2023 New York Laws › ISC - Insurance › Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations › 4307 - Providers of Services.

§ 4307. Providers of services. (a) Any hospital service corporation or
health  service  corporation  may  provide benefits for the rendering of
hospital service to persons covered under its contracts (i) by hospitals
maintained by the  state  or  any  of  its  political  subdivisions,  or
maintained  by  a  corporation organized for hospital purposes under the
not-for-profit  corporation  law,  (ii)   by   such   other   hospitals,
convalescent  institutions and nursing homes as shall have been approved
by the commissioner of health for such purpose, (iii) with such  private
or  public  instrumentalities  providing  home nursing services as shall
have been approved by the  commissioner  of  health  for  such  purpose,
and/or  (iv) subject to the approval of the superintendent, with similar
corporations of other states and hospitals of other  states  subject  to
the supervision of such other states.
* (d)  In  the event a health maintenance organization which is either
licensed as a health  service  corporation  under  this  article  or  is
operating  pursuant  to a certificate of authority granted in accordance
with the provisions of article forty-four of the public health  law,  or
any other health service corporation is deemed insolvent, as provided in
subsection  (c)  of  section  four  thousand  three  hundred ten of this
article, then no individual subscriber or enrollee of, or served by, the
health maintenance organization or health service corporation  shall  be
liable  to any provider of health care services for any covered services
of the insolvent  health  maintenance  organization  or  health  service
corporation.  No  provider of health care services or any representative
of such provider shall collect or attempt to collect from the individual
subscriber or enrollee sums owed by a health maintenance organization or
health  service  corporation  deemed  insolvent,  and  no  provider   or
representative  of  such provider may maintain any action at law against
an individual subscriber or  enrollee  to  collect  sums  owed  to  such
provider  by  such  health  maintenance  organization  or health service
corporation.
* NB Amended by § 112-a and Repealed by § 143 of 639/96
* § 4307. Providers of services. (a) Any hospital service  corporation
or  health service corporation may provide benefits for the rendering of
hospital service to persons covered under its contracts (i) by hospitals
maintained by the  state  or  any  of  its  political  subdivisions,  or
maintained  by  a  corporation organized for hospital purposes under the
not-for-profit  corporation  law,  (ii)   by   such   other   hospitals,
convalescent  institutions and nursing homes as shall have been approved
by the commissioner of health for such purpose, (iii) with such  private
or  public  instrumentalities  providing  home nursing services as shall
have been approved by the  commissioner  of  health  for  such  purpose,
and/or  (iv) subject to the approval of the superintendent, with similar
corporations of other states and hospitals of other  states  subject  to
the supervision of such other states.
(b)  All  rates  of payments to hospitals, nursing homes, convalescent
institutions and instrumentalities providing home nursing services  made
by such corporation pursuant to the contracts provided for in subsection
(a)  hereof  shall  prior  to  payment,  (i) in the case of institutions
subject to article twenty-eight of the public health law,  be  certified
by the commissioner of health pursuant to the provisions of such article
twenty-eight   of   the   public   health   law   and  approved  by  the
superintendent, and, (ii) in the case of other institutions, approved as
to reasonableness by the superintendent.
(c) Notwithstanding subsections (a) and (b) of this section,  approval
by  the  superintendent  shall  not  be required for rates of payment by
article  forty-three  corporations  for  in-patient  hospital   services
provided  after  December thirty-first, nineteen hundred eighty-three by

general hospitals subject to article twenty-eight of the  public  health
law.
(d)  After  approval  by the superintendent each corporation organized
under this article shall notify each hospital and health related service
of its approved rates of payment for out-patient services, in  instances
where such rates are determined on the basis of a cost based formula, at
least thirty days prior to the beginning of each rate year.
* NB  Expired  January  1, 1986. Remains effective prior to such date.
See ch 906/85 § 3