New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter B - Public Assistance
Article 2 - Determination of Eligibility-Categorical
Part 360 - MEDICAL ASSISTANCE
Subpart 360-6 - Entitlement To Medical Assistance
Section 360-6.2 - Authorization for MA

Universal Citation: 18 NY Comp Codes Rules and Regs § 360-6.2

Current through Register Vol. 46, No. 39, September 25, 2024

(a) When a social services district finds an applicant eligible, it will prepare an authorization for MA for the applicant and eligible applying members of the applicant' s household. No initial authorization may be effective for more than one year from the date of application. No reauthorization will be effective for more than one year.

(b) Identification cards.

(1) The department will issue an MA identification card to every MA recipient with the exception of:

(i) persons residing in residential health care facilities licensed pursuant to article 28 of the Public Health Law;

(ii) persons residing in developmental centers operated by the Office of Mental Retardation and Developmental Disabilities;

(iii) persons residing in psychiatric centers operated by the Office of Mental Health;

(iv) persons residing in residential treatment facilities required to have an operating certificate issued by the Commissioner of Mental Health pursuant to section 31.02 (a)(4) of the Mental Hygiene Law; and

(v) foster care children placed with authorized child care agencies, as defined in subdivision 10 of section 371 of the Social Services Law, that are receiving MA per diem payments.

(2) An identification card issued pursuant to paragraph (1) of this subdivision will contain a photo image unless the MA recipient is:

(i) a recipient of benefits under the supplemental security income program;

(ii) a child under the age of 21 living with a caretaker relative, foster parent, or guardian;

(iii) a person who applies at a location authorized by the department other than a social services district office, until the district's next contact with the person or the first time MA eligibility is recertified, whichever is earlier;

(iv) a person who is confined to his or her home due to an illness or injury, including such persons who are receiving personal care, home health care, or long-term home health care services, for the period of such confinement;

(v) a foster child placed with an authorized child care agency, as defined in subdivision 10 of section 371 of the Social Services Law, who is not receiving MA per diem payments;

(vi) a person residing in a facility or institution required to have an operating certificate issued by the Commissioner of Mental Retardation and Developmental Disabilities pursuant to article 16 of the Mental Hygiene Law;

(vii) a person residing in a residential facility, residential care center for adults, or in an institution operated by the Commissioner of Mental Health pursuant to article 31 of the Mental Hygiene Law;

(viii) a person whose MA eligibility is determined by the department pursuant to section 365 of the Social Services Law;

(ix) a person receiving MA services through the Office of Mental Retardation and Developmental Disabilities home and community based services (HCBS) waiver; and

(x) at the option of the social services district, a person who is over 18 years of age but less than 21 years of age and who is not living with a caretaker relative, foster parent, or guardian.

(3) If the authorization for MA is limited to a specific care or service, an MA identification card will not be issued.

(4) A recipient must present the MA identification card or a department approved equivalent to the MA provider before receiving medical services or supplies.

(5) If the authorization for MA is limited because of utilization thresholds or improper use, the MA provider will be informed of the limitations when he/she verifies the recipient's MA eligibility.

(6) The social services district may make provisions for obtaining surrender of the MA identification card when a recipient is no longer eligible for MA.

(c) An initial authorization will be made effective for inpatient and outpatient care and services provided to a recipient during the three-month period preceding the month of application for MA, if the recipient was eligible in the month in which the care and services were provided. An authorization can never be issued for care or services provided prior to this three-month period.

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