N.Y. Comp. Codes R. & Regs. tit. 10 § 85.42
Current through Register Vol. 46, No. 50, December 11, 2024
Section 85.42 - Catastrophic health care expense program(a) The Expanded Health Care Coverage Act of 1988 (chapter 703 of the Laws of 1988) establishes, under the jurisdiction of the New York State Department of Social Services, the Catastrophic Health Care Expense Program (CHCEP). The Department of Social Services will permit authorized counties to make available assistance with cost sharing to eligible county individuals and families for the purpose of assisting such individuals and families with catastrophic health care expenses. The CHCEP program requires participants eligible for cost sharing to receive such assistance in accordance with a schedule that sets forth the cost sharing shares between the participant and the program.(b) The following schedule entitled "Cost Sharing Proportional Schedule" shall be used by the New York State Department of Social Services in determining a beneficiary's fiscal responsibility for catastrophic health care expenses covered under the CHCEP assistance with cost sharing program: Cost Sharing Proportional Schedule
| Category of Service | Recipient Cost Share Responsibility |
| Hospital Emergency Room | 75 percent |
| Selected Optional Services | 50 percent |
| Podiatry |
| Clinical Psychology |
| Optometry/Eye Care Services |
| Transportation |
| Inpatient Hospitalization | 30 percent |
| Physician, Dental & Clinic Services, | 25 percent |
| Health Maintenance Organization, Home Health Care |
| (freestanding and hospital-based) including ordered diagnostic and treatment services: |
| Pharmacy |
| Durable Medical Equipment |
| Laboratory |
| Radiology |
| Referred Ambulatory |
| Audiology (Hearing Aid) |
| Ambulatory Surgery and Outpatient Surgery | 15 percent |
N.Y. Comp. Codes R. & Regs. Tit. 10 § 85.42