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This entry was published on 2020-04-17
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Authorization to enroll and provide medical assistance
Public Health (PBH) CHAPTER 45, ARTICLE 36
§ 3605-c. Authorization to enroll and provide medical assistance. 1. A
licensed home care services agency (LHCSA) shall not enroll as a
provider in the medical assistance program operated pursuant to title
eleven of article five of the social services law or provide or claim
for services pursuant thereto, whether provided under the state plan, a
waiver thereto or through a managed care organization, without being
authorized to do so by contract with the department entered into
pursuant to this section. Authorization under this section shall not
substitute for or duplicate the requirements of licensure under this
article or the screening and enrollment process required for
participation in the medical assistance program.

2. Notwithstanding any inconsistent provision of section one hundred
sixty-three of the state finance law, or sections one hundred forty-two
and one hundred forty-three of the economic development law, the
commissioner shall enter into a sufficient number of contracts with
LHCSAs to ensure medical assistance recipients have access to care and
services, provided, however, that:

(a) the department shall post on its website for a period of no less
than thirty days:

(i) a description of the proposed services to be provided pursuant to
the contract or contracts;

(ii) the criteria for selection of LHCSA contractors, including but
not limited to: licensure under this article, the ability to
appropriately serve medical assistance recipients as determined by the
commissioner, a geographic distribution of LHCSAs to ensure access
statewide including in rural and underserved areas, demonstrated
cultural and language competencies specific to the population of
recipients and those of the available workforce, ability to provide
timely assistance to recipients, experience serving individuals with
disabilities, efficient and economic administration of LHCSA services,
and demonstrated compliance with all applicable federal and state laws
and regulations including, but not limited to, past compliance with
labor law and existing wage and labor standards, and compliance with
equal employment opportunity requirements and anti-discrimination laws;

(iii) the period of time during which a prospective contractor may
seek selection, which shall be no less than thirty days after such
information is first posted on the website; and

(iv) the manner by which a prospective contractor may submit a
proposal for selection, which may include submission by electronic

(b) the commissioner shall review in a timely fashion all reasonable
and responsive submissions that are received from prospective

(c) the commissioner shall select such contractors that, in the
commissioner's discretion, are best suited to efficiently and
economically administer medical assistance services;

(d) all decisions made and approaches taken pursuant to this section
shall be documented in a procurement record as defined in section one
hundred sixty-three of the state finance law;

(e) the commissioner may institute a continuous recruitment process
provided that the information required under paragraph (a) of this
subdivision remains on the department's website for the entire duration
of the recruitment process, until such date as the commissioner may
determine upon no less than ten days notice being posted on the website;

(f) the commissioner may reoffer contracts under the same terms of
this subdivision, if determined necessary by the commissioner, on a
statewide or regional basis.

3. (a) The department may terminate a LHCSA's contract under this
section or suspend or limit the LHCSA's rights and privileges under the
contract upon thirty day's written notice to the LHCSA if the
commissioner finds that the LHCSA has failed to comply with the
provisions of this section or any regulations promulgated hereunder. The
written notice shall include:

(i) a description of the conduct and the issues related thereto that
have been identified as failure of compliance; and

(ii) the time frame of the conduct that fails compliance.

(b) Notwithstanding paragraph (a) of this subdivision, upon
determining that a medical assistance recipient's health or safety would
be imminently endangered by the continued operation or actions of the
LHCSA, the commissioner may terminate the LHCSA's contract or suspend or
limit the LHCSA's rights and privileges under the contract immediately
upon written notice.

(c) All orders or determinations under this subdivision shall be
subject to review as provided in article seventy-eight of the civil
practice law and rules.

(d) Any procedural rights or privileges afforded pursuant to this
subdivision shall apply only to actions taken under this subdivision
with respect to compliance with the terms of the contract. Actions taken
under this subdivision shall not constitute and shall not be construed
to constitute an action with respect to a LHCSA's licensure or
enrollment in the medical assistance program, which the department may
undertake separately or in conjunction with an action pursuant to this

4. The provisions of this section shall not apply unless any and all
necessary approvals under federal law and regulation have been obtained
to receive federal financial participation in the costs of services that
would be provided by LHCSAs in accordance with the terms of contracts
entered into pursuant to this section.