Section 360-11.7 Review process for a managed care plan in an MCP that includes special
care furnished on more than an incidental basis.
(a) The special care provisions of a managed care plan which includes
the provision of special care to participants in MCPs who require special care furnished
on more than an incidental basis must be submitted to the department by the social
services district in accordance with section 360-10.7 of this Title.
(b) Such special care provisions of a managed care plan must be
approved by the commissioner, in accordance with section 360-10.7 of this Title, and the
RSCA.
(c) Upon submission of special care provisions by the social services
district to the commissioner, the department will forward such special care provisions to
the RSCA for review. The RSCA must inform the department of its approval or disapproval of
such special care provisions within 60 days after receiving the provisions for review.
(d) After being informed of the results of the RSCA's review, the
department must notify the social services district of the approval or disapproval of the
special care provisions of its managed care plan and whether an amendment to the special
care provisions must be submitted by the district.
(e) The social services district must submit an amendment to such
special care provisions within 90 days after receipt of written disapproval of the
provisions from the department.
(f) The RSCA must inform the department of its approval or disapproval
of the amendment to the special care provisions within 30 days after receiving such
amendment for review.
(g) After being informed of the result of the RSCA's review, the
department must notify the social services district of the approval or disapproval of the
amendment to the special care provisions. The department's notification to the social
services district must be made within 60 days after receipt of the required amendment from
the district.
(h) The RSCA, in reviewing the special care provisions, or an amendment
to the special care provisions, may approve only a part of such provisions or amendment,
while disapproving the remainder, if the approved part is capable of being implemented by
the social services district and managed special care providers and would further the
objectives of the MCP.