NY Pub Health L § 4416 (2021)
2021 New York Laws PBH - Public Health Article 44 - Health Maintenance Organizations 4416 - Excess Reserves of Certain Health Maintenance Organizations.

* § 4416. Excess reserves of certain health maintenance organizations.   1.  The  commissioner  is authorized to require any comprehensive health   services plan issued a special purpose certificate  of  authority  under   section  forty-four  hundred three-a of this article, that satisfies the   definition of corporation in  subparagraph  five  of  paragraph  (a)  of   section  one  hundred  two  of  the not-for-profit corporation law or is   exempt from taxation under section 501 of the Internal Revenue  Code  of   1986   to   submit  all  financial  and  other  books  and  records  the   commissioner deems necessary in  order  to  evaluate  an  organization's   reserves.  The  commissioner, in consultation with the superintendent of   the department of financial  services,  shall  examine  such  books  and   records   and   shall   issue   a   report  on  the  health  maintenance   organization's reserves. A request under this section  may  be  made  no   more than two times per year per plan.2.  Except  for  any  public  benefit corporation, the commissioner is   authorized to promulgate regulations establishing a presumptive  reserve   ceiling  for  any  comprehensive  health  services plan issued a special   purpose  certificate  of  authority  under  section  forty-four  hundred   three-a  of this article that satisfies the definition of corporation in   subparagraph five of paragraph (a) of section one  hundred  two  of  the   not-for-profit  corporation  law  or  that is exempt from taxation under   section 501 of the Internal Revenue Code of 1986. Such regulations shall   express the presumptive reserve ceiling as a percentage of  the  minimum   contingent reserves applicable to such health maintenance organizations.   The  presumptive reserve ceiling shall be no less than one hundred fifty   percent of the minimum contingent reserves applicable to such plans.  In   the  event  that the commissioner determines that a plan subject to this   subdivision has reserves in excess of the  presumptive  reserve  ceiling   for  two  consecutive  quarters, the commissioner may make a preliminary   determination that all or a portion of such reserves in  excess  of  the   ceiling  should  be redeployed by depositing such excess reserves in the   health care transformation fund pursuant to subdivision  three  of  this   section.  Prior  to making a preliminary determination, the commissioner   shall consider whether such redeployment is  consistent  with  financial   soundness  and  efficiency  and to the extent to which such reserves are   being maintained consistent with the programmatic goals  of  the  state.   Upon  making  such  a  preliminary  determination,  the department shall   notify the plan and the plan shall be afforded an opportunity to  submit   information  to the department to justify why such reserves in excess of   the ceiling are necessary and should  not  be  so  redeployed.  Provided   however,  under no circumstances shall the redeployment of such reserves   for any plan exceed seven hundred and fifty million dollars annually.3. If, after considering the information submitted by  the  plan,  the   commissioner  adheres to the preliminary determination that the reserves   in excess of the ceiling should be redeployed,  the  commissioner  shall   direct that such reserves be deposited to the health care transformation   fund  established pursuant to section ninety-two-hh of the state finance   law or its successor to be used for investment in the transformation  of   health  care delivery, including for capital investment, debt retirement   or restructuring, housing and other social determinants  of  health,  or   transitional  operating  support to health care providers, pursuant to a   plan prepared by the commissioner and approved by the  director  of  the   division of the budget.4.  Notwithstanding any law to the contrary, on or after August first,   two thousand eighteen no entity  subject  to  subdivision  two  of  this   section  shall transfer or loan any funds to any subsidiary or member of   the entity's holding company system or to a member or stockholder  where    a  purpose  of  the transfer or loan is to avoid the application of this   section.* NB Repealed August 1, 2023