Department Responsibility for Standards for Medical Assistance Payments to Providers and Quality Reporting of Providers – N.Y. Soc. Serv. Law § 364

Department Responsibility for Standards for Medical Assistance Payments to Providers and Quality Reporting of Providers

This section falls under Title 11—Medical Assistance for Needy Persons—in the New York Social Services Act, and splits the responsibility of maintaining the standards of the medical assistance program primarily between the Department of Social Services and the Department of Health. 

This section requires that the Department of Health:

1.    Establish and maintain standards for all hospitals providing medical care and services under this medical assistance program

2.    Establish and maintain standards for all non-institutional health care providers providing services under this medical assistance program

3.    Receive and approve local social service medical plans under this program

4.    Establish a uniform system for reporting quality of care

5.    Review the quality and availability of care

6.    Provide assistance to health care and service providers in qualifying for payments under NY and federal social security law

7.    Establish standards for deciding who qualifies for medical assistance under this program

8.    Make policy and regulations to establish a system of appeals on decisions related to eligibility for medical assistance through the program

This section requires that the Department of Social Security:

1.    Determine who is eligible for care under this program based upon the standards established by the Department of Health (as mentioned above)

2.    Audit payments to providers of care and services under this program

3.    Collaborate with department of health to publish and disseminate information about this program so that the public is aware of services available to them

The section further requires that all offices in the Department of Mental Hygiene ensure that standards of care and services are maintained at all institutions operated/supervised by them.

The section tasks the public health and health planning council with establishing the qualifications required for persons employed by social service districts as professional directors for this medical assistance program.