New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 1 - General
Part 500 - General Provisions
Section 500.1 - Introduction

(a) Medical care which may be provided under the medical assistance program, as authorized by title 11 of article five of the Social Services Law, consists of the care, services and supplies enumerated therein, together with any other care, services or supplies authorized to be provided by these regulations and furnished in accordance with these regulations, sound medical practice and the rules and regulations of the state board or body supervising the respective professions.

(b) The department will limit the amount, duration and scope of medical assistance authorized to be provided under the Social Services Law and this Title to medical care, services and supplies which are medically necessary and appropriate, consistent with quality care and generally accepted professional standards.

(c) The department will employ methods and procedures to deter unnecessary utilization of medical care, services and supplies reimbursed under the medical assistance program including, but not limited to, requiring prior authorization or prior approval of medical care, services and supplies and the use of utilization controls, recipient restrictions, utilization thresholds, and service limits.

(d) The department will employ such methods and procedures as are necessary to ensure the proper and efficient operation and administration of the medical assistance program and the delivery of medically necessary and appropriate care, services and supplies to medical assistance recipients.