N.Y. Comp. Codes R. & Regs. tit. 14 § 583.6

Current through Register Vol. 46, No. 43, October 23, 2024

Section 583.6 - Responsibilities of the Office or Commissioner's designee

(a) The office or the commissioner's designee shall receive all applications for authorization to access residential treatment facility services.

(1) The office or the commissioner's designee shall review applications for authorization to access residential treatment facility services for completeness in accordance with standards and procedures established by office or commissioner's designee within seven business days of receipt of the application.

(b) Prior to a residential treatment facility admission, and as frequently as the office or commissioner's designee deems necessary, the office or commissioner's designee shall evaluate each complete application for authorization by a child or youth applicant or recipient of medical assistance, pursuant to Social Services Law title 11, article 5, to determine their eligibility for accessing residential treatment facilities. The eligibility review to determine whether such child or youth meets the eligibility criteria shall be conducted in accordance with this Part and as specified in standards and procedures established by the office or commissioner's designee.

(1) The eligibility reviews shall include an assessment of educational needs. When an assessment of a child or youth's educational needs is required and is not available from a committee on special education, the office or commissioner's designee shall request such assessment from the appropriate committee on special education, in accordance with Education Law section 4003.5. For the purposes of this Part, the appropriate committee on special education shall be the committee on special education of the school district of residence at the time of the application for eligibility.

(c) Upon completion of the eligibility review, the office or the commissioner's designee shall notify the child or youth, child or youth's legally authorized representative, the referral source, and Local Government Unit in writing that:

(1) the child or youth meets the eligibility criteria and has authorization to access residential treatment facility services; or

(2) the application requires additional documentation in order to make a determination regarding eligibility for authorization to access residential treatment facility services. Such notice shall include the timeframe in which the additional information must be submitted for consideration to the office or commissioner's designee. Additional time to submit documentation may be requested in writing to the office or commissioner's designee, by the child or youth's legally authorized representative, for a period not to exceed an additional 30 calendar days from the date on the notification. Such extension, if approved, will be confirmed by the office or commissioner's designee in writing. If additional information is not submitted in the requested timeframe or extended time frame, the office or commissioner's designee shall consider the application incomplete and issue an administrative denial; or

(3) the child or youth does not meet eligibility criteria and is not authorized to access residential treatment facility services.

(i) The office or commissioner's designee shall provide the child or youth, child or youth's legally authorized representative, the referral source, and Local Government Unit with a notice detailing the right to request a reconsideration of the denial within 30 days of the notice date.

(ii) If a request for reconsideration is received within 30 days of the notice date, the office or commissioner's designee shall complete a reconsideration of eligibility review.

(iii) After the reconsideration review is completed, the office or the commissioner's designee shall notify the child or youth, child or youth's legally authorized representative, the referral source, and Local Government Unit in writing that:

(a) the child or youth meets the eligibility criteria and is authorized to access residential treatment facility services; or

(b) the application requires additional documentation in order to make a determination regarding eligibility for authorization to access residential treatment facility services. Such notice shall include the timeframe in which the additional information must be submitted for consideration to the office or commissioner's designee. If additional information is not submitted in the requested timeframe the office or commissioner's designee shall consider the application incomplete and issue an administrative denial; or

(c) the child or youth does not meet eligibility criteria and is not authorized to access residential treatment facility services.

(1) The office or commissioner's designee shall inform the child or youth and the child or youth's legally authorized representative of the right to request a Medicaid fair hearing within 60 days of the notice.

(2) Such fair hearings shall be adjudicated in accordance with 18 NYCRR 3582.30 and 18 NYCRR 358-5, and any procedures used by the entity conducting the hearing.

(d) Where a child or youth receives an authorization to access residential treatment facility services and the child or youth has not been admitted to a residential treatment facility, or the authorization was subsequently suspended, the office or commissioner's designee shall conduct additional reviews to reconfirm eligibility in accordance with standards and procedures established by the office. If a child or youth is found eligible, the office or commissioner's designee shall issue an authorization and send the authorized application to the residential treatment facilities that would best be able to serve the child or youth's needs based upon the facility's admission criteria.

(1) To conduct a reconfirmation of eligibility review, the office or the commissioner's designee shall request a written update of the child or youth's status in a form, substance and timeframe to be established by the office or commissioner's designee. If a written update is not provided as required by the office or commissioner's designee, the application shall be considered incomplete and an administrative denial shall be issued.

(2) The office or commissioner's designee shall base its reconfirmation of eligibility on a review of the documentation provided.

(3) Notification of eligibility will be completed in accordance with subdivision (c) of this section (e) Where the office or commissioner's designee has authorized a child or youth for access to residential treatment facility services and the child or youth is expected to be temporarily unavailable for admission, the child or youth's authorization shall be suspended for a period of time as determined by the office. To end the suspension of an authorization, the office or commissioner's designee shall conduct a review to reconfirm eligibility in accordance with this subdivision (d) of this section.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 583.6

Amended New York State Register July 3, 2024/Volume XLVI, Issue 27, eff. 7/3/2024