N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-6.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 360-6.3 - Free choice by recipient guaranteed

(a) Once authorized, MA recipients are entitled to obtain MA care and services from any provider enrolled in the MA program who is both qualified and agrees to provide the care and services. Exceptions to this provision are found in section 360-6.4 of this Subpart.

(b)

(1) A social services district must offer to persons eligible for MA the option of membership in any health maintenance organization or other entity which offers comprehensive health services plans to persons residing within the district. This option must be provided unless the district is granted a waiver by the commissioner on the grounds that the organization or entity is not geographically accessible to eligible recipients who reside within the district, the capitation rate is above the expected average fee-for-service cost within the district, or the entity refuses to enter into a contract with the district.

(2) Persons who, prior to becoming eligible for MA, are enrolled in a health maintenance organization or other entity offering a comprehensive health services plan must be offered the option of continuing that enrollment.

(c) A social services district must offer to eligible recipients the option of membership in the voluntary medical care coordinator program provided for in section 360-6.8 of this Part. This option must be provided unless a participating provider is not reasonably accessible to eligible recipients who reside within the district.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-6.3