N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.13

Current through Register Vol. 46, No. 51, December 18, 2024

Section 86-8.13 - Out-of-state providers

(a) Rates for services specified in section 86-8.1(a) of this Subpart provided in outpatient facilities located outside New York state shall be as follows:

(1) rates in effect for similar services for providers located in the downstate region of New York State shall apply with regard to services provided by out-of-state providers located in the New Jersey Counties of Sussex, Passaic, Bergen, Hudson, Essex, Union, Middlesex and Monmouth, in the Pennsylvania County of Pike, and in the Connecticut Counties of Fairfield and Litchfield; and

(2) rates in effect for similar services for providers located in the upstate region of New York State shall apply with regard to all other out-of-state providers.

(b) Notwithstanding any inconsistent provision of this section, in the event the department determines that an out-of-state provider is providing services which are not available within New York State, the department may negotiate payment rates and conditions with such a provider. Prior approval by the department shall be required with regard to services provided by such providers.

(c) For the purposes of this section, the downstate region of New York State shall consist of the New York Counties of Bronx, New York, Kings, Queens, Richmond, Nassau, Suffolk, Westchester, Rockland, orange, Putnam and Dutchess, and the upstate region of New York State shall consist of all other New York counties.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.13