N.Y. Comp. Codes R. & Regs. Tit. 10 § 85.42 - Catastrophic health care expense program
(a) The Expanded Health Care Coverage Act of
1988 (chapter 703 of the Laws of 1988) establishes, under the jurisdiction of
the New York State Department of Social Services, the Catastrophic Health Care
Expense Program (CHCEP). The Department of Social Services will permit
authorized counties to make available assistance with cost sharing to eligible
county individuals and families for the purpose of assisting such individuals
and families with catastrophic health care expenses. The CHCEP program requires
participants eligible for cost sharing to receive such assistance in accordance
with a schedule that sets forth the cost sharing shares between the participant
and the program.
(b) The following
schedule entitled "Cost Sharing Proportional Schedule" shall be used by the New
York State Department of Social Services in determining a beneficiary's fiscal
responsibility for catastrophic health care expenses covered under the CHCEP
assistance with cost sharing program:
Cost Sharing Proportional Schedule
Category of Service | Recipient Cost Share Responsibility |
Hospital Emergency Room | 75 percent |
Selected Optional Services | 50 percent |
Podiatry | |
Clinical Psychology | |
Optometry/Eye Care Services | |
Transportation | |
Inpatient Hospitalization | 30 percent |
Physician, Dental & Clinic Services, | 25 percent |
Health Maintenance Organization, Home Health Care | |
(freestanding and hospital-based) including ordered diagnostic and treatment services: | |
Pharmacy | |
Durable Medical Equipment | |
Laboratory | |
Radiology | |
Referred Ambulatory | |
Audiology (Hearing Aid) | |
Ambulatory Surgery and Outpatient Surgery | 15 percent |
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(a) The Expanded Health Care Coverage Act of 1988 (chapter 703 of the Laws of 1988) establishes, under the jurisdiction of the New York State Department of Social Services, the Catastrophic Health Care Expense Program (CHCEP). The Department of Social Services will permit authorized counties to make available assistance with cost sharing to eligible county individuals and families for the purpose of assisting such individuals and families with catastrophic health care expenses. The CHCEP program requires participants eligible for cost sharing to receive such assistance in accordance with a schedule that sets forth the cost sharing shares between the participant and the program.
(b) The following schedule entitled "Cost Sharing Proportional Schedule" shall be used by the New York State Department of Social Services in determining a beneficiary's fiscal responsibility for catastrophic health care expenses covered under the CHCEP assistance with cost sharing program:
Cost Sharing Proportional Schedule
Category of Service | Recipient Cost Share Responsibility |
Hospital Emergency Room | 75 percent |
Selected Optional Services | 50 percent |
Podiatry | |
Clinical Psychology | |
Optometry/Eye Care Services | |
Transportation | |
Inpatient Hospitalization | 30 percent |
Physician, Dental & Clinic Services, | 25 percent |
Health Maintenance Organization, Home Health Care | |
(freestanding and hospital-based) including ordered diagnostic and treatment services: | |
Pharmacy | |
Durable Medical Equipment | |
Laboratory | |
Radiology | |
Referred Ambulatory | |
Audiology (Hearing Aid) | |
Ambulatory Surgery and Outpatient Surgery | 15 percent |