New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIII - Office of Mental Health
Part 593 - Medical Assistance Payments For Community Rehabilitation Services Within Residential Programs For Adults And Children And Adolescents
Section 593.8 - Enforcement of service planning and reimbursement standards

(a) The Office of Mental Health may review any program which receives reimbursement pursuant to this Part to determine whether such program is in compliance with this Part or other requirements established by State or Federal agencies.

(b) A provider of services shall exercise due diligence in complying with the requirements of this Part. Due diligence means the exercise of reasonable and appropriate efforts to ensure that reimbursement is sought only for authorized services and that the service planning and review process is implemented pursuant to section 593.6 of this Part.

(c) To facilitate determinations as to whether providers are exercising the requisite due diligence, the Office of Mental Health may develop and maintain profiles of performance of providers of service which shall permit comparison of providers of service.

(d) If, based on a review of profiles of performance and such additional information as may be available, the Office of Mental Health determines that a provider of service is not exercising due diligence, the Office of Mental Health shall give notice of the deficiency to the provider of service and may also initiate the following:

(e) If the provider of service fails to prepare an acceptable plan of correction within a reasonable time or refuses to permit the Office of Mental Health to provide technical assistance or fails to promptly or effectively implement a plan of correction which has been approved by the Office of Mental Health, it shall be determined that the provider of service is in violation of this Part.

(f) Upon a determination that a provider of service is in violation of this Part or upon a determination that a provider of service has failed to otherwise comply with the terms of its operating certificate or with the provisions of any applicable statute, rule or regulation, the commissioner may revoke, suspend or limit the provider's operating certificate or impose fines in accordance with Mental Hygiene Law section 31.16 and Parts 53 and 503 of this Title.

(g) Notwithstanding the provisions of this section, if a provider of service seeks reimbursement in excess of the limits imposed in section 593.7 of this Part, the provider shall be presumed to have violated the provisions of this Part, whereupon the Office of Mental Health shall notify the Department of Health in order that the Department of Health may exercise its authority to recover such overpayment as may have occurred.

(h) Nothing in this section shall limit or preclude the commissioner from taking whatever immediate measures may be necessary, including the exercise of his authority under Mental Hygiene Law, sections 31.16(b) and 31.28, in the event that a resident's health or safety is in imminent danger or there exists any condition or practice which poses imminent danger to the health or safety of any resident or the public.