N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-6.6

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

Section 360-6.6 - Where care and services may be provided

Medical care and services under the MA program may be provided to a recipient residing in his/her own home or in an approved medical institution or facility.

(a) A recipient's home may be a home where he/she receives room and board, a family home or boarding home, an approved nonprofit institution for child care, a licensed public child care institution which accommodates no more than 25 children and is not operated primarily for delinquent children or family-type group, or a family-type, family care or residential care facility certified by the department or an office of the State Department of Mental Hygiene.

(b) An approved medical institution or facility includes the following when operated according to the Public Health Law or other applicable law:

(1) a private proprietary or nonprofit nursing home;

(2) the approved infirmary section of a home for the aged;

(3) a public home infirmary or other similar public facility for the chronically ill;

(4) an intermediate care facility;

(5) a facility or part of a facility for the treatment of narcotic addiction which is operated pursuant to the provisions of article 23 of the Mental Hygiene Law, as long as Federal aid is available;

(6) an inpatient alcoholism facility;

(7) an approved hospital, nursing home, or intermediate care facility section of a public institution operated for the care of the mentally disabled;

(8) a State hospital for the mentally disabled operated by the State Department of Mental Hygiene; and

(9) a hospital other than one caring primarily for the mentally disabled.

(c) Medical care and services may be provided to a recipient in a general or chronic disease hospital, regardless of the disease diagnosed.

(d) Medical care and services will be provided to eligible veterans and their dependents in those parts of the New York State Home for Veterans and their Dependents at Oxford which have been approved pursuant to law as either a nursing home or an intermediate care facility. Such recipients will have care and services provided in a hospital while on release from that home for the purpose of receiving care in such hospital.

(e) Medical care and services will be provided to an eligible person receiving inpatient psychiatric services in an institution used primarily for the care of the mentally ill as follows:

(1) For an eligible person under 21 years of age, such care and services must conform to Federal and State standards. A team, consisting of physicians and other qualified personnel, must determine that the care and services are necessary on an inpatient basis and can reasonably be expected to improve the condition being treated so that such care and services will no longer be necessary. If a person attains the age of 21 during the course of hospitalization, such services may continue until he/she reaches the age of 22.

(2) For an eligible person 65 years of age or over, such care and services must conform to Federal and State standards.

(3) Persons receiving inpatient, psychiatric services in an institution primarily for the care of the mentally ill who fall outside the categories in paragraphs (1) and (2) of this subdivision are ineligible for MA.

(f) MA will be provided to an eligible person who enters or leaves a public institution only for the part of the month in which the person is not residing in the institution.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-6.6