New York Codes, Rules and Regulations
Title 9 - EXECUTIVE DEPARTMENT
Subtitle KK - Program for Elderly Pharmaceutical Insurance Coverage
Part 9610 - Application And Determination Of Eligibility
Section 9610.4 - Decision on eligibility
Universal Citation: 9 NY Comp Codes Rules and Regs ยง 9610.4
Current through Register Vol. 46, No. 12, March 20, 2024
(a) Decision on eligibility is the conclusion or determination reached in the application process. Such decision shall constitute the decision of the contractor. The decision shall be one of the following:
(1) Accepted for coverage. This means that
eligibility has been established through review and verification to the
satisfaction of the contractor.
(2)
Not accepted for coverage. Applications are denied when:
(i) in the course of the application process
the information given by the applicant establishes, without the need for
further review and verification, that he/she is ineligible;
(ii) ineligibility is determined in the
course of or upon completion of a review and verification, or if the applicant
refuses to comply with any requirement essential to the determination of
eligibility; or
(iii) the
application is incomplete.
(3) No decision is required when:
(i) an application is withdrawn by the
applicant; or
(ii) the contractor
documents that the applicant has died, cannot be located, or has left the State
prior to the completion of the review and verification.
(b) The applicant shall be notified in writing of the decision in accordance with these regulations.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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