Section 360-11.9 Managed special care provider qualifications and standards.
(a) To be eligible to participate as a managed special care provider, a
provider must possess all necessary approvals from the RSCA as provided by law, including
but not limited to:
(1) approval by OMH and the local mental
hygiene director as a provider of mental health services; or
(2) approval by OMRDD, or other entity if
designated by OMRDD, and the local mental hygiene director as a provider of developmental
disabilities services; or
(3) approval by OASAS, or other entity if
designated by OASAS, and the local mental hygiene director as a provider of alcoholism
services or substance abuse services pursuant to 14 NYCRR 300, 800 or 1000.
(b) A provider eligible to participate as a managed special care
provider must:
(1) possess sufficient resources to assure
delivery of quality special care to participants in an appropriate and timely manner;
(2) satisfy the requirements of subdivisions
(g) through (i) of section 360-10.4 of this Title concerning the furnishing of special
care;
(3) be enrolled as a provider in the MA
program;
(4) inform the participant's managed care
provider of the special care provided to the participant; and
(5) make available an adequate grievance
procedure for participants in accordance with the managed care plan, as provided for in
subdivision (i) of section 360-10.8 of this Title.