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 521 - Fraud, Waste and Abuse Prevention
Subpart 521-2 - MEDICAID MANAGED CARE FRAUD, WASTE AND ABUSE PREVENTION
Section 521-2.1 - Scope and applicability

(a) Scope. Social Services Law requires managed care providers, including managed long term care plans, to adopt and implement programs designed to detect and prevent fraud, waste and abuse in the MA program. This SubPart sets forth the standards for managed care fraud, waste and abuse prevention programs pursuant to subdivision 39 of section 364-j of the Social Services Law.

(b) Applicability. This SubPart applies to managed care providers and includes managed care long term care plans, which shall hereinafter be collectively, unless otherwise noted, referred to as "Medicaid managed care organizations" or "MMCO."

(c) Related regulations. Section 98-1.21 of Title 10 and section 86.6 of Title 11 set forth requirements related to the establishment and operation, for certain managed care plans, of fraud and abuse prevention plans and programs. MMCOs subject to those sections shall continue to comply with such requirements, provided that, as it pertains to the MMCO's participation in the MA program, the requirements of this SubPart are met. To the extent that any requirements of this SubPart conflict with or are greater than the requirements of those sections, the requirements of this SubPart shall apply to the MMCO.