Statutes, codes, and regulations
New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICESChapter II - Regulations of the Department of Social ServicesSubchapter E - Medical CareArticle 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 513 - Prior Approval Of Medical, Dental And Remedial Care
Section 513.5 - Obligations and responsibilities of the Department of Health

N.Y. Comp. Codes R. & Regs. tit. 18 § 513.5

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Current through Register Vol. 46, No. 45, November 2, 2024
Section 513.5 - Obligations and responsibilities of the Department of Health
(a) The Department of Health must assist the recipient in obtaining information and documentation in support of his or her request from: providers who have treated the recipient; social services district records; and other sources, including any information in the recipient's case file or medical history, information from public or private social welfare agencies, nonmedical sources, other practitioners and observations by Department of Health and social services district personnel.
(b) The Department of Health may require a clinical examination of the recipient by an independent practitioner under contract with or designated by the Department of Health to obtain more detailed medical information, or technical or specialized information about the recipient or the necessity of the care, service or supplies to prevent, diagnose, correct or cure a condition in the recipient; or to resolve conflicts or differences in medical or other information, or assessments of the recipient's condition or needs.
(c) Since the ordering practitioner is the preferred sources of information, the Department of Health must make all reasonable efforts to obtain needed information from the ordering practitioner before evaluating information obtained from other sources or requesting a clinical examination. If the information provided by the ordering practitioner is incomplete, the Department of Health must attempt to secure additional information, interpretations or explanations from the ordering practitioner, the treating practitioner and the potential provider before requesting a clinical examination.
(d) The Department of Health must give the recipient reasonable prior notice of any required clinical examination, the date, time and place of the examination, and the name and title of the person who will conduct the examination.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 513.5