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 635-12.7 - Obligations of individuals receiving or requesting services and liable parties-preexisting services

(1) Individuals receiving preexisting services and other liable parties shall, by the payment start date, provide information upon the provider's request regarding 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 the information required in paragraph (1) of this subdivision and throughout the period that preexisting services are received, the individual and other liable parties shall notify the provider of 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) Prior to the payment start date, each individual receiving preexisting services must:

(4) In addition, if an individual not already enrolled in the HCBS waiver is receiving preexisting services that are offered through the HCBS waiver, the individual must take all necessary steps to enroll in the HCBS waiver by the payment start date and must take all necessary steps to maintain enrollment in the HCBS waiver.

(5) Unless the fee is waived by the provider, if the individual does not obtain full Medicaid coverage by the payment start date, or if the individual loses full Medicaid coverage on or after the payment start date, the individual and/or liable parties must either:

(6) For Medicaid service coordination; day treatment services; the following HCBS waiver services: at home residential habilitation services, prevocational services, supported employment services, respite services; and blended and comprehensive services: If a notice from the Medicaid district has been received prior to March 15, 2010, which states that the individual is losing full Medicaid coverage on or after March 15, 2010, the individual or other party receiving the notice shall notify the provider about such notice by March 22, 2010.

(7) On or after the preexisting compliance date, 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.