Part 69 Family Health

Whenever a newborn is born outside of a hospital, the birth attendant shall be responsible for the collection of a satisfactory specimen and shall ensure compliance with the following procedures: (a) The birth attendant shall inform the parent(s) of each newborn, of the purpose a…

The responsible provider shall obtain initial screening results within 14 days of birth and shall ensure compliance with the following procedures: (a) When notified by the testing laboratory that a repeat specimen is required, the responsible provider shall notify the parent(s) w…

Public health officers shall ensure collection of a satisfactory specimen when directed by the testing laboratory and shall ensure compliance with the following procedures: (a) The public health officer shall inform the newborn's parent(s) of the purpose and need for newborn scre…

The specialty care center director shall be responsible for submitting to the testing laboratory, within the time frame for each condition as directed by the testing laboratory, the diagnostic evaluation, test results and treatment plan for each newborn referred to the specialty …

The testing laboratory may: (a) request case follow-up information from hospitals, birth attendants, responsible providers and specialty care centers; (b) record diagnoses and case follow-up information; (c) maintain tracking records on identified cases; and (d) provide education…

The testing requirements of this Subpart shall not apply if the chief executive officer of a hospital providing care to the newborn or the newborn’s birth attendant determines that the newborn’s parent(s) hold genuine and sincere religious beliefs contrary to the testing required…

As used in this Subpart: (a) Activities of daily living mean basic self-care tasks such as dressing and undressing, self-feeding, bowel and bladder management, ambulation with or without the use of an assistive device, communication, functional transfers from one place to another…

(a) A request for AT, as defined in section 69-10.1 of this Subpart, will be considered to include a request for AT services, which is assistance provided to the enrollee in the selection, acquisition, and use of the appropriate AT device and necessary training of the enrollee, t…

(a) A request for private duty nursing in the hospital or in the home must be accompanied by a physician's written order and treatment plan. (b) In a hospital setting, the physician's order must state that the enrollee is in need of individual and continuous care beyond that avai…

(a) Requests for prior approval for transportation for medical care and services may be made by the enrollee or a person authorized to act on the enrollee's behalf. Such a request may be made for a one-time appointment or for multiple appointments during a specific period of time…

A request for prior approval of treatment with a specialty drug must be accompanied by a written statement from the enrollee’s treating physician stating why treatment with the specialty drug is necessary, what other alternatives have been tried or explored, and what testing the …

(a) A request for prior approval for experimental treatment must be accompanied by a letter from the treating physician explaining why the enrollee needs the experimental treatment being requested and documentation that either no standard treatment has been effective in treating …

(a) An expedited prior approval determination will be made within two business days of receiving a prior approval request of a physician on the physician's letterhead that states that the enrollee has an emergency need for a service or item that requires prior approval and the re…

(a) A request for review of a denial of a claim or of a prior approval request shall be made by completing and submitting a review request form provided by the fund administrator for denial of a claim or a prior approval request no later than 30 days from receipt of the denial. T…

(a) An expedited review will be provided upon an enrollee showing that: (1) he or she submitted a written statement from a physician, physician assistant, or nurse practitioner on the practitioner’s letterhead or on the letterhead of the supervising or collaborating physician, if…

(a) A request for review of a claim or prior approval request denial will be considered to have been withdrawn under the following circumstances: (1) the fund administrator has received a written statement from the enrollee or the enrollee's authorized representative stating that…

(a) Following the annual deposit set forth in section 2999-i(5) of the Public Health Law, and quarterly thereafter, the superintendent shall conduct an actuarial calculation of the estimated liabilities of the fund for the year following such annual deposit, resulting from qualif…

(a) An application for enrollment into the fund may be submitted by: (1) a qualified plaintiff; (2) a person who is authorized to act on a qualified plaintiff's behalf; or (3) a defendant in a medical malpractice claim or action that results in a court-approved settlement or judg…

(a) When the fund's current liabilities equal or exceed 80 percent of the fund's assets, as determined by the actuarial calculation performed under section 69-10.19 of this Subpart, the fund administrator shall suspend enrollment in the fund and new enrollments will no longer be …

(a) Physicians shall be paid at the 80th percentile of the usual and customary charges for services provided in private physician practices, as reported by FAIR Health, Inc. in its Usual, Customary and Reasonable (URC) database at the time of billing. Payment of these charges sha…

(a) Eligibility for or continued enrollment in the fund is not dependent on the current or past residency of a qualified plaintiff or enrollee. (b) The fund administrator shall advise enrollees to notify the fund administrator of any changes in address within 10 business days fro…

Duties of the claims assistance manager shall include, but not be limited to, the following: (a) answering questions regarding the information and documentation needed for completion of the application process; (b) handling any issues raised about alleged delays by the fund admin…

(a) Case management means functions, including but not limited to: (1) conducting an initial assessment and periodic reassessments of the enrollee's medical needs; (2) evaluating the enrollee's strengths, informal support system and environmental factors relevant to his/her care;…

(a) All providers providing services to an enrollee must accept assignment of payment from the fund. (b) The claims submission process will include both electronic and manual options for submission of claims. (c) The unique enrollee identifier must be included in the designated a…

Assistive technology, vehicle modifications, environmental modifications, myo-electric limbs, certain types of transportation for medical care and services (including travel involving overnight accommodations), private duty nursing, treatment with a specialty drug, experimental t…

(a) An emod may be approved only when made to the enrollee’s primary residence, except that if physical custody is being shared pursuant to a court order, an emod may also be approved pursuant to this section when made to the primary residence of the enrollee’s non-custodial pare…

(a) An emod may be conditionally approved for a prospective primary residence of an enrollee, including new construction, provided payment is conditioned upon the following: (1) the fund administrator approves the Emods to be made to the specified property in accordance with the …

(a) A vehicle modification request may only be made for a vehicle owned by the enrollee or a member of the enrollee's household who has consistent and ongoing contact with the enrollee and provides unpaid primary, long-term support to the enrollee. Proof of ownership of the vehic…

As used in this Part: (a) Assisted reproductive technology service or ART service means a medical procedure intended to result in a pregnancy, including, but not limited to, in vitro fertilization (including intracytoplasmic sperm injection), embryo transfer and gamete intrafallo…

A licensee may invalidate any license by delivering it to the department, in the form and manner prescribed by the department, but such delivery does not affect any civil or criminal liability or the authority to enforce this Subpart for acts committed in violation thereof. (b) A…

(a) An assisted reproduction service provider is prohibited from performing any medical procedures for a gestational surrogacy agreement unless such assisted reproduction service provider is registered with the department. In order to register with the department as an assisted r…

(a) The assisted reproduction service providers shall develop and maintain policies to avoid conflicts of interest while facilitating, arranging, and engaging in the services contemplated in a surrogacy agreement. (b) The assisted reproduction service provider’s conflict of inter…

All assisted reproduction service providers shall adhere to all applicable tissue bank regulations set forth in Part 52 of this Title, including but not limited to the informed consent requirements therein.

(a) Assisted reproduction service providers shall develop policies and procedures relating to the selection and evaluation of prospective ova donors as set forth in Part 52 of this Title. (b) Such policies and procedures must adhere to the department’s guidelines and best practic…

(a) Any assisted reproduction service provider that performs ova donor evaluation and selection shall enroll in the department’s ova donation registry, the central tracking registry of ova donors in New York State who have voluntarily agreed to participate in such registry. (b) U…

(a) In order to operate a surrogacy program in New York State, a person or entity must be duly and currently licensed by the department. As a condition for licensure, each owner shall submit to the department, on a form and in a manner prescribed by the department: (1) proof of t…

(a) The surrogacy program shall provide, as a condition of licensure, business and owner information to the department such as: (1) the business name, each business address, tax ID number, and date of incorporation if applicable; (2) the true full legal name, date of birth, drive…

(a) Surrogacy programs shall, as a condition of licensure, develop and maintain policies to avoid conflicts of interest while facilitating, arranging, and engaging in the services contemplated in a surrogacy agreement. (b) The surrogacy program’s conflict of interest policy shall…

(a) Surrogacy programs shall obtain written informed consent from all prospective parties to the surrogacy agreement prior to entering into such agreement and shall develop and implement an informed consent form. The informed consent form shall be written in plain language and av…

(a) Each surrogacy program shall, as a condition of licensure, ensure that all assisted reproduction service providers who work with surrogacy programs are registered with the department in accordance with this Subpart. (b) Policies and procedures for screening of gestational sur…

(a) At such time as the surrogacy program obtains a license, the surrogacy program shall, as a condition of licensure, enroll in the department’s surrogacy registry, the central tracking registry of surrogates in New York State who have voluntarily agreed to participate in such r…

Any agency, business, person or entity that is required to be licensed as a surrogacy program under this Subpart shall apply and must be approved for licensure pursuant to this section prior to commencing operations.

Upon the filing of an initial application for a license pursuant to this Subpart, the owner shall pay an application fee to the department in the amount of $1,000. Surrogacy program licensees shall renew their license annually by submitting the information required to be submitte…

(a) Responsible physician means the physician or other licensed health care provider named on the specimen collection form, the infant's primary health care provider, if different, or the hospital staff physician as designated by the chief executive officer and identified to the …

Every responsible physician or birth attendant shall acquire from all infants born, whether alive or dead after 22 weeks gestation, a sample of blood from the umbilical cord and submit it to an approved laboratory for standard serological tests for syphilis. If body blood from th…

The chief executive officer shall ensure that: (a) a satisfactory specimen is submitted to an approved laboratory for each infant born in the responsible institution; (b) specimens shall be taken from the cord immediately after birth, or if a specimen is taken from the mother, th…