N.Y. Social Services Law § 364 (2026)

§ 364. Responsibility for standards. To assure that the medical care
and services rendered pursuant to this title are of the highest quality
and are available to all who are in need, the responsibility for
establishing and maintaining standards for medical care and eligibility
shall be as follows:
  1. The department of social services shall be responsible for
  (a) determining eligibility for care and services pursuant to this
title and consistent with standards established by the commissioner of
the department of health and, as authorized by such commissioner, for
hearing appeals and making findings and recommendations relating
thereto;
  (b) auditing payments to providers of care, services and supplies
under the medical assistance program; and
  (c) publishing and distributing to the public, from time to time and
in consultation with the department of health, information relating to
the medical assistance program, to promote maximum public awareness of
the availability of, and the procedure for obtaining, such assistance.
  2. The department of health shall be responsible for
  (a) establishing and maintaining standards for all hospital and
related services pursuant to article twenty-eight of the public health
law, and for all medical care and services furnished in an institution
operated by the department of health pursuant to other provisions of the
public health law;
  (b) establishing and maintaining standards for all non-institutional
health care and services rendered pursuant to this title, including but
not limited to procedural standards relating to the revocation,
suspension, limitation or annulment of qualification for participation
as a provider of care and services, on a determination that the provider
is an incompetent provider of specific services or has exhibited a
course of conduct which is either inconsistent with program standards
and regulations or which exhibits an unwillingness to meet such
standards and regulations, or is a potential threat to the public health
or safety pursuant to section two hundred six of the public health law;
  (c) reviewing and approving local social services medical plans;
  (d) establishing by regulation requirements for a uniform system of
reports relating to the quality of medical care and services furnished
pursuant to this title;
  (e) reviewing the quality and availability of medical care and
services furnished under local social services medical plans, to assure
that the quality of medical care and services is in the best interest of
the recipients;
  (f) providing consultative services to hospitals, nursing homes, home
health agencies, clinics, laboratories, and such other institutions as
the secretary of the federal department of health and human services may
specify in order to assist them: to qualify for payments under the
provisions of this title and title XIX of the federal social security
act; in providing information needed to determine such payments; in
establishing and maintaining such fiscal records as may be necessary for
the proper and efficient administration of medical assistance;
  (g) establishing standards of eligibility for medical assistance,
consistent with the provisions of this title; and
  (h) making policy, rules and regulations for maintaining a system of
hearings for applicants and recipients of medical assistance adversely
affected by the actions of the department or social service districts
and for making final administrative determinations and issuing final
decisions concerning such matters.
  3. Each office within the department of mental hygiene shall be
responsible for establishing and maintaining standards for medical care
and services received in institutions operated by it or subject to its
supervision pursuant to the mental hygiene law.
  4. The public health and health planning council shall be responsible
for establishing and maintaining qualifications for persons employed by
social services districts as professional directors.