N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 521-1.1

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

Section 521-1.1 - Scope and applicability

(a) Scope. Social Services Law requires certain persons participating in the Medical Assistance (MA) program to adopt and implement programs designed to detect and prevent fraud, waste and abuse in the MA program. Required providers may be able to detect and correct payment and billing mistakes and fraud if required to develop and implement a compliance program. This SubPart sets forth the requirements for establishing and operating effective compliance programs pursuant to section 363-d of the Social Services Law, the obligation to self-disclose overpayments, and the procedures for reviewing compliance programs.

(b) Applicability. The following persons shall be subject to the provisions of this SubPart, and shall hereinafter be referred to as "required providers":

(1) any person subject to the provisions of articles 28 or 36 of the Public Health Law;

(2) any person subject to the provisions of articles 16 and 31 of the Mental Hygiene Law;

(3) any managed care provider or managed long term care plan, which shall hereinafter be collectively, unless otherwise noted, referred to as "Medicaid managed care organization" or "MMCO;" and

(4) any other person for whom the MA program is, or is reasonably expected by the person to be, a substantial portion of their business operations.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 521-1.1

Adopted New York State Register December 28, 2022/Volume XLIV, Issue 52, eff. 12/28/2022