reglab/statecodes huggingface dataset:
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4403-B - Development of Comprehensive Health Services Plans.

* §  4403-b.  Development  of comprehensive health services plans. The
  commissioner is authorized, after consultation with the commissioner  of
  social  services,  and  subject  to  the approval of the director of the
  budget, to make grants to diagnostic and treatment centers  and  general
  hospitals operating pursuant to article twenty-eight of this chapter, to
  aid  in  the  planning,  development and implementation of comprehensive
  health services plans.  The  total  amount  expended  pursuant  to  this
  section  shall  not  exceed the amount appropriated for such purposes in
  any fiscal year.
* NB Expires March 31, 2026
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4403-D - Special Needs Managed Care Plans.

§  4403-d.  Special  needs  managed  care  plans.  No person, group of
  persons, county or counties may operate a  special  needs  managed  care
  plan  without  first  obtaining  a  certificate  of  authority  from the
  commissioner, issued jointly with the  commissioner  of  the  office  of
  mental  health  and  the  commissioner  of  the office of alcoholism and
  substance abuse services.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4404 - Health Maintenance Organizations; Continuance of Certificate of Authority.

§  4404.  Health maintenance organizations; continuance of certificate
  of authority. 1.  Continuance by the commissioner of  a  certificate  of
  authority  issued under section forty-four hundred three of this article
  shall be contingent upon satisfactory performance by the organization as
  to the delivery, continuity, accessibility and quality of  the  services
  to  which an enrolled member is entitled, compliance with the provisions
  of this article and rules and regulations  promulgated  thereunder,  and
  the  continuing  fiscal  solvency of the organization as set out in this
  section.
2. Except as provided  in  subdivision  three  of  this  section,  the
  commissioner may revoke, limit or annul a certificate of authority as of
  the  termination  of  the  current  period of all then existing enrollee
  contracts, after a hearing, and only after a finding  of  unsatisfactory
  performance  or  fiscal  insolvency.  However,  in  the  event  of  such
  revocation,  limitation  or  annulment,  the   organization   shall   be
  prohibited  from entering into any new enrollee contracts as of the date
  of notification of such action by the commissioner. Notification of such
  action shall  be  given  by  the  organization  to  each  enrollee.  The
  commissioner   shall   give   prior   notice   of  such  action  to  the
  superintendent.
3. The commissioner may revoke or limit a  certificate  of  authority,
  after  a  hearing, for violations of any applicable statute or rules and
  regulations which threatened to directly affect the  health,  safety  or
  welfare  of any enrollee. Upon notice of his intent to revoke or limit a
  certificate of authority, the commissioner may prohibit the organization
  from entering into any new enrollee contracts pending final  action  and
  may  require notification of such action to be given by the organization
  to each enrollee. The  commissioner  shall  give  prior  notice  to  the
  superintendent  of his intent to prohibit the organization from entering
  into any enrollee contracts. In any action pursuant to this subdivision,
  the commissioner and the superintendent shall take action to assure  the
  continued insurance coverage of enrollees of the organization.
4.  In  addition  to,  or  in  lieu  of, any revocation, limitation or
  annulment, the commissioner may assess a  penalty  pursuant  to  section
  twelve  of  this  chapter for any violation of this chapter or rules and
  regulations promulgated pursuant to this article.
5. All orders or determinations made in accordance with the provisions
  of this section shall be  subject  to  review  as  provided  in  article
  seventy-eight  of the civil practice law and rules. Application for such
  review must be made within sixty days after  service  in  person  or  by
  registered  mail  of  a  copy  of  the  order  or determination upon the
  organization.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4405 - Health Maintenance Organizations; Powers.

§ 4405. Health maintenance organizations; powers. The powers of health
  maintenance  organizations, in addition to any other powers conferred by
  the laws under which such organization is constructed, shall include:
1. subject to the provisions of article twenty-eight of this  chapter,
  the purchase, lease, construction, renovation, operation, or maintenance
  of   hospitals,   medical  facilities,  or  both,  and  their  ancillary
  equipment, and such property as  may  reasonably  be  required  for  its
  principal  office  or for such other purposes as may be necessary in the
  transaction of the business of the organization;
2. the furnishing of comprehensive health care services on  a  prepaid
  basis  through hospitals and other health care providers which are under
  contract with, otherwise associated with,  or  employed  by  the  health
  maintenance organization;
3.  the  marketing,  enrollment  and administration of a comprehensive
  health services plan;
4. the contracting with an insurer licensed in this state;
5. the offering, in addition to  health  care  services,  of  benefits
  covering out-of-area or emergency services;
6.  the  provision  of  additional health services not included in the
  comprehensive health services  plan  on  a  fee-for-service  basis,  the
  provision  of  health services on a fee-for-service basis to persons who
  are not members of the enrolled population;
7. the entering into contracts in furtherance of the purposes of  this
  article;
8.   the   acceptance  from  government  agencies,  private  agencies,
  corporations,  associations,  groups,  individuals,  or  other  persons,
  payments  covering  all  or  part  of  the  cost of health care services
  provided to enrollees, in accordance with the provisions of the plan and
  this chapter; and
9. the indemnification of enrollees for the services  of  health  care
  providers,   other  than  primary  care  practitioners  responsible  for
  supervising and coordinating the care of enrollees, not participating in
  a plan to the extent authorized in section  forty-four  hundred  six  of
  this article; and
10.  notwithstanding  any  other  provision  of  law, to advertise the
  comprehensive health services which it renders and the plan relating  to
  the  rendition of such services, provided, however, that all information
  disseminated to the public shall  be  strictly  factual  in  nature  and
  accurate  in  all respects and shall not in any way be misleading to the
  public.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4405-A - Immunizations Against Poliomyelitis, Mumps, Measles, Diphtheria and Rubella.

§   4405-a.   Immunizations  against  poliomyelitis,  mumps,  measles,
  diphtheria and rubella. 1. It shall be the duty  of  the  administrative
  officer   or   other   person  in  charge  of  each  health  maintenance
  organization, as defined in this article, to inquire of each  person  in
  its  care under the age of eighteen, or of a person in parental relation
  to such person, whether all necessary immunizations have  been  received
  for  poliomyelitis,  mumps, measles, diphtheria and rubella and, if not,
  to make available such immunizations and a certificate  or  certificates
  of such immunizations.
2.  This section shall not apply to children whose parent, parents, or
  guardian are bona fide members of a  recognized  religious  organization
  whose teachings are contrary to the practices herein required.
3.  If  any  physician  licensed  to  practice  medicine in this state
  certifies that any such immunization may be  detrimental  to  a  child's
  health,  the  requirements  of  this section shall be inapplicable until
  such immunization is found no longer to be detrimental  to  the  child's
  health.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4406-B - Primary and Preventive Obstetric and Gynecologic Care.

§  4406-b.  Primary  and preventive obstetric and gynecologic care. 1.
  The health maintenance organization shall not limit a female  enrollee's
  direct  access  to  primary  and  preventive  obstetric  and gynecologic
  services, including annual examinations, care resulting from such annual
  examinations, and treatment of  acute  gynecologic  conditions,  from  a
  qualified  provider  of such services of her choice from within the plan
  or for any  care  related  to  a  pregnancy,  provided  that:  (a)  such
  qualified  provider  discusses such services and treatment plan with the
  enrollee's primary care practitioner in accordance with the requirements
  of the health maintenance organization; and (b) such qualified  provider
  agrees  to  adhere to the health maintenance organization's policies and
  procedures, including any applicable procedures regarding referrals  and
  obtaining  prior  authorization  for  services  other than obstetric and
  gynecologic services rendered by such qualified provider, and agrees  to
  provide  services  pursuant to a treatment plan (if any) approved by the
  health maintenance organization.
2. A health maintenance organization  shall  treat  the  provision  of
  obstetric  and  gynecologic  care, and the ordering of related obstetric
  and gynecologic items  and  services,  pursuant  to  the  direct  access
  described  in  subdivision  one  of  this  section  by  a  participating
  qualified provider of such services, as the authorization of the primary
  care provider.
3. It shall be the duty of the administrative officer or other  person
  in  charge of each health maintenance organization to advise each female
  enrollee, in writing, of the provisions of this section.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4406-F - Maternal Depression Screenings.

§  4406-f.  Maternal  depression  screenings.  To  the  extent  a plan
  provides  coverage  for  maternal  depression   screening,   no   health
  maintenance  organization  subject  to  this  article shall by contract,
  written policy or procedure limit a patient enrollee's direct access  to
  screening   and   referral   for  maternal  depression,  as  defined  in
  subdivision one of section twenty-five hundred-k of this chapter, from a
  provider of obstetrical,  gynecologic,  or  pediatric  services  of  her
  choice;  provided  that  the patient enrollee's access to such services,
  coverage and choice of provider is otherwise subject to  the  terms  and
  conditions of the plan under which the patient enrollee is covered.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4406-G - Telehealth Delivery of Services.

§  4406-g.  Telehealth  delivery  of services. 1. A health maintenance
  organization shall not exclude from coverage a service that is otherwise
  covered under an enrollee contract of a health maintenance  organization
  because the service is delivered via telehealth, as that term is defined
  in  subdivision  two  of  this section; provided, however, that a health
  maintenance organization may exclude from coverage a service by a health
  care provider where the provider is  not  otherwise  covered  under  the
  enrollee  contract.  A  health  maintenance organization may subject the
  coverage  of  a  service  delivered  via  telehealth   to   co-payments,
  coinsurance  or deductibles provided that they are at least as favorable
  to the enrollee as those established  for  the  same  service  when  not
  delivered  via telehealth. A health maintenance organization may subject
  the coverage  of  a  service  delivered  via  telehealth  to  reasonable
  utilization  management  and  quality  assurance  requirements  that are
  consistent  with  those  established  for  the  same  service  when  not
  delivered via telehealth.
2.  For  purposes  of  this  section,  "telehealth"  means  the use of
  electronic information and communication technologies by a  health  care
  provider  to  deliver  health  care  services  to an enrollee while such
  enrollee is located at a site that is different from the site where  the
  health care provider is located.
* 3.  A  health  maintenance  organization that provides comprehensive
  coverage for hospital, medical or surgical care shall reimburse  covered
  services  delivered  via telehealth on the same basis, at the same rate,
  and to the extent that such services are reimbursed  when  delivered  in
  person;  provided  that  reimbursement  of covered services delivered by
  means of  telehealth  shall  not  require  reimbursement  of  costs  not
  actually incurred in the provision of the telehealth services, including
  charges  related  to  the use of a clinic or other facility when neither
  the originating site nor the distant site occur  within  the  clinic  or
  other   facility.   The   commissioner,   in   consultation   with   the
  superintendent, may promulgate regulations to implement  the  provisions
  of this section.
* NB Repealed April 1, 2026
* 4.  A  health  maintenance  organization that provides comprehensive
  coverage for hospital, medical, or  surgical  care  with  a  network  of
  health care providers shall ensure that such network is adequate to meet
  the  telehealth  needs of insured individuals for services covered under
  the policy when medically appropriate.
* NB Repealed April 1, 2026
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4406-H - Health Care Facility Applications.

§  4406-h.  Health  care  facility applications. 1. A health care plan
  shall, upon request, make available and disclose to  facilities  written
  application  procedures  and  minimum  qualification requirements that a
  facility must meet in order to be considered by the health care plan for
  participation in the in-network benefits  portion  of  the  health  care
  plan's  network.  The  health care plan shall consult with appropriately
  qualified facilities in developing  its  qualification  requirements.  A
  health  care plan shall complete review of the facility's application to
  participate in the in-network portion of the health care plan's  network
  and  shall,  within  sixty  days  of  receiving  a  facility's completed
  application to participate in the health care plan's network, notify the
  facility as to: (a) whether the facility is credentialed; or (b) whether
  additional time is necessary  to  make  a  determination  because  of  a
  failure  of  a  third  party to provide necessary documentation. In such
  instances where additional time  is  necessary  because  of  a  lack  of
  necessary  documentation,  a health care plan shall make every effort to
  obtain such information as soon as  possible  and  shall  make  a  final
  determination   within   twenty-one  days  of  receiving  the  necessary
  documentation.
2. For the purposes of this section, "facility" shall  mean  a  health
  care  provider  entity  or  organization  that  is licensed or certified
  pursuant to article five, twenty-eight, thirty-six,  forty,  forty-four,
  or forty-seven of this chapter or article sixteen, nineteen, thirty-one,
  thirty-two, or thirty-six of the mental hygiene law.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4411 - Construction.

§  4411.  Construction. The provisions of laws other than this article
  shall not be applicable to the certification of any  health  maintenance
  organization  under  this  article  except where so specified; provided,
  however, that no health maintenance organization shall  include  in  its
  name the words "insurer", "casualty", "health and accident" or any words
  generally  regarded  as  descriptive of the insurance function; provided
  further, that this provision shall not be construed as  prohibiting  the
  participation in a comprehensive health services plan of any corporation
  or  other  entity organized under any other law, to the extent that such
  corporations or entities are authorized to participate by law, including
  but  not  limited  to  the  insurance  law,  business  corporation  law,
  education law, not-for-profit corporation law, or general municipal law;
  nor  shall  this section be considered to prevent the application of any
  other law to the entities comprising such plan.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4412 - Separability.

§ 4412. Separability. If any clause, sentence, paragraph, subdivision,
  section  or  part  of  this  article  shall  be adjudged by any court of
  competent jurisdiction to be invalid, the  judgment  shall  not  affect,
  impair,  or  invalidate  the remainder thereof, but shall be confined in
  its operation to the clause, sentence, paragraph,  subdivision,  section
  or  part  thereof  directly  involved  in  the  controversy in which the
  judgment shall have been rendered.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4413 - Savings Clause.

§  4413.  Savings clause. Nothing contained in this article or any act
  amendatory thereof shall affect or impair the validity of any  act  done
  or right accruing, accrued or acquired or any order, judgment, or status
  established  prior  to  the  enactment  of  this article or prior to the
  amendment of any act amendatory thereof.
Medical corporations organized pursuant to the  provisions  of  former
  article  forty-four  of  the  public  health  law in effect prior to the
  effectiveness of the provisions of this article may continue to  operate
  pursuant  to  the provisions of law in effect prior to the effectiveness
  hereof.
Health maintenance organizations that  applied  for  a  license  under
  article  forty-three  of  the  insurance  law and receive approval under
  article twenty-eight of the public health law  may  continue  under  the
  provisions  of  the  laws  in  existence  on  the effective date of this
  article.
2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4414 - Health Care Compliance Programs.

§  4414.  Health  care compliance programs. 1. The commissioner, after
  consultation with the superintendent of  financial  services,  shall  by
  regulation  establish  standards and criteria for compliance programs to
  be implemented by persons providing coverage  or  coverage  and  service
  pursuant to any public or governmentally-sponsored or supported plan for
  health  care  coverage  or  services.  Such  regulations  shall  include
  provisions for the design and implementation of programs or processes to
  prevent,  detect  and  address  instances  of  fraud  and  abuse.   Such
  regulations  shall take into account the nature of the entity's business
  and the size of  its  enrolled  population.  The  commissioner  and  the
  superintendent of financial services shall accept programs and processes
  implemented  pursuant  to section four hundred nine of the insurance law
  as satisfying the  obligations  of  this  section  and  the  regulations
  promulgated  thereunder when such programs and processes incorporate the
  objectives contemplated by this section.
2. Notwithstanding any provisions of section twelve of this chapter to
  the  contrary,  penalties  collected   from   any   health   maintenance
  organization  certified  pursuant  to  this  article  resulting  from  a
  violation of the health maintenance  organization's  mental  health  and
  substance use disorder parity compliance program shall be deposited into
  the  behavioral health parity compliance fund as established pursuant to
  section ninety-nine-hh of the state finance law.
2023 New York Laws › PBH - Public Health › Article 45 - Medical Referral Services › 4500 - Legislative Findings and Statement of Policy.

§  4500. Legislative findings and statement of policy. The security of
  the health and welfare of the residents of this state requires, that the
  utmost attention be given to assure that persons  seeking  medical  care
  and  treatment  in  this state receive adequate care rendered within the
  standards of ethics and public policy applicable  to  all  practices  of
  medicine.   Medical   referral  services,  organized  as  profit  making
  enterprises within this state, have been found  to  be  engaged  in  the
  practice of medicine, have been sharing fees received for referrals with
  doctors and hospitals to whom patients are referred, have been otherwise
  compensating  doctors  and  hospitals for accepting patients referred to
  them, have been giving medical advice by telephone  to  persons  seeking
  referrals  and have been advertising their services, all in violation of
  the standards of ethics and public policy applicable to the practice  of
  medicine  and  which  would  be  violations of standards of professional
  conduct if the acts were performed by physicians.   Such  profit  making
  referral services have consistently engaged in practices inimical to the
  public interest which would be prohibited to physicians and have engaged
  in  relationships with physicians which are in violation of the laws and
  public policy of this state  and  which  have  permitted  physicians  to
  benefit  indirectly from acts and practices which would be prohibited to
  them directly.  It is hereby declared to be the public  policy  of  this
  state that the public health, safety and welfare of the citizens of this
  state   require   that  such  profit  making  medical  referral  service
  organizations be declared to be invalid and unlawful in this state.
2023 New York Laws › PBH - Public Health › Article 45 - Medical Referral Services › 4501 - Medical Referral Service Businesses Prohibited.

§  4501. Medical referral service businesses prohibited. 1. No person,
  firm, partnership, association or  corporation,  or  agent  or  employee
  thereof,  shall  engage  in  for profit any business or service which in
  whole or in part includes the referral or recommendation of persons to a
  physician, dentist, hospital, health related facility, or dispensary for
  any form of medical or dental  care  or  treatment  of  any  ailment  or
  physical  condition.  The  imposition  of  a  fee or charge for any such
  referral or recommendation shall create a presumption that the  business
  or service is engaged in for profit.
2.  No  physician,  dentist,  hospital,  health  related  facility  or
  dispensary shall enter into a contract or other  form  of  agreement  to
  accept  for  medical  or dental care or treatment any person referred or
  recommended for such care or treatment by a medical or  dental  referral
  service  business  located  in or doing business in another state if the
  medical or dental referral service business would  be  prohibited  under
  this  section  if the business were located in or doing business in this
  state.
2023 New York Laws › PBH - Public Health › Article 45 - Medical Referral Services › 4502 - Penalties.

§  4502.  Penalties.  1. A violation of the provisions of this section
  shall constitute a  misdemeanor  and  upon  conviction  thereof  may  be
  punished  by  imprisonment for not longer than one year or a fine of not
  more than five thousand dollars or by both such fine and imprisonment.
2. Whenever there shall be a violation of this section, an application
  also may be made by the attorney general in the name of  the  people  of
  the state of New York to a court or justice having jurisdiction to issue
  an  injunction,  and  upon notice to the defendant of not less than five
  days, to enjoin and restrain the continuance of such violation;  and  if
  it  shall  appear  to  the satisfaction of the court or justice that the
  defendant has, in fact, violated this  section,  an  injunction  may  be
  issued  by  such court or justice, enjoining and restraining any further
  violation, without requiring proof that any person has,  in  fact,  been
  injured  or  damaged  thereby. In any such proceeding the court may make
  allowances  to  the  attorney  general  as  provided  in  section  8303,
  subdivision  6  of  the civil practice law and rules. In connection with
  any such proposed application, the attorney  general  is  authorized  to
  take  proof  and make a determination of the relevant facts and to issue
  subpoenas in accordance with the civil practice law and rules.
2023 New York Laws › PBH - Public Health › Article 45 - Medical Referral Services › 4503 - Application.

§ 4503. Application. The provisions of this article shall not apply to
  any  individual,  agency,  association  or  corporation not organized or
  incorporated  for  pecuniary  profit  or  financial  gain  or   to   any
  organization  or  association  which is exempt from taxation pursuant to
  section 501 (c) of title 26 of the United States Code, constituting  the
  Internal Revenue Code of l954, as amended.
2023 New York Laws › PBH - Public Health › Article 45-A - Disclosure of Material Transactions › 4551 - Disclosure of Material Transactions.

§ 4551. Disclosure of material transactions. Pursuant to this article,
  the  department  shall  adopt a process for the disclosure and notice of
  material transactions. The items disclosed  shall  include  the  factors
  listed  in this article. Nothing in this article shall limit or restrict
  the authority of the superintendent of financial services under  article
  fifteen,  sixteen,  seventeen,  forty-two,  forty-three, seventy-one, or
  seventy-three  of  the  insurance  law,   or   regulations   promulgated
  thereunder.
2023 New York Laws › PBH - Public Health › Article 45-A - Disclosure of Material Transactions › 4552 - Notice of Material Transactions; Requirements.

§  4552.  Notice  of  material transactions; requirements. 1. A health
care  entity  shall  submit  to  the  department  written  notice,  with
supporting  documentation  as  described  below  and  further defined in
regulation developed by the department, which the department shall be in
receipt of  at  least  thirty  days  before  the  closing  date  of  the
transaction,  in  the  form  and  manner  prescribed  by the department.
Immediately upon the submission to the department, the department  shall
submit electronic copies of such notice with supporting documentation to
the  antitrust,  health  care and charities bureaus of the office of the
New York attorney general. Such written notice shall include, but not be
limited to:
(a) The names of the parties to the  material  transaction  and  their
current addresses;
(b)  Copies  of  any  definitive agreements governing the terms of the
material transaction, including pre- and post-closing conditions;
(c) Identification of all locations where  health  care  services  are
currently  provided by each party and the revenue generated in the state
from such locations;
(d) Any plans to reduce or eliminate services and/or participation  in
specific plan networks;
(e) The closing date of the proposed material transaction;
(f)  A  brief  description  of  the nature and purpose of the proposed
material transaction including:
(i) the anticipated  impact  of  the  material  transaction  on  cost,
quality, access, health equity, and competition in the impacted markets,
which may be supported by data and a formal market impact analysis; and
(ii)  any commitments by the health care entity to address anticipated
impacts.
2. (a) Except as  provided  in  paragraph  (b)  of  this  subdivision,
supporting documentation as described in subdivision one of this section
shall  not  be  subject  to  disclosure  under article six of the public
officers law.
(b) During such thirty-day period  prior  to  the  closing  date,  the
department shall post on its website:
(i) a summary of the proposed transaction;
(ii) an explanation of the groups or individuals likely to be impacted
by the transaction;
(iii) information about services currently provided by the health care
entity,  commitments by the health care entity to continue such services
and any services that will be reduced or eliminated; and
(iv) details about how to submit comments, in a format that is easy to
find and easy to read.
3. A health care entity that is a  party  to  a  material  transaction
shall  notify the department upon closing of the transaction in the form
and manner prescribed by the department.
4. Failure to notify the department of a  material  transaction  under
this section shall be subject to civil penalties under section twelve of
this chapter. Each day in which the violation continues shall constitute
a separate violation.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4600 - Legislative Findings and Purpose.

§ 4600. Legislative findings and purpose. The dramatic increase in the
  numbers  of  elderly  people, especially those seventy-five years of age
  and older, coupled with the special housing and  health  care  needs  of
  this  growing segment of the population, requires the development of new
  and creative approaches to help ensure  the  care  of  older  people  in
  residential  settings  of  their  own  choice.  If carefully planned and
  monitored, life  care  communities  have  the  potential  to  provide  a
  continuum  of  care  for  older  people  that will provide an attractive
  residential option for such persons, while meeting their long term  care
  needs  for life. To ensure that the financial, consumer, and health care
  interest  of  individuals  who  enroll  in  such  communities  will   be
  protected,  such  communities  must be effectively managed and carefully
  overseen.
The intent of the legislature, therefore, is to allow for the  prudent
  development  of  life care communities.  The legislature further intends
  to require that the relevant state agencies coordinate the regulation of
  such communities in order to ensure that there are  adequate  safeguards
  for  those  elderly  who  become  residents and to assist in the orderly
  development, of such communities. Although lead responsibility  for  the
  interagency  coordination  of  the  regulation and establishment of such
  communities is vested in the department of health, the legislature  does
  not  intend  that  such  communities become or be perceived as primarily
  medically-oriented facilities. The legislature  intends,  instead,  that
  such  communities  be viewed as an attractive and innovative residential
  alternative for older New Yorkers who are seeking to  maintain,  to  the
  extent  possible, an independent and active life in a community in which
  their long-term care needs will be met.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4605 - Certificate of Authority; Authority of Operator.

§  4605.  Certificate  of  authority;  authority  of  operator.  1.  A
  certificate of authority shall authorize an operator:
a. to operate a continuing care retirement community and to enter into
  contracts pertaining to such community;
b. to prepare and make public information that details  the  terms  of
  any contract relating to a community;
c.  to  advertise  the community and the related services that will be
  provided pursuant to this article; and
d. to  offer  and  execute  contracts,  including  the  collection  of
  entrance  fees  and deposits pursuant to section forty-six hundred eight
  of this article.
2.  a.  The  commissioner,  in  consultation  with  the  council,  may
  authorize  an  operator  of  a  community  with an on-site or affiliated
  residential health care facility  to  provide,  for  a  limited  period,
  residential  health  care  facility  services  to  persons,  who are not
  residents of the community, provided, however, that the  operator  shall
  not  discriminate in the admission, retention or care of any such person
  because such person is or will be eligible  for,  or  receives  or  will
  receive, medical assistance benefits pursuant to title eleven of article
  five of the social services law.
b.  The  commissioner, in consultation with the council, may authorize
  an operator of a community with an  on-site  or  affiliated  adult  care
  facility  to provide, for a limited period, adult care facility services
  to persons, who are not residents of the community,  provided,  however,
  that  the operator shall not discriminate in the admission, retention or
  care of any such person because such person is or will be eligible  for,
  or  receives  or  will  receive, medical assistance benefits pursuant to
  title eleven of article five of the social services law or  supplemental
  security income benefits pursuant to title sixteen of the federal social
  security  act  and any additional state payments made under title six of
  article five of the social services law.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4605-A - Certificate of Authority; Authority to Offer Continuing Care at Home Contracts.

§ 4605-a. Certificate of authority; authority to offer continuing care
at  home  contracts.  A  continuing  care retirement community may offer
continuing care at home contracts upon approval by the council to  amend
the  continuing care retirement community's certificate of authority. In
order to qualify for an amendment to its certificate of  authority,  the
continuing  care  retirement  community shall submit to the commissioner
the following:
1. a  business  plan  to  the  commissioner  and  superintendent  that
includes the following:
(a) a description of the continuing care at home services that will be
provided,  the market that will be served by the continuing care at home
contracts, and the fees to be charged to prospective continuing care  at
home contract holders;
(b) a copy of the proposed continuing care at home contract; and
(c)   an  actuarial  study  prepared  by  an  independent  actuary  in
accordance with standards adopted by the American Academy  of  Actuaries
demonstrating the impact that the continuing care at home contracts will
have  on  the  overall  operations  of  the  continuing  care retirement
community and further demonstrating that the addition of continuing care
at home contracts will not jeopardize  the  financial  solvency  of  the
continuing care retirement community.
2.  a  market  feasibility study demonstrating to the commissioner and
superintendent sufficient consumer interest in continuing care  at  home
contracts and further demonstrating that the addition of continuing care
at  home  contracts  will not have an adverse impact on the provision of
services to continuing care retirement contract holders.
3. materials that meet all requirements established by  the  New  York
state department of financial services.
4.  A  copy  of  the  notification  sent to continuing care retirement
contract holders describing the anticipated impact of  the  addition  of
continuing   care  at  home  contracts  on  continuing  care  retirement
community  resources  and  proof  that  such   notification   has   been
distributed to all continuing care retirement contract holders.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4605-B - Certificate of Authority; Limitation on Continuing Care at Home Contracts.

§  4605-b.  Certificate of authority; limitation on continuing care at
home contracts. The number of continuing care at home contracts approved
on a certificate of authority shall be limited to:
1. The  number  of  approved  living  units  on  the  continuing  care
retirement  community's  premises  that  are intended for ILU residents,
except  that  the  council  may  approve  additional  contracts  upon  a
submission  to  the  commissioner  by  an  operator  consistent with the
provisions set  forth  in  section  forty-six  hundred  five-a  of  this
article;
2. The demonstrated number of continuing care at home contract holders
that can be supported in the existing or approved future capacity of the
adult  care  facility  and  skilled nursing facility consistent with the
provisions set  forth  in  section  forty-six  hundred  five-a  of  this
article; and
3.  Conditions set forth by the New York state department of financial
services, based upon the superintendent's assessment of the following:
(a) the overall financial impact on the community; and
(b) the submitted materials set forth  in  section  forty-six  hundred
five-a of this article.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4607 - Annual Statement.

§  4607.  Annual  statement.  1.  Within  four  months of close of the
operator's fiscal year, unless an extension of time  to  file  has  been
granted,   the   operator  shall  file  an  annual  statement  with  the
commissioner and superintendent showing the condition as of the last day
of the preceding calendar  or  fiscal  year.  If  the  commissioner  and
superintendent do not receive the annual statement within four months of
the  end  of the operator's fiscal year or have not granted an extension
of time to file, the council may charge a late fee.
2. The  annual  statement  shall  be  in  such  form  as  the  council
prescribes and shall contain at least the following:
a. Any change in status with respect to the information required to be
submitted pursuant to section forty-six hundred four of this article;
b.  Financial  statements  audited  by an independent certified public
accountant, which  shall  contain,  for  two  or  more  periods  if  the
community has been in existence that long, the following:
(i) an accountant's opinion and, in accordance with generally accepted
accounting principles:
(A) a balance sheet,
(B) a statement of income and expenses,
(C) a statement of equity or fund balances,
(D) a statement of changes in financial position,
(ii)  notes  to  the  financial  statements  considered  customary  or
necessary  to  ensure  full  disclosure  of  the  financial  statements,
financial condition, and operation;
c. A detailed listing of the assets maintained for the reserves;
d.  A  copy  of  the  most  recent  actuarial review of the community,
including such information as may  be  required  by  the  superintendent
including  an  opinion  of  a  qualified  consulting  actuary, as to the
current and projected soundness of the community, provided however  that
a new actuarial review must be submitted triennially; and
e.  Such  other  reasonable  financial  and  other  information as the
council may require with respect to the operator or  the  community,  or
its   directors,   controlling  persons,  trustees,  members,  branches,
subsidiaries or affiliates to determine  the  financial  status  of  the
community and the management capabilities of the operator.
3.  Sixty  days before commencement of each calendar or fiscal year or
official opening date, whichever is applicable, each operator shall file
with the commissioner and superintendent a  computation  of  the  annual
long-term  debt  service  and  a  projected  annual  revenue and expense
summary for the next ten years.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4608-A - Continuing Care at Home Requirements.

§  4608-a.  Continuing  care  at  home  requirements.  Continuing care
  retirement communities offering continuing care at home contracts shall:
1. Ensure that all continuing care retirement community  employees  or
  contractors  providing  services  to  continuing  care  at home contract
  holders are duly licensed or certified  pursuant  to  law,  which  shall
  include  but  not  be  limited  to  any  licensure  requirements for the
  provision of home care services set forth in article thirty-six of  this
  chapter;
2.  Include  all  operating  expenses  for  continuing  care  at  home
  contracts in the calculation of reserve  requirements  required  by  the
  department of financial services; and
3.  Include  all  operating  activities  for  continuing  care at home
  contracts in the  total  operation  of  the  community  when  submitting
  financial  reports  as  required by the department and the department of
  financial services.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4609 - Withdrawal, Death or Dismissal of Person; Refund.

§  4609. Withdrawal, death or dismissal of person; refund. 1. Upon the
  giving of written notice of cancellation by certified mail of  at  least
  thirty days, the contract may be cancelled by a resident for any reason,
  or  by  an  operator  if  the  applicant has willfully mismanaged assets
  needed to pay monthly care fees. A resident shall not be discharged  for
  inability  to  pay the monthly fee except where a showing of the willful
  mismanagement of assets needed to pay monthly care fees has been made.
2. If the notice required by subdivision one of this section is  given
  within  the first ninety days of occupancy, the resident shall receive a
  refund of not less than the entry fee and any  other  pre-payments  less
  the actual cost of any services actually provided and the actual cost of
  refurbishing  the  unit  for  resale.  After  the  first  ninety days of
  occupancy, any refund shall be not less than the  entrance  fee,  except
  that  the  operator  may  retain  no  more than two percent per month of
  occupancy by the resident of such fee and no more than  a  four  percent
  fee for processing.
3.  Refunds  upon death will be made on the same basis as refunds upon
  withdrawal.
4. Any refund made pursuant to this section must be paid no later than
  thirty days after the formerly occupied unit has been resold, but in  no
  event  later  than  one  year  after the formerly occupied unit has been
  vacated.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4611 - Reserves and Supporting Assets.

§  4611. Reserves and supporting assets. 1. An operator shall maintain
  reserve liabilities and supporting assets  in  an  amount  and  for  the
  purposes  set  forth  in  a  regulation  issued by the superintendent of
  financial services. Liquid assets must be maintained for  the  following
  reserve liabilities:
a.  Principal  and  interest  payments  and  payments  for  taxes  and
  insurance for up to twelve months;
b. Total estimated operating costs for up to six months as set by  the
  superintendent;
c. Repairs and replacements for up to twelve months; and
d.  In  addition,  the amount of liquid assets must meet any cash flow
  requirements and conditions as set forth in a regulation.
2. The assets in support of reserve liabilities of subdivision one  of
  this section shall meet quantitative and qualitative standards set forth
  in regulations issued by the superintendent.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4612 - Residents' Organizations.

§  4612.  Residents'  organizations.  1.  Continuing  care  retirement
  contract holders shall have the right of self-organization, the right to
  be represented by one or more individuals of their own choosing, and the
  right to engage in concerted  activities  for  the  purpose  of  keeping
  informed of the operation of the community in which they live.
2.  The board of directors, a designated representative, or other such
  governing body of a continuing care retirement community shall  meet  at
  least four times a year with residents' representatives and shall hold a
  general  meeting  of  all  residents  once  a  year  for  the purpose of
  discussing  subjects  including,  but  not  limited  to,  the  financial
  position  of the community, the quality of social and health services at
  the community,  and  any  proposed  changes  in  policies,  programs  or
  services.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4613 - Advertisements.

§  4613. Advertisements. No person, partnership, corporation, company,
  trust or association, or any agent or employee thereof, shall publish or
  cause  to  be  published,  circulated,  or  disseminated  any  financial
  statement,  pamphlet,  circular,  form  letter,  advertisement, or other
  sales literature or advertising communication addressed or intended  for
  distribution  to  prospective  residents  of  continuing care retirement
  communities that contains statements or illustrations that  are  untrue,
  deceptive,  misleading,  or  omit  material  facts  or  omit  any  other
  information required by regulations appropriate  to  a  continuing  care
  retirement community.
2023 New York Laws › PBH - Public Health › Article 46 - Continuing Care Retirement Communities › 4614 - Audits.

§   4614.   Audits.   1.   The  commissioner,  or  designee;  and  the
  superintendent, or designee; may at any time, and shall  at  least  once
  every  three years, visit each community and examine the business of any
  applicant for a certificate of authority and any operator engaged in the
  execution of continuing care retirement contracts or continuing care  at
  home  contracts  or engaged in the performance of obligations under such
  contracts. Routine examinations may be  conducted  by  having  documents
  designated  by  and  submitted  to such commissioners or superintendent,
  which shall  include  financial  documents  and  records  conforming  to
  commonly accepted accounting principles and practices. The final written
  report  of  each  such  examination  conducted  by such commissioners or
  superintendent shall be filed with the commissioner and, when so  filed,
  shall  constitute  a  public  record.  A  copy  of  each report shall be
  provided to members of the continuing care retirement community council.
  Any operator being examined shall, upon  request,  give  reasonable  and
  timely  access  to  all  of  its records. The representative or examiner
  designated by the commissioners or superintendent, respectively, may, at
  any time, examine the records and affairs and  inspect  the  community's
  facilities, whether in connection with a formal examination or not.
2.  Any  duly  authorized  officer,  employee,  or agent of the health
  department, or department of financial services may,  upon  presentation
  of  proper  identification,  have  access  to,  and inspect, any records
  maintained  by  the  community  relevant  to  the  respective   agency's
  regulatory   authority,  with  or  without  advance  notice,  to  secure
  compliance with, or to prevent a violation of,  any  provision  of  this
  article.
3.  Reports  of the results of such examinations and inspections shall
  be kept on file  by  the  commissioner  and  shall  be  open  to  public
  inspection at the community, provided any records, reports, or documents
  which  by state or federal law or regulation are deemed confidential may
  not be distributed or made available unless and until such  confidential
  status has expired.