N.Y. Comp. Codes R. & Regs. tit. 10 § 708.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 708.3 - Procedures

(a) Any person or entity subject to review under this Part shall, at the request of the commissioner, submit data relating to criteria developed for review in a manner and format specified by the commissioner to effectuate his review. Any such person or entity shall, in response to such request, furnish any information or documentation as is required to effectuate the review by the commissioner within 30 days of such request.

(b) The commissioner shall provide to the applicable health systems agency that information which he has collected and which is relevant to the review and the preparation of a recommendation with regard to the appropriateness of the hospital service or home care service being reviewed.

(c) The commissioner shall establish procedures to be followed by health systems agencies for transmittal of recommendations to the commissioner.

(d) The commissioner shall commence his review by providing written notice to affected persons of the beginning of such review.

(e) No review by the commissioner shall, to the extent practicable, take longer than 180 days from the date of notification of the beginning of a review to the date of the commissioner's proposed finding. The commissioner shall not make a proposed finding until the health systems agency has had 180 days to make a recommendation to the commissioner.

(f) During the course of his review, the commissioner shall provide an opportunity for affected persons to present their views about the service under review in a public hearing.

(g) The commissioner shall, upon the written request of persons or entities subject to appropriateness review, make available information relative to such review to such persons or entities.

(h) The commissioner shall prepare an analysis of the service being reviewed, and shall forward the health systems agency recommendation, together with his analysis and recommendation, to the State Hospital Review and Planning Council. The State Hospital Review and Planning Council shall review the commissioner's analysis and recommendation and the health systems agency recommendation regarding the appropriateness of the service being reviewed, and, in accordance with the criteria established pursuant to this Part, make a recommendation to the commissioner with regard to the appropriateness of the service. Where the State Hospital Review and Planning Council recommends that the commissioner make a finding that a service is not appropriate, such a recommendation shall include a recommendation for remedial action.

(i) After consideration of the recommendations made by a health systems agency and by the State Hospital Review and Planning Council, the commissioner shall, in accordance with the procedures and criteria set forth in this Part, make a written finding as to the appropriateness of the service reviewed, subject to the provisions of subdivisions (j), (k) and (l) of this section, and make such finding public.

(j) The commissioner shall afford to any affected person, for good cause shown, within 30 days of making his proposed finding, a public hearing respecting such proposed finding. For purposes of this section, "good cause" shall require such person to establish that a public hearing is required for:

(1) presentation of significant, relevant information not previously considered by the commissioner; or

(2) demonstration that there have been significant changes in factors or circumstances relied upon by the commissioner in reaching his decision. "Good cause" shall not be deemed to be established where information or documentation was previously available and could reasonably have been submitted to the commissioner.

(k) Where the commissioner proposes to make an institution-specific finding that a service is not appropriate, the commissioner shall provide written notification of such proposed finding, by certified or registered mail, to the person or entity whose service is being reviewed. Within 30 days of receipt of such written notification, such person or entity may file a notice of appeal with the commissioner by registered or certified mail.

Such notice shall set forth the reasons for disagreement with the proposed finding. The appeal shall be reviewed by the appropriateness review administrative review board, which shall make a recommendation to the commissioner based upon the data and information previously submitted and on any written arguments submitted with such notice of appeal. The appropriateness review administrative review board shall consist of such members as designated by the commissioner. At least one of these members shall be a member of the State Hospital Review and Planning Council. The commissioner shall make his finding upon consideration of the recommendation of the appropriateness review administrative review board.

(l) Where the commissioner proposes to make an appropriateness review finding which is inconsistent with a recommendation made by the respective health systems agency, he shall provide written notification of his proposed decision to such health systems agency and provide an opportunity for administrative review, in accordance with the provisions of subdivision (k) of this section, prior to making his finding.

(m) Written findings shall be based on an areawide review and shall address the appropriateness of the service over the health service area or the entire State. Where a health systems agency recommendation in regard to a particular service is institution-specific, the commissioner shall also make an institution-specific finding. Where a health systems agency recommendation is not institution-specific, the commissioner shall, where practicable, make an institution-specific finding. Where the health systems agency has made an areawide recommendation and the commissioner proposes to make an institution-specific finding, the commissioner shall request the health systems agency to provide, within 60 days, an institution-specific recommendation or a written statement of the reasons for not making an institution-specific recommendation.

(n) Where the commissioner makes a written finding that a service is not appropriate, such a finding shall be accompanied by a statement that the service does not meet one or more of the criteria for appropriateness established pursuant to this Part which shall address the ways in which the service failed to meet the criteria. In addition, such a finding shall, to the extent practicable, be accompanied by a written recommendation for remedial action.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 708.3