N.Y. Social Services Law § 364: Responsibility for standards

§ 364. Responsibility for standards. To assure that the medical care

and services rendered pursuant to this title are of the highest quality

and are available to all who are in need, the responsibility for

establishing and maintaining standards for medical care and eligibility

shall be as follows:

1. The department of social services shall be responsible for

(a) determining eligibility for care and services pursuant to this

title and consistent with standards established by the commissioner of

the department of health and, as authorized by such commissioner, for

hearing appeals and making findings and recommendations relating

thereto;

(b) auditing payments to providers of care, services and supplies

under the medical assistance program; and

(c) publishing and distributing to the public, from time to time and

in consultation with the department of health, information relating to

the medical assistance program, to promote maximum public awareness of

the availability of, and the procedure for obtaining, such assistance.

2. The department of health shall be responsible for

(a) establishing and maintaining standards for all hospital and

related services pursuant to article twenty-eight of the public health

law, and for all medical care and services furnished in an institution

operated by the department of health pursuant to other provisions of the

public health law;

(b) establishing and maintaining standards for all non-institutional

health care and services rendered pursuant to this title, including but

not limited to procedural standards relating to the revocation,

suspension, limitation or annulment of qualification for participation

as a provider of care and services, on a determination that the provider

is an incompetent provider of specific services or has exhibited a

course of conduct which is either inconsistent with program standards

and regulations or which exhibits an unwillingness to meet such

standards and regulations, or is a potential threat to the public health

or safety pursuant to section two hundred six of the public health law;

(c) reviewing and approving local social services medical plans;

(d) establishing by regulation requirements for a uniform system of

reports relating to the quality of medical care and services furnished

pursuant to this title;

(e) reviewing the quality and availability of medical care and

services furnished under local social services medical plans, to assure

that the quality of medical care and services is in the best interest of

the recipients;

(f) providing consultative services to hospitals, nursing homes, home

health agencies, clinics, laboratories, and such other institutions as

the secretary of the federal department of health and human services may

specify in order to assist them: to qualify for payments under the

provisions of this title and title XIX of the federal social security

act; in providing information needed to determine such payments; in

establishing and maintaining such fiscal records as may be necessary for

the proper and efficient administration of medical assistance;

(g) establishing standards of eligibility for medical assistance,

consistent with the provisions of this title; and

(h) making policy, rules and regulations for maintaining a system of

hearings for applicants and recipients of medical assistance adversely

affected by the actions of the department or social service districts

and for making final administrative determinations and issuing final

decisions concerning such matters.

3. Each office within the department of mental hygiene shall be

responsible for establishing and maintaining standards for medical care

and services received in institutions operated by it or subject to its

supervision pursuant to the mental hygiene law.

4. The public health and health planning council shall be responsible

for establishing and maintaining qualifications for persons employed by

social services districts as professional directors.