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 521-3 - SELF-DISCLOSURE PROGRAM
Section 521-3.2 - Definitions
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 521-3.2
Current through Register Vol. 46, No. 39, September 25, 2024
(a) For purposes of this SubPart, the terms defined in Parts 504 and 515 of this Title, and SubPart 521-1 of this Part, except as otherwise noted in this SubPart, shall apply.
(b) In addition, for the purposes of this SubPart, the following terms have the following meanings:
(1) "Managed long term care
plan" means an entity that has received a certificate of authority
pursuant to section 4403-f of
the Public Health Law to provide or arrange for health and long term care
services on a capitated basis for a population which the plan is authorized to
enroll.
(2) "MMCO"
means:
(i) a managed care provider as defined
in in subdivision 1 of section 364-j of
the Social Services Law; and
(ii) a
managed long term care plan.
(3) "Overpayment" has the
same meaning as used in subdivision (c) of section
518.1 of this Title.
(4) "Person" means:
(i) a provider as defined in section
504.1 of this Title;
(ii) an MMCO, and any subcontractors or
network providers of an MMCO; and
(iii) does not include MA program
recipients.
(5)
"Self-Disclosure and Compliance Agreement" or
"SDCA" means the stipulation of settlement between OMIG and a
person who agrees to repay the MA program the amount of the overpayment and
interest in accordance with the provisions of section
518.4 of this Title through
installment payments and/or agrees to implement corrective action to prevent
recurrence of the conduct giving rise to the overpayment.
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