New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIV - Office for People With Developmental Disabilities
Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities
Subpart 635-12 - Liability for Services
Section 635-12.6 - Obligations of individuals receiving or requesting services and liable parties - services other than Preexisting services
Universal Citation: 14 NY Comp Codes Rules and Regs § 635-12.6
Current through Register Vol. 47, No. 12, March 26, 2025
(a) This section applies only to services which are not preexisting services.
(b) Responsibility for provision of information.
(1) Prior to the receipt
of services, and upon request of the provider, individuals requesting or
receiving services, and other liable parties, shall provide personal and
financial information as may be reasonably required to identify liable parties
and to ascertain the individual's and any other liable parties' ability to pay
for services or the individual's ability to obtain and maintain full Medicaid
coverage.
(2) Subsequent to the
provision of information required in paragraph (1) of this subdivision and
throughout the period that services are received, the individual and other
liable parties shall notify the provider about any changes in liable parties,
any changes in the individual's Medicaid coverage and any changes that may
affect the individual's eligibility for full Medicaid coverage and/or the
individual's and other liable parties' ability to pay for services. If the
individual or any other party receives a notice from the Medicaid district that
the individual is losing full Medicaid coverage, the individual or party must
inform the provider within five days of receipt of the notice.
(3) Each individual requesting or receiving
services must:
(i) present evidence of and
maintain full Medicaid coverage; or
(ii) take all necessary steps to obtain and
maintain full Medicaid coverage; or
(iii) disclose to the provider such
information as may be reasonably required to obtain and maintain full Medicaid
coverage, and allow the provider to assist the individual to take all necessary
steps to obtain and maintain full Medicaid coverage or apply on the
individual's behalf; or
(iv) agree
to pay for the services in accordance with the applicable fee schedule in
section 635-12.9 of this Subpart. Liable
parties may agree in lieu of the individual; or
(v) agree to pay for the services in
accordance with the reduced fee established by the provider and acknowledge
that any reduction of the fee shall not constitute nor be construed as a
release of the individual or any liable party from liability for payment of the
full fee. Other liable parties may agree and acknowledge same in lieu of the
individual; or
(vi) acknowledge
that the fee has been waived by the provider and that any waiver of the fee
shall not constitute nor be construed as a release of the individual or any
liable party from liability for payment of the full fee. Other liable parties
may acknowledge same in lieu of the individual.
(4) In addition, if HCBS waiver services are
requested, the individual must take all necessary steps to enroll in the HCBS
waiver and take all necessary steps to maintain enrollment in the HCBS
waiver.
(5) Unless the individual
has full Medicaid coverage or the fee is waived by the provider, the individual
and/or liable parties must either:
(i) pay for
the services in accordance with the applicable fee schedule in section
635-12.9 of this Subpart;
or
(ii) pay for the services with
the reduced fees established by the provider.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
