NY Pub Health L § 4410 (2021)
2021 New York Laws PBH - Public Health Article 44 - Health Maintenance Organizations 4410 - Health Maintenance Organizations; Professional Services.

§  4410.  Health  maintenance organizations; professional services. 1. The provision of comprehensive health services directly  or  indirectly, by  a  health  maintenance organization through its comprehensive health services plan shall not be considered the practice of the profession  of medicine by such organization or plan. However, each member, employee or agent  of such organization or plan shall be fully and personally liable and  accountable  for  any  negligent  or  wrongful  act  or  misconduct committed  by him or any person under his direct supervision and control while rendering professional services on behalf of such organization  or plan.   2.  Unless  the  patient waives the right of confidentiality, a health maintenance organization or its comprehensive health services plan shall not be allowed to disclose any information which was  acquired  by  such organization  or  plan  in  the  course of the rendering to a patient of professional services by  a  person  authorized  to  practice  medicine, registered   professional   nursing,   licensed  practical  nursing,  or dentistry, and which was necessary to acquire to enable such  person  to act  in  that  capacity,  except  as may be otherwise required by law. A non-participating provider shall provide an enrollee's organization with such patient information as is reasonably required by  the  organization to  administer  its  plan.  In  making  such disclosure a provider shall comply with the provisions of subdivision six  of  section  eighteen  of this  chapter  concerning the disclosure of patient information to third parties provided, however, that with respect to a  protected  individual as  defined in subdivision six of section twenty-seven hundred eighty of this chapter, disclosure shall be made only pursuant  to  an  enrollee's written  authorization  and  shall  otherwise  be  consistent  with  the requirements of such  section  and  rules  and  regulations  promulgated pursuant thereto.   3.  Notwithstanding  the provisions of this section, the provisions of section four hundred twenty-two of the social services law  shall  apply to  any  information  or  reports  submitted  by  a  health  maintenance organization to the  statewide  central  register  of  child  abuse  and maltreatment reports.   4.  (a) The commissioner shall have access to patient-specific medical information,  including  encounter  data,   maintained   by   a   health maintenance  organization  or  other  organization certified pursuant to this article for  the  purposes  of  quality  assurance  and  oversight, subject  to  any  other  limitations  of federal and state law regarding disclosure thereof to third parties and subject  to  the  provisions  of this subdivision. The provisions of sections thirty-one hundred one, and forty-five hundred four, forty-five hundred seven and forty-five hundred eight  of  the  civil  practice law and rules, subdivision three of this section and section 33.13 of the  mental  hygiene  law,  shall  not  bar disclosure  by  the  health maintenance organization to the commissioner for such purposes.  (b) The commissioner may only obtain enrollee information  subject  to the   establishment   of   protocols   that   will   ensure   that  such patient-specific information is not disclosed  to  third  parties  other than  to  entities  serving  as  agents of the state for the purposes of quality assurance and oversight. Such protocols shall  be  developed  in consultation  with  representatives of health maintenance organizations, health care provider organizations and consumer organizations and shall, where  possible,  include  the  development  of  a  unique  confidential identifier  to  be  used in connection with patient-specific data. These protocols shall address issues relating to the collection,  maintenance, and  disclosure  of  such  patient-specific  information. Such protocols shall be promulgated as regulations, provided however, that protocols or  regulations in use prior to the effective date of this subdivision shall remain  in  effect  until  the  regulations  developed   hereunder   are promulgated.  (c)  In  addition to any other sanction or penalty as provided by law, any employee of the department who willfully violates this regulation or any other rule or procedure pertaining to the disclosure of any material collected pursuant to this subdivision shall be deemed to have committed an act of misconduct and shall be disciplined  in  accordance  with  the provisions of the civil service law.