Current through Register Vol. 46, No. 39, September 25, 2024
(a) The office or the commissioner's designee
shall receive all applications for authorization to access residential treatment
facility services.
(1) The office or the
commissioner's designee shall review applications for authorization to access
residential treatment facility services for completeness in accordance with
standards and procedures established by office or commissioner's designee within
seven business days of receipt of the application.
(b) Prior to a residential treatment facility
admission, and as frequently as the office or commissioner's designee deems
necessary, the office or commissioner's designee shall evaluate each complete
application for authorization by a child or youth applicant or recipient of medical
assistance, pursuant to Social Services Law title 11, article 5, to determine their
eligibility for accessing residential treatment facilities. The eligibility review
to determine whether such child or youth meets the eligibility criteria shall be
conducted in accordance with this Part and as specified in standards and procedures
established by the office or commissioner's designee.
(1) The eligibility reviews shall include an
assessment of educational needs. When an assessment of a child or youth's
educational needs is required and is not available from a committee on special
education, the office or commissioner's designee shall request such assessment from
the appropriate committee on special education, in accordance with Education Law
section 4003.5. For the purposes of this Part, the appropriate committee on special
education shall be the committee on special education of the school district of
residence at the time of the application for eligibility.
(c) Upon completion of the eligibility review, the
office or the commissioner's designee shall notify the child or youth, child or
youth's legally authorized representative, the referral source, and Local Government
Unit in writing that:
(1) the child or youth meets
the eligibility criteria and has authorization to access residential treatment
facility services; or
(2) the
application requires additional documentation in order to make a determination
regarding eligibility for authorization to access residential treatment facility
services. Such notice shall include the timeframe in which the additional
information must be submitted for consideration to the office or commissioner's
designee. Additional time to submit documentation may be requested in writing to the
office or commissioner's designee, by the child or youth's legally authorized
representative, for a period not to exceed an additional 30 calendar days from the
date on the notification. Such extension, if approved, will be confirmed by the
office or commissioner's designee in writing. If additional information is not
submitted in the requested timeframe or extended time frame, the office or
commissioner's designee shall consider the application incomplete and issue an
administrative denial; or
(3) the child
or youth does not meet eligibility criteria and is not authorized to access
residential treatment facility services.
(i) The
office or commissioner's designee shall provide the child or youth, child or youth's
legally authorized representative, the referral source, and Local Government Unit
with a notice detailing the right to request a reconsideration of the denial within
30 days of the notice date.
(ii) If a
request for reconsideration is received within 30 days of the notice date, the
office or commissioner's designee shall complete a reconsideration of eligibility
review.
(iii) After the reconsideration
review is completed, the office or the commissioner's designee shall notify the
child or youth, child or youth's legally authorized representative, the referral
source, and Local Government Unit in writing that:
(a) the child or youth meets the eligibility
criteria and is authorized to access residential treatment facility services;
or
(b) the application requires
additional documentation in order to make a determination regarding eligibility for
authorization to access residential treatment facility services. Such notice shall
include the timeframe in which the additional information must be submitted for
consideration to the office or commissioner's designee. If additional information is
not submitted in the requested timeframe the office or commissioner's designee shall
consider the application incomplete and issue an administrative denial; or
(c) the child or youth does not meet eligibility
criteria and is not authorized to access residential treatment facility services.
(1) The office or commissioner's designee shall
inform the child or youth and the child or youth's legally authorized representative
of the right to request a Medicaid fair hearing within 60 days of the
notice.
(2) Such fair hearings shall be
adjudicated in accordance with 18 NYCRR 3582.30 and 18 NYCRR 358-5, and any
procedures used by the entity conducting the hearing.
(d) Where a child
or youth receives an authorization to access residential treatment facility services
and the child or youth has not been admitted to a residential treatment facility, or
the authorization was subsequently suspended, the office or commissioner's designee
shall conduct additional reviews to reconfirm eligibility in accordance with
standards and procedures established by the office. If a child or youth is found
eligible, the office or commissioner's designee shall issue an authorization and
send the authorized application to the residential treatment facilities that would
best be able to serve the child or youth's needs based upon the facility's admission
criteria.
(1) To conduct a reconfirmation of
eligibility review, the office or the commissioner's designee shall request a
written update of the child or youth's status in a form, substance and timeframe to
be established by the office or commissioner's designee. If a written update is not
provided as required by the office or commissioner's designee, the application shall
be considered incomplete and an administrative denial shall be issued.
(2) The office or commissioner's designee shall
base its reconfirmation of eligibility on a review of the documentation
provided.
(3) Notification of
eligibility will be completed in accordance with subdivision (c) of this section (e)
Where the office or commissioner's designee has authorized a child or youth for
access to residential treatment facility services and the child or youth is expected
to be temporarily unavailable for admission, the child or youth's authorization
shall be suspended for a period of time as determined by the office. To end the
suspension of an authorization, the office or commissioner's designee shall conduct
a review to reconfirm eligibility in accordance with this subdivision (d) of this
section.
