N.Y. Comp. Codes R. & Regs. Tit. 10 § 85.37 - Time limits within which determinations shall be made
(a) All decisions on requests for prior
approval must be made and all required notices shall be sent by the New York
State Department of Health to the requesting provider and, where required, to
the medical assistance patient-recipient, within 21 calendar days of receipt of
such requests by the New York State Department of Health; except that in cases
where prior approval requests for dental care are received in area offices
outside the five boroughs of New York City and a clinic examination is
necessary, the required notices above shall be transmitted within 30 calendar
days of receipt of such requests by the respective upstate area
office.
(b) In the event prior
approval requests must be returned to the requesting provider for submission of
additional information, the calendar day limit in subdivision (a) of this
section will be tolled from the day the request is returned to the provider
until the day the request plus additional information is returned to the New
York State Department of Health.
(c) In the event the prior approval request
and the requested additional information from the provider is received on a
Thursday or Friday which occurs after the 19th calendar day referenced in
subdivision (b) of this section, two additional working days may be added to
the 21-calendar day limit specified in subdivision (a) of this
section.
(d) If a determination is
not made and transmitted in accordance with provisions in subdivisions (a)-(c)
of this section, the New York State Department of Health shall, within two
working days from the expiration of the time limits set forth in subdivisions
(a)-(c) of this section, notify the requesting provider and patient-recipient
of such fact and of the patient's-recipient's right to request a fair hearing
to determine whether the prior approval request should be approved.
Notes
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