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 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 513 - Prior Approval Of Medical, Dental And Remedial Care
Section 513.3 - Obligations end responsibilities of recipients

Current through Register Vol. 46, No. 12, March 20, 2024

(a) The recipient is responsible for establishing that the medical, dental and remedial care, services or supplies are medically necessary to prevent, diagnose, correct or cure a medical condition and that any specific statutory or regulatory requirements for prior approval of the care, services or supplies are met.

(b) The recipient is responsible for providing all information, appropriate to the request, that the Department of Health reasonably requires to evaluate a request, including detailed health information and information concerning his or her education, training and employment, activities of daily life, and current living arrangements.

(c) The recipient must cooperate with the Department of Health in obtaining information necessary to evaluate a request. If the Department of Health determines that available information is not sufficient to enable it to make an informed determination, the recipient must submit to a clinical examination by an independent practitioner under contract with the Department of Health or by a practitioner employed or designated by the Department of Health.

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