N.Y. Social Services Law § 366-e: Certified home health agency medicare billing

§ 366-e. Certified home health agency medicare billing. (a) Certified

home health agencies shall bill under title XVIII of the federal social

security act for services provided to all patients eligible for such

program who, as defined by federal law and regulations, are: (i)

homebound; (ii) receiving skilled services; and (iii) are receiving such

services on an intermittent basis. The department, in consultation with

the department of health and representatives of certified home health

agencies with demonstrated ability to maximize medicare revenue, may

promulgate regulations to implement this subdivision. Nothing contained

herein shall be construed to prohibit agencies from billing for medical

assistance reimbursement for eligible services provided to such patients

which are not covered under title XVIII of the federal social security

act meeting the standards established by the department pursuant to this

section. Patient cases that meet the criteria established pursuant to

this subdivision, where coverage has been denied under title XVIII of

the federal social security act for the cost of care provided by a

certified home health agency shall be referred by such agency to an

organization pursuant to subdivision (b) of this section.

(b) The commissioner shall enter into agreements with persons or

entities to provide for representation of persons meeting the criteria

specified in subdivision (a) of this section who have been denied

reimbursement, under title XVIII of the federal social security act, for

services provided by a certified home health agency.