NY Pub Health L § 4403-A (2021)
2021 New York Laws PBH - Public Health Article 44 - Health Maintenance Organizations 4403-A - Special Purpose Certificate of Authority.

* §   4403-a.   Special  purpose  certificate  of  authority.  1.  The commissioner may issue a special purpose certificate of authority  to  a provider,  applying  on forms prescribed by the commissioner, seeking to offer a comprehensive health services  plan  on  a  prepaid  contractual basis  either  directly, or through an arrangement, agreement or plan or combination thereof to an enrolled population,  which  is  substantially composed  of persons eligible to receive benefits under title XIX of the federal social security act or other public programs.   2. A not-for-profit corporation  established  to  operate  a  hospital pursuant  to  article twenty-eight of this chapter, a government agency, an entity or a group of entities seeking to provide comprehensive health services pursuant to the provisions of this  section  may  apply  for  a special  purpose  certificate  of  authority;  provided, however, that a shared health facility, as defined by article forty-seven of the  public health law, shall not be eligible for such a certificate.   3.  The  commissioner shall not issue a special purpose certificate of authority unless the applicant has demonstrated  to  the  commissioner's satisfaction  that  the requirements of this article and any regulations promulgated pursuant thereto have been met and will continue to be  met, provided,  however,  that the commissioner may waive one or more of such requirements,  or  portions  thereof,  pertaining  to  financial   risk, employer  requirements  and  subscriber  contracts if he determines that such  waiver  will  serve  to  promote  the   efficient   provision   of comprehensive health services and that the proposed plan will provide an appropriate  and  cost-effective  alternative method for the delivery of such services in a manner which will meet the needs of the population to be served.   4. (a) No contract for the provision of comprehensive health  services pursuant  to  this  section  shall  be  entered  into  by a local social services district unless the commissioner certifies that  all  pertinent requirements   with   respect  to  financial  arrangements,  rates,  and standards relating to arrangements for and the delivery of patient  care services   have  been  satisfied  and  that  the  contract  and  related arrangements will ensure access to and the  delivery  of  high  quality, appropriate  medical  services  including  an assurance that recipients' access to preventive health services is not diminished.  (b) No contract for the provision of comprehensive health services  to persons  eligible  for  medical assistance under title eleven of article five of the social services  law  shall  be  entered  into  without  the approval  of  the  commissioner  of  social services pursuant to section three hundred sixty-five-a of the social  services  law  and  the  state director  of  the  budget. The commissioner of social services shall not approve such a contract unless the contract:  (i)  provides  that  enrollment  shall  be  voluntary   and   contains provisions  to  ensure that persons eligible for medical assistance will be provided  sufficient  information  regarding  the  plan  to  make  an informed  and  voluntary  choice whether to enroll or, in the event that enrollment  in  the  entity  is  pursuant  to  section   three   hundred sixty-four-j of the social services law, provides that enrollment in the entity is governed by that section;  (ii)  provides  adequate  safeguards  to  protect persons eligible for medical assistance from being misled concerning the plan and from  being coerced  into  enrolling in the plan or, in the event that enrollment in the entity is undertaken pursuant to section three hundred  sixty-four-j of  the  social  services law, provides that enrollment in the entity is governed by that section;  (iii) establishes adequate opportunities for public review and comment prior to implementation of the plan;  (iv) provides adequate grievance procedures for recipients who  enroll in the plan; and  (v) establishes quality assurance mechanisms.   5.  A  special  purpose certificate of authority shall be issued to an approved  provider  of  comprehensive  health  services  for  a  maximum effective  period  of  twenty-four  months  subject  to  the  applicable provisions of section  forty-four  hundred  four  of  this  article  and provided   that   federal   financial  participation  is  available  for expenditures made on behalf of recipients  of  medical  assistance.  The commissioner  upon application, after consultation with the commissioner of social services, may issue a certificate for an additional period  of up  to  twenty-four  months  if  satisfied  that  the  plan has and will continue to demonstrate satisfactory performance and compliance with all requirements imposed for initial certification.  If  the  plan  provides comprehensive  services  pursuant  to  a  contract solely to individuals eligible for medical assistance under title eleven of  article  five  of the  social  services  law,  the  certificate  shall expire when (a) the medical assistance contract is revoked or expires and is not extended or renewed or (b) federal approval of the medical  assistance  contract  is withdrawn.   6.   All   individuals   eligible  for  medical  assistance  enrolling voluntarily in a comprehensive health services plan offered by an entity with a special purpose certificate of authority  will  be  given  thirty days  from  the  effective  date  of enrollment in the plan to disenroll without  cause.    After  this  thirty  day  disenrollment  period,  all individuals  participating  in the plan will be enrolled for a period of six months, except that all participants will be permitted to  disenroll for  good  cause,  as  defined by the commissioner of social services in regulation.   7. Notwithstanding any inconsistent provision  of  this  section,  the commissioner  shall  issue  special  purpose  certificates  of authority pursuant to this section to no more than eighteen  entities  other  than those  entities initially authorized by chapter seven hundred fifteen of the laws of nineteen hundred eighty-two and by a chapter of the laws  of nineteen  hundred  eighty-four  authorizing  the  Monroe  county medicap demonstration project.   * NB Expires March 31, 2023