N.Y. Comp. Codes R. & Regs. tit. 14 § 580.11

Current through Register Vol. 46, No. 51, December 18, 2024

Section 580.11 - Managed Care Organizations

The facility shall cooperate with managed care organizations. Such cooperation shall include, but not be limited to:

(a) notifying the appropriate managed care organization of an admission for a behavioral health condition for which coverage is provided by Medicaid, Child Health Plus, Essential Plan, or any other government-sponsored or private coverage to an individual who is not also enrolled in the Medicare program or for individuals enrolled in the Medicare program, to an MCO providing services under title XVIII of the federal Social Security Act. Such notification shall be provided within two business days of such admission. When coverage cannot be determined at the time of admission, notification shall be provided as soon as practicably possible after confirmation of coverage;

(b) cooperating with utilization review activities;

(c) ensuring that the discharge plan for such an individual includes consideration of physical health needs and services;

(d) notifying such managed care organization within 24 hours of the discharge of such an individual or, for a discharge occurring on a Friday, Saturday, Sunday or public holiday, by 5:00 p.m. on the next business day following such discharge;

(e) receiving and providing physical and mental health information, pursuant to section 33.13(d) of the Mental Hygiene Law; and

(f) seeking to obtain, such individual's consent to receive and provide information regarding substance use disorder treatment as may be required pursuant to federal law.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 580.11

Amended New York State Register December 18, 2024/Volume XLVI, Issue 51, eff. 12/18/2024