has directed a determination pursuant to this section, no

assignment to work activities may be made until completion of such

determination, unless the applicant or recipient agrees to a limited

work assignment not inconsistent with the medical condition alleged by

such person.

6. When an applicant or recipient receives notification of the

examining medical professional's disability determination, he or she

shall also be notified of his or her right to request a fair hearing

within ten days of such notice. If such applicant timely requests a fair

hearing, no assignment to work activities pursuant to this title may be

made pending such hearing and determination unless the applicant or

recipient agrees to a limited work assignment not inconsistent with the

medical condition alleged by such person. Provided, however, that if a

social services district has reason to believe that such recipient or

applicant does not actually suffer from a work limiting condition, the

district shall provide the applicant or recipient with notice of

potential sanctions pursuant to subdivision three of section three

hundred forty-two of this title, and provided further that recipients

will be subject to sanctions pursuant to subdivision three of section

three hundred forty-two of this title if the district determines, based

on clear medical evidence, that there is no basis for the individual's

claim that he or she is unable to fully engage in work activities, and

that the individual intentionally misrepresented his or her medical

condition.

7. Any applicant or recipient determined to be work limited pursuant

to this section may be assigned to work activities only in accordance

with the limitations and protections set forth in paragraph (e) of

subdivision five of section three hundred thirty-five-b of this title.