Prior authorization by a local social services official for care in an NF or ICF/MR is required pursuant to Part 504 of this Title. In no case can prior authorization exceed the maximum eligibility period permitted by regulations of the Department of Social Services. Failure by an NF or ICF/MR to comply with the requirements of this subdivision may result in retroactive denial of authorization by the local social services official. In addition, if the Commissioner of Health, or his or her designee, determines that a recipient received a level of care that was not medically necessary, authorization will be retroactively rescinded.
The maximum reimbursable rate for payments made for nursing facility care provided in a nursing facility located in the State of New York will be at the rate approved by the Director of the Budget.
Consistent with the regulations of the Department of Health (10 NYCRR Part 414), on and after January 1, 1990, residential health care facilities must use nurse aides who meet the following standards:
The department will pay residential health care facilities for the training and competency evaluation of nurse aides as administrative costs under the medical assistance program. Payment will be limited to the actual costs which residential health care facilities incur, up to a maximum payment established by the department. The department will consult with the Department of Health when developing the maximum payment permitted under this subdivision.
A residential health care facility must submit a voucher to the department detailing its actual expenditures for the training and competency evaluation of nurse aides not less than 30 days after the end of each calendar quarter. Each such voucher must include:
Region | Counties in Region | Regional Caps |
Albany | Albany, Columbia, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Fulton | $ 450 |
Binghamton | Broome, Tioga | $ 450 |
Erie | Cattaraugus, Chautauqua, Erie, Niagara, Orleans | $ 475 |
Elmira | Chemung, Steuben, Schuyler | $ 558 |
Glens Falls | Essex, Warren, Washington | $ 450 |
Long Island | Nassau, Suffolk | $ 483 |
Orange | Chenango, Delaware, Orange, Otsego, Sullivan, Ulster | $ 567 |
New York City | Bronx, Kings, Queens, Richmond, New York | $ 450 |
Poughkeepsie | Dutchess, Putnam | $450 |
Rochester | Livingston, Monroe, Ontario, Wayne | $589 |
Central Rural | Cayuga, Cortland, Seneca, Tompkins, Yates | $ 450 |
Syracuse | Madison, Onondaga | $ 501 |
Utica | Herkimer, Jefferson, Lewis, Oneida, Oswego | $ 450 |
Westchester | Rockland, Westchester | $ 450 |
Northern Rural | Clinton, Franklin, Hamilton, St. Lawrence | $ 450 |
Western Rural | Allegany, Genesee, Wyoming | $ 450 |
N.Y. Comp. Codes R. & Regs. Tit. 18 § 505.9