N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 521-3.2

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

Section 521-3.2 - Definitions

(a) For purposes of this SubPart, the terms defined in Parts 504 and 515 of this Title, and SubPart 521-1 of this Part, except as otherwise noted in this SubPart, shall apply.

(b) In addition, for the purposes of this SubPart, the following terms have the following meanings:

(1) "Managed long term care plan" means an entity that has received a certificate of authority pursuant to section 4403-f of the Public Health Law to provide or arrange for health and long term care services on a capitated basis for a population which the plan is authorized to enroll.

(2) "MMCO" means:

(i) a managed care provider as defined in in subdivision 1 of section 364-j of the Social Services Law; and

(ii) a managed long term care plan.

(3) "Overpayment" has the same meaning as used in subdivision (c) of section 518.1 of this Title.

(4) "Person" means:

(i) a provider as defined in section 504.1 of this Title;

(ii) an MMCO, and any subcontractors or network providers of an MMCO; and

(iii) does not include MA program recipients.

(5) "Self-Disclosure and Compliance Agreement" or "SDCA" means the stipulation of settlement between OMIG and a person who agrees to repay the MA program the amount of the overpayment and interest in accordance with the provisions of section 518.4 of this Title through installment payments and/or agrees to implement corrective action to prevent recurrence of the conduct giving rise to the overpayment.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 521-3.2

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