2023 New York Laws › PBH - Public Health › Article 25 - Maternal and Child Health › Title 1-A - Child Health Insurance Plan › 2511 - Child Health Insurance Plan.

§  2511.  Child  health  insurance  plan  1.  (a) The commissioner, in
consultation with the superintendent, shall establish a program  to  the
extent of funds available therefor through contractual arrangements with
approved  organizations to provide covered health care services coverage
for eligible children. The availability  of  coverage  for  primary  and
preventive  health  care  services  and  inpatient  health care services
coverage shall be continued pending approval of contractual arrangements
that include covered health care services coverage and implementation of
such coverage to the extent of funds available therefor.
(b) Coverage for covered health care services shall not  be  effective
until  such  time  as  contractual arrangements are executed pursuant to
this section for such purposes and an eligible child is enrolled in  the
program.
2.  In  order  to  be  eligible  for  a  subsidy  payment  pursuant to
subdivision three of this section, a  child  shall  meet  the  following
criteria:
(a) (i) effective January first, nineteen hundred ninety-nine, resides
in  a  household  having  a net household income at or below one hundred
ninety-two percent of the non-farm federal poverty level (as defined and
updated by the United States department of health and human services) or
the gross equivalent of such net income; and
(ii) effective July first, two thousand, resides in a household having
a gross household income at or below two hundred fifty  percent  of  the
non-farm  federal  poverty  level  (as defined and updated by the United
States department of health and human services); and
(iii) effective September first, two  thousand  eight,  resides  in  a
household  having a household income at or below four hundred percent of
the non-farm federal poverty level (as defined and updated by the United
States department of health and human services);
(b) is not eligible for medical assistance, except that  a  child  who
becomes eligible for medical assistance after becoming an eligible child
under  this  title,  may  be  eligible for a subsidy payment pursuant to
subdivision three of this section as medical assistance for a period  up
to three months after becoming eligible for medical assistance; and
(c)  does not have health care coverage under insurance, as defined by
the commissioner, in consultation with the superintendent. The applicant
for insurance shall attest to the  source  and  nature  of  the  child's
health care coverage under this paragraph, if any; and
* (e)  is  a  resident  of  New  York  state.  Such residency shall be
demonstrated by adequate proof, as determined by the commissioner, of  a
New  York state street address. If the child has no street address, such
proof may include, but not  be  limited  to,  school  records  or  other
documentation determined by the commissioner.
* NB  Effective until January 1, 2014 or a later date to be determined
by the commisioner of health (see chapter 56 of 2013 Part D § 76 sb h)
* (e) is a resident  of  New  York  state.  Such  residency  shall  be
attested  to  by  the  applicant  for  insurance,  provided however, the
commissioner shall require adequate proof of a  New  York  state  street
address  in  circumstances when there is an inconsistency with residency
information from other data sources.
* NB Effective January 1, 2014 or a later date to be determined by the
commissioner of health (see chapter 56 of 2013 Pt. D § 76 sub h)
(f)  * (i)  In  order  to  establish  income  eligibility  under  this
subdivision  at  initial  application,  a  household  shall provide such
documentation specified in subparagraph  (iii)  of  this  paragraph,  as
necessary  and  sufficient  to determine a child's financial eligibility
for a subsidy payment under this title. The commissioner may verify  the
accuracy  of  such  income  information  provided  by  the  household by

matching it against income information contained in databases  to  which
the commissioner has access, including the state's wage reporting system
pursuant to subdivision five of section one hundred seventy-one-a of the
tax  law  and by means of an income verification performed pursuant to a
cooperative agreement  with  the  department  of  taxation  and  finance
pursuant to subdivision four of section one hundred seventy-one-b of the
tax law.
* NB  Effective until January 1, 2014 or a later date to be determined
by the commisioner of health (see chapter 56 of 2013 Part D § 76 sb h)
* (i) In order to establish income eligibility under this  subdivision
at  initial  application,  a household shall provide the social security
numbers for each parent and legally responsible adult who is a member of
the household, subject  to  subparagraph  (v)  of  this  paragraph.  The
commissioner  shall  determine  eligibility  based on income information
contained in databases to which the commissioner has  access,  including
the  state's  wage  reporting  system  pursuant  to  subdivision five of
section one hundred seventy-one-a of the tax law  and  by  means  of  an
income  verification  performed pursuant to a cooperative agreement with
the department of taxation and finance pursuant to subdivision  four  of
section one hundred seventy-one-b of the tax law. The commissioner shall
require  an  attestation  by  the  household that the income information
obtained from electronic data  sources  is  accurate.  Such  attestation
shall  include  any other household income information not obtained from
an electronic data source that  is  necessary  to  determine  a  child's
financial  eligibility  for  a  subsidy payment under this title. If the
attestation is reasonably  compatible  with  information  obtained  from
available  data  sources,  no  further  information  or documentation is
required.  If  the  attestation  is  not  reasonably   compatible   with
information obtained from available data sources, documentation shall be
required as specified in subparagraph (iii) of this paragraph.
* NB Effective January 1, 2014 or a later date to be determined by the
commissioner of health (see chapter 56 of 2013 Pt. D § 76 sub h)
(ii)  In  order to establish income eligibility under this subdivision
at recertification, the  commissioner  may  make  a  redetermination  of
eligibility without requiring information from the individual if able to
do  so  based  on  reliable  information  contained  in the individual's
enrollment file or other more current information contained in databases
to which  the  commissioner  has  access,  including  the  state's  wage
reporting  system  and  by  means  of  an  income verification performed
pursuant to a cooperative agreement with the department of taxation  and
finance   pursuant   to   subdivision   four   of  section  one  hundred
seventy-one-b  of  the  tax  law.  The  commissioner  shall  require  an
attestation  by  the  household that the income information contained in
the  enrollment  file  or  obtained  from  electronic  data  sources  is
accurate.  Such  attestation  shall  include  any other household income
information  not  obtained  from  an  electronic  data  source  that  is
necessary  to  redetermine a child's financial eligibility for a subsidy
payment under this title. In the event that there  is  an  inconsistency
between  the  income  information  attested  to by the household and any
information obtained by the commissioner from other sources pursuant  to
this subparagraph, and such inconsistency is material to the household's
eligibility  for  a  subsidy  payment under this title, the commissioner
shall require the household to provide income documentation as specified
in subparagraph (iii) of this paragraph.
* (iii) Income documentation shall include, but not be limited to, one
or more of the following for each parent and legally  responsible  adult
who  is  a  member of the household and whose income is available to the
child;
(A) current annual income tax returns;
(B) paycheck stubs;
(C) written documentation of income from all employers; or
(D) written documentation of income eligibility of a child for free or
reduced  breakfast or lunch through the school meal program certified by
the child's school, provided that:
(I) the commissioner  may  verify  the  accuracy  of  the  information
provided in the same manner and way as provided for in subparagraph (ii)
of this paragraph; and
(II)  such  documentation  may  not be suitable proof of income in the
event of a material inconsistency in income after the  commissioner  has
performed  verification pursuant to subparagraph (ii) of this paragraph;
or
(E) other documentation of income (earned or unearned)  as  determined
by  the  commissioner,  provided,  however, such documentation shall set
forth the source of such income.
* NB Effective until January 1, 2014 or a later date to be  determined
by the commisioner of health (see chapter 56 of 2013 Part D § 76 sb h)
* (iii)   If   the   attestation   of  household  income  required  by
subparagraphs  (i)  and  (ii)  of  this  paragraph  is  not   reasonably
compatible   with   information  obtained  from  data  sources,  further
information,  including  documentation,  shall   be   required.   Income
documentation  shall  include, but not be limited to, one or more of the
following for each parent and legally responsible adult who is a  member
of the household and whose income is available to the child;
(A) current annual income tax returns;
(B) paycheck stubs;
(C) written documentation of income from all employers; or
(D) written documentation of income eligibility of a child for free or
reduced  breakfast or lunch through the school meal program certified by
the child's school, provided that:
(I) the commissioner  may  verify  the  accuracy  of  the  information
provided in the same manner and way as provided for in subparagraph (ii)
of this paragraph; and
(II)  such  documentation  may  not be suitable proof of income in the
event of a material inconsistency in income after the  commissioner  has
performed  verification pursuant to subparagraph (ii) of this paragraph;
or
(E) other documentation of income (earned or unearned)  as  determined
by  the  commissioner,  provided,  however, such documentation shall set
forth the source of such income.
* NB Effective January 1, 2014 or a later date to be determined by the
commissioner of health (see chapter 56 of 2013 Pt. D § 76 sub h)
* (iv) In the event a household does not provide income  documentation
required  by  subparagraph  (iii) of this paragraph within two months of
the approved organization's request,  the  approved  organization  shall
disenroll  the  child  at  the  end  of such two month period. Except as
provided in  paragraph  (c)  of  subdivision  five-a  of  this  section,
approved  organizations shall not be obligated to repay subsidy payments
made by the state on behalf of children enrolled during this  two  month
period.
* NB  Effective until January 1, 2014 or a later date to be determined
by the commisioner of health (see chapter 56 of 2013 Part D § 76 sb h)
* (iv) In the event a household does not provide income  documentation
required  by  subparagraph  (iii) of this paragraph within two months of
the  approved  organization's  or  state  enrollment  center's  request,
whichever  is  applicable, the approved organization or state enrollment
center shall disenroll the child at the end of such  two  month  period.

Except  as  provided  in  paragraph  (c)  of  subdivision five-a of this
section, approved organizations shall not be obligated to repay  subsidy
payments  made  by  the state on behalf of children enrolled during this
two month period.
* NB Effective January 1, 2014 or a later date to be determined by the
commissioner of health (see chapter 56 of 2013 Pt. D § 76 sub h)
* (v)  In  the  event  a  household  chooses not to provide the social
security numbers required by subparagraph (ii) of this  paragraph,  such
household  shall  provide income documentation specified in subparagraph
(iii) of this paragraph  as  a  condition  of  the  child's  enrollment.
Nothing  in  this paragraph shall be construed as obligating a household
to provide social security numbers of  parents  or  legally  responsible
adults  as  a  condition  of  a  child's enrollment or eligibility for a
subsidy payment under this title.
* NB Effective until January 1, 2014 or a later date to be  determined
by the commisioner of health (see chapter 56 of 2013 Part D § 76 sb h)
* (v)  In  the  event  a  household  chooses not to provide the social
security  numbers  required  by  subparagraphs  (i)  and  (ii)  of  this
paragraph,  such  household shall provide income documentation specified
in subparagraph (iii) of this paragraph as a condition  of  the  child's
enrollment. Nothing in this paragraph shall be construed as obligating a
household  to  provide  social  security  numbers  of parents or legally
responsible adults as a condition of a child's enrollment or eligibility
for a subsidy payment under this title.
* NB Effective January 1, 2014 or a later date to be determined by the
commissioner of health (see chapter 56 of 2013 Pt. D § 76 sub h)
* (vi) Any income verification response by the department of  taxation
and  finance  pursuant  to  subparagraphs (i) and (ii) of this paragraph
shall not  be  a  public  record  and  shall  not  be  released  by  the
commissioner,  the  department  of  taxation  and finance or an approved
organization except pursuant to this  paragraph.  Information  disclosed
pursuant to this paragraph shall be limited to information necessary for
verification. Information so disclosed shall be kept confidential by the
party  receiving  such  information.  Such information shall be expunged
within a reasonable time to be determined by the  commissioner  and  the
department of taxation and finance.
* NB  Effective until January 1, 2014 or a later date to be determined
by the commisioner of health (see chapter 56 of 2013 Part D § 76 sb h)
* (vi) Any income verification response by the department of  taxation
and  finance  pursuant  to  subparagraphs (i) and (ii) of this paragraph
shall not  be  a  public  record  and  shall  not  be  released  by  the
commissioner,  the  department  of  taxation  and  finance,  an approved
organization, or the state enrollment center, except  pursuant  to  this
paragraph.  Information  disclosed  pursuant  to this paragraph shall be
limited  to  information  necessary  for  verification.  Information  so
disclosed  shall  be  kept  confidential  by  the  party  receiving such
information. Such information shall be expunged within a reasonable time
to be determined by the commissioner and the department of taxation  and
finance.
* NB Effective January 1, 2014 or a later date to be determined by the
commissioner of health (see chapter 56 of 2013 Pt. D § 76 sub h)
* (g)  (i)  Notwithstanding  any  inconsistent provision of law to the
contrary  and  subject  to  the  availability   of   federal   financial
participation  under  title  XIX  of  the federal social security act, a
child under the age of nineteen shall be presumed  to  be  eligible  for
subsidy payments and temporarily enrolled for coverage under this title,
once  during  a  twelve  month period, beginning on the first day of the
enrollment period following  the  date  that  an  approved  organization

determines,  on the basis of preliminary information, that a child's net
household income does not exceed the income  level  specified  in  title
eleven  of article five of the social services law for children eligible
for  medical  assistance  based  on  such  child's  age.  The  temporary
enrollment period shall continue  until  the  earlier  of  the  date  an
eligibility determination is made pursuant to this title or title eleven
of article five of the social services law, or two months after the date
temporary  enrollment  begins;  provided however, a temporary enrollment
period may be extended in the event an eligibility  determination  under
this title or title eleven of article five of the social services law is
not  made within such two month period through no fault of the applicant
for insurance for medical assistance. The commissioner shall assure that
children who  are  enrolled  pursuant  to  this  paragraph  receive  the
appropriate  follow-up  for  a determination of eligibility for benefits
under this title or title eleven of article five of the social  services
law  prior  to  the  termination of the temporary enrollment period. The
commissioner shall assure that children and their families are  informed
of all available enrollment sites in accordance with subdivision nine of
this section.
(ii)  Effective  September  first  two  thousand  seven, through March
thirty-first, two thousand fourteen  temporary  enrollment  pursuant  to
subparagraph  (i)  of  this paragraph shall be provided only to children
who apply for recertification of coverage under this title who appear to
be eligible for medical assistance under title eleven of article five of
the social services law.
* NB Expires July 1, 2025
* (h) The commissioner may, in consultation with  the  superintendent,
promulgate rules and regulations necessary to prevent fraud and abuse in
eligibility  determinations  made  by approved organizations pursuant to
this subdivision.
* NB Expires July 1, 2025
(i)  Notwithstanding  any  inconsistent  provision  of  law,  rule  or
regulation:
(i)  A  newborn  child who meets the eligibility criteria set forth in
this subdivision or subdivision five of this section, as  determined  by
an  approved  organization or the health insurance exchange marketplace,
whichever is applicable, shall be enrolled retroactively  to  the  first
day of the month in which the child is born, provided that the applicant
for  insurance  submits  a completed and signed application and required
information and documentation within sixty days of the child's birth.
(ii) A newborn child shall be presumed eligible for  subsidy  payments
under  this  subdivision or eligible for coverage under subdivision five
of this section, provided that the applicant  for  insurance  submits  a
completed and signed application within sixty days of the child's birth.
Once  eligibility  is  determined  by  the  approved organization or the
health insurance exchange marketplace, whichever is applicable,  on  the
basis   of   preliminary   information,  the  child  shall  be  enrolled
retroactively to the first day of the month in which the child is  born.
All  other  procedures  and  standards  regarding presumptive enrollment
applicable to eligible children enrolled under this title and  specified
in  state  contracts  with  approved organizations or implemented by the
health insurance exchange marketplace, whichever  is  applicable,  shall
apply to presumptive enrollment of newborn children.
(j)  Where  an  application for recertification of coverage under this
title contains insufficient information for  a  final  determination  of
eligibility  for  continued coverage, a child shall be presumed eligible
for a period not  to  exceed  the  earlier  of  two  months  beyond  the
preceding  period  of  eligibility  or  the  date  upon  which  a  final

determination  of  eligibility  is  made  based  on  the  submission  of
additional  data.  In  the  event  such  additional  information  is not
submitted within two months of  the  approved  organization's  or  state
enrollment  center's  request,  whichever  is  applicable,  the approved
organization or  state  enrollment  center  shall  disenroll  the  child
following the expiration of such two month period. Except as provided in
paragraph   (c)   of   subdivision  five-a  of  this  section,  approved
organizations shall not be obligated to repay subsidy payments  received
on behalf of children enrolled during this two month period.
2-a. (a) An approved organization that has reasonable cause to believe
that an applicant for insurance, parent or legally responsible adult has
provided  false  income information may submit tax returns and any other
available income information, including, if not  prohibited  by  federal
law  for  purposes  of  income  verification,  social  security  account
numbers, to the department as  may  be  necessary  to  determine  income
eligibility.  The department shall promptly furnish to the department of
taxation  and  finance,  pursuant  to  the  agreements   authorized   by
subdivision  five  of  section one hundred seventy-one-a and subdivision
four of section one hundred seventy-one-b of the  tax  law,  the  names,
address  and  social  security  account  numbers,  if  available, of the
parents and legally responsible adults who are members of the household,
together with a request that the department  of  taxation  and  finance,
pursuant to those agreements, promptly ascertain insofar as is possible,
and  from  the most recent available data, whether the collective income
reported by those individuals exceeds the income eligibility  level  for
that  household,  as  determined  by  the  department in compliance with
paragraph (a) of subdivision two of this  section.  The  department,  in
consultation   with  the  department  of  taxation  and  finance,  shall
establish  a  methodology  for  comparing  numerical   equivalents.   In
ascertaining whether a household's income exceeds the income eligibility
threshold  transmitted by the department, the department of taxation and
finance shall also examine information available pursuant to section one
hundred seventy-one-a of the tax law where any of the named  individuals
have  failed  to  file  a  New York state income tax return for the most
recent filing year or where there is an indication, from the  department
or otherwise, that the individual's income may have changed. Reliance on
such  section  one  hundred seventy-one-a information shall be specially
indicated in the department of taxation  and  finance's  response.  This
provision shall not be construed to authorize the department of taxation
and  finance  to  disclose any figure on any personal income tax return.
The department shall promptly inform the approved  organization  of  the
response  from  the  department  of  taxation and finance. Submission of
income information for verification shall not delay the  application  of
any  other provision of this section to an applicant for insurance or an
enrolled child.
(b) Before an approved organization submits income information to  the
department for verification with the department of taxation and finance,
it shall:
(i)  provide  the  applicant  for  insurance  with notification of its
intent to seek such verification;
(ii) notify the applicant for insurance  of  the  confidentiality  and
expungement  provisions  contained in paragraph (c) of this subdivision;
and
(iii) provide the applicant for  insurance  with  the  opportunity  to
review and modify the income information.
(c)   Such   income  information  and  verification  response  by  the
department of taxation and finance shall not  be  a  public  record  and
shall  not be released by the department, the department of taxation and

finance  or  the  approved  organization   except   pursuant   to   this
subdivision.    Information  disclosed pursuant to this section shall be
limited  to  information  necessary  for  verification.  Information  so
disclosed  shall  be  kept  confidential  by  the  party  receiving such
information.  Such  income  information  shall  be  expunged  within   a
reasonable time to be determined by the department and the department of
taxation and finance.
2-b.  (a)  For  purposes  of  claiming federal financial participation
under paragraph nine of subsection (c)  of  section  twenty-one  hundred
five of the federal social security act, a household shall provide:
(i) the social security number for the applicant to be verified by the
commissioner  in  accordance  with  a  process established by the social
security administration pursuant to federal law, or
(ii) documentation  of  citizenship  and  identity  of  the  applicant
consistent  with  requirements  under the medical assistance program, as
specified by the commissioner on the initial application.
(b) Pending receipt of the information required by subparagraph (i) of
paragraph (a) of this subdivision, an initial application shall continue
to be processed by an approved organization  or  enrollment  facilitator
and a child shall be presumptively enrolled in the program in accordance
with procedures and timeframes currently specified in contracts.
2-c.  Express  lane  eligibility. (a) Notwithstanding any inconsistent
provision of law, rule or regulation, the commissioner is authorized  to
(i)  establish  standards and procedures for express lane enrollment and
renewal implemented in accordance  with  section  2107(e)(1)(B)  of  the
federal  social security act, including but not limited to reliance on a
finding  made  by  an  express  lane  agency,  as  defined  in   section
1902(e)(13)(F)  of the federal social security act, to determine whether
a child meets one or more of  the  eligibility  criteria  set  forth  in
subdivision  two  of  this  section;  (ii)  specify  such  standards and
procedures in the state child health plan established under title XXI of
the federal social security act and applicable contracts  with  approved
organizations   and   enrollment   facilitators;  and  (iii)  waive  any
information and documentation requirements set  forth  in  this  section
necessary  to  implement  express lane eligibility pursuant to standards
and procedures established under subparagraphs  (i)  and  (ii)  of  this
paragraph;   provided,   however,  that  information  and  documentation
required pursuant to subdivision  two-b  of  this  section  may  not  be
waived.
(b)  Subject  to federal approval, such standards and procedures shall
specify that information and  documentation  regarding  citizenship  and
immigration  status  collected by an express lane agency and provided to
the commissioner for the purpose of express lane eligibility may be used
to satisfy the requirements of subdivision two-b of this section.
(c) Such standards and procedures shall also  include  a  process  for
determining  enrollment  error rates and implementing corrective actions
as required by section 1902(e)(13)(E) of  the  federal  social  security
act.
3.  Subsidy  payments  shall be made, pursuant to subdivision eight of
this section, to approved organizations for the purposes of  subsidizing
the  entire  cost of coverage for eligible children meeting the criteria
of subdivision two of this  section.  Notwithstanding  any  inconsistent
provision  of  this subdivision, the total annual aggregate cost-sharing
with respect to all eligible children in a  family  under  this  section
shall not exceed amounts provided pursuant to applicable federal law. In
order  to be eligible for a subsidy payment pursuant to this subdivision
a premium payment shall be paid for an eligible child in accordance with
the provisions of subdivision nine of section twenty-five hundred ten of

this title. Nothing herein shall preclude  payment  of  the  premium  on
behalf  of  an  eligible  child  on a monthly, quarterly, semi-annual or
annual basis.
4.  Households  shall  report  to  the  approved organization or state
enrollment center, whichever is  applicable,  within  thirty  days,  any
changes  in  New  York  state  residency  or  health care coverage under
insurance that may make a child ineligible for subsidy payments pursuant
to this section. Any individual who, with the intent to obtain benefits,
willfully  misstates  income  or  residence  to  establish   eligibility
pursuant to subdivision two of this section or willfully fails to notify
an  approved  organization  or  state  enrollment  center of a change in
residence or health care coverage pursuant  to  this  subdivision  shall
repay  such  subsidy  to the commissioner. Individuals seeking to enroll
children for coverage shall be informed that such  willful  misstatement
or failure to notify shall result in such liability.
4-a. Any individual who, with the intent to obtain benefits, willfully
misstates  income  or  residence  to  establish  eligibility pursuant to
subdivision two of this section or willfully fails to notify an approved
organization of an increase in income or change in residence pursuant to
subdivision two  of  this  section  shall  repay  such  subsidy  to  the
commissioner.  Individuals seeking to enroll children for coverage shall
be informed that such willful misstatement or failure  to  notify  shall
result in such liability.
5.  Notwithstanding  any inconsistent provisions of subdivision two of
this section, an individual who meets the criteria of paragraphs (b) and
(c) of subdivision two of this section but not the criteria of paragraph
(a) of  such  subdivision  may  be  enrolled  for  covered  health  care
services,  provided  however, that an approved organization shall not be
eligible to receive a subsidy payment for  providing  coverage  to  such
individuals.   The   cost   of  coverage  shall  be  determined  by  the
commissioner, in consultation with the superintendent and  shall  be  no
more than the cost of providing such coverage.
5-a.  Obligations  of  approved  organizations or the state enrollment
center.  (a)  An  approved  organization  or  state  enrollment  center,
whichever  is  applicable,  shall  have  the  obligation  to  review all
information provided pursuant to subdivision two  of  this  section  and
shall not certify or recertify a child as eligible for a subsidy payment
unless the child meets the eligibility criteria.
(b)  An approved organization or state enrollment center, whichever is
applicable,  shall  promptly  review  all  information  relating  to   a
potential  change  in eligibility based on information provided pursuant
to subdivision four of this section. Within at least thirty  days  after
receipt   of  such  information,  the  approved  organization  or  state
enrollment center shall make a determination whether the child is  still
eligible  for  a  subsidy payment and shall notify the household and the
commissioner if it determines the child is not eligible  for  a  subsidy
payment.
(c)  Any approved organization which engages in a pattern and practice
of enrolling or recertifying children who  are  ineligible  pursuant  to
subdivision  two  of this section, as determined by the commissioner, in
consultation with the superintendent, shall be  required  to  repay  all
subsidy  payments  received  on account of ineligible children. Improper
enrollment based upon a  good  faith  reliance  on  documentation  which
appears accurate on its face shall not constitute a pattern or practice.
Any  such  approved  organization  may  also  be  removed as an approved
organization, provided however, that eligible children shall continue to
receive services until such time as  the  orderly  transition  to  other
approved organizations can be effected.
6.  The  commissioner  shall, in consultation with the superintendent,
establish  guidelines  for  the  submission  of  proposals  by  eligible
organizations for the purposes of providing covered health care services
coverage  to  eligible  children  including,  but  not  limited  to, the
following components:
(a)  standards  for  individual  enrollment  including  mechanisms for
presumptive eligibility and annual recertification;
(b) standards for provider enrollment;
(c) standards for scope of covered health care service benefits;
(d) standards for health care provider payment methodologies, provided
however, that levels and methods of payment  shall  be  consistent  with
those provided under similar insurance plans;
(e)  standards  for  appropriate utilization review, quality assurance
and case management mechanisms; and
(f) such other criteria which may be deemed necessary.
6-a. The commissioner, in consultation with  the  superintendent,  may
establish  a  program  for  cards  issued to eligible children which can
store or access information electronically, including  the  identity  of
the   child   and  such  other  medical  data  and  information  as  the
commissioner, in consultation with the superintendent, may prescribe.
7. (a) A proposal submitted by an eligible organization shall meet the
following criteria:
(i) designate the geographic area to be served  by  the  program,  and
estimate  the number of eligible participants and actual participants in
such designated area;
(ii) assure access  to  and  delivery  of  high  quality,  appropriate
covered  health care services and, when applicable, include a network of
health  care  providers  in  sufficient   numbers   and   geographically
accessible to service program participants;
(iii)   describe   the   procedures   for  marketing  and  determining
eligibility for the health care coverage plan in the  program  location,
including  the  designation  of  other  entities  which may perform such
functions under contract with the organization;
(iv) describe proposed health care provider payment methodologies;
(v) describe in detail the  estimated  expenses,  including  personnel
costs  and other types of administrative expenses which will be incurred
in the development and implementation of the program;
(vi) describe the  quality  assurance,  utilization  review  and  case
management mechanisms to be implemented;
(vii)  demonstrate  the  applicant's ability to meet the data analysis
and reporting requirements of the program;
(viii) describe the benefit package to be offered by the  program  and
the cost of such benefit package;
(ix)  describe the provisions for arranging for or offering conversion
coverage in the event of termination of coverage under this title;
(x) demonstrate financial feasibility of the program;
(xi) describe the premium, copayments and deductibles to  be  paid  by
program participants who are ineligible for subsidy payments; and
(xii)  include  such  other  information  as  the commissioner and the
superintendent may deem appropriate.
(b) The commissioner, in consultation with the  superintendent,  shall
make  a  determination  whether  to  approve,  disapprove  or  recommend
modification of the proposal. In order for a proposal to be approved  by
the   commissioner,   the   proposal   must  also  be  approved  by  the
superintendent with respect to the provisions of subparagraphs (ix)  and
(xii) of paragraph (a) of this subdivision.
(c)  The  commissioner, in consultation with the superintendent, shall
ensure, to  the  extent  possible,  that  child  health  insurance  plan

coverage  is  available  in  all  geographic areas. The commissioner may
approve more than one approved organization to serve all or  part  of  a
geographic area.
7-a.  (a)  Notwithstanding any inconsistent provisions of subdivisions
one and three of section two thousand five hundred ten  of  this  title,
subdivisions  six and seven of this section, subject to paragraph (b) of
this subdivision, and section  one  hundred  sixty-three  of  the  state
finance  law,  the commissioner may contract with organizations approved
under section three hundred sixty-four-j of  the  social  services  law,
without  a  competitive  bid or request for proposal process, to provide
covered health care services coverage for eligible children pursuant  to
this title.
(b)  In  order  to  be  approved  pursuant  to  this  subdivision,  an
organization shall meet the criteria set forth in subdivision  seven  of
this  section  and  shall  comply  with  standards  established  by  the
commissioner, in  consultation  with  the  superintendent,  pursuant  to
subdivision six of this section.
(c)  Organizations  approved pursuant to this subdivision shall comply
with  the  requirements  of  this  title  and   contractual   provisions
established thereunder, title XXI of the federal social security act and
any  implementing federal regulations, and requirements set forth in the
state child health plan established pursuant to title XXI of the federal
social security act.
(d) Notwithstanding any inconsistent provision of section one  hundred
twelve  or  one  hundred  sixty-three  of  the state finance law, at the
discretion of the commissioner, without a competitive bid or request for
proposal process, contractual arrangements with approved  organizations,
as defined in subdivision two of section twenty-five hundred ten of this
article,  in  effect in two thousand seven may be extended to any period
on and after July first, two thousand seven to provide an  uninterrupted
continuation of services and may be amended as deemed necessary.
8.  The  commissioner  shall  determine  the  amount  of  funds  to be
allocated to an approved organization  for  the  purposes  described  in
subdivision one of this section within such funds which may be available
for  the purposes of this article. (a) Subsidy payments made to approved
organizations on and after April first, two thousand five through  March
thirty-first,  two  thousand  six, shall be at amounts approved prior to
April first, two thousand five. Applications for  increases  to  subsidy
payments submitted by approved organizations to the superintendent on or
after  January  first,  two  thousand  five, shall not be considered for
approval until after March thirty-first, two thousand six. (b)  Further,
subsidy  payments  made  to  approved  organizations  on and after April
first, two thousand  seven  through  March  thirty-first,  two  thousand
eight,  shall  be at amounts approved prior to April first, two thousand
seven. Applications for  increases  to  subsidy  payments  submitted  by
approved  organizations to the superintendent on or after January first,
two thousand seven, shall not be considered  for  approval  until  after
March  thirty-first, two thousand eight. (c) Nothing in this subdivision
shall prohibit decreases in subsidy payments in accordance with relevant
contract provisions.
(d)(i) Effective April first, two thousand nine, payment for marketing
and facilitated enrollment activities set forth in subdivision  nine  of
this   section  and  included  in  subsidy  payments  made  to  approved
organizations providing such services pursuant to a  contract  with  the
state  shall  be  limited  to  an  amount  determined  annually  by  the
commissioner.
(ii) Such subsidy payments shall be adjusted by  the  commissioner  to
remove  any  costs  of  approved  organizations  in excess of the amount

determined in accordance with subparagraph (i) of this  paragraph  based
on cost reports submitted to the department by approved organizations.
(f)  The  commissioner  shall adjust subsidy payments made to approved
organizations on and after April  first,  two  thousand  eleven  through
March thirty-first, two thousand twelve, so that the amount of each such
payment is reduced by one and seven-tenths percent.
(g)  The  commissioner  may increase subsidy payments made to approved
organizations that voluntarily participate in  the  multi-payor  patient
centered  medical  home  program  to reflect additional costs associated
with enhanced payments made  to  certified  medical  homes  by  approved
organizations as required by article twenty-nine-AA of this chapter.
(h) Notwithstanding any inconsistent provision of this title, articles
thirty-two  and  forty-three  of the insurance law and subsection (e) of
section eleven hundred twenty of the insurance law, for the period April
first, two thousand fourteen through March  thirty-first,  two  thousand
fifteen,  subsidy  payments  made  to approved organizations shall be at
amounts approved prior to April first, two thousand fourteen.
(i) Notwithstanding any inconsistent provision of this title, articles
thirty-two and forty-three of the insurance law and  subsection  (e)  of
section eleven hundred twenty of the insurance law:
(i) The commissioner shall, subject to approval of the director of the
division   of   the  budget,  develop  reimbursement  methodologies  for
determining  the  amount  of   subsidy   payments   made   to   approved
organizations  for  the  cost  of  covered health care services coverage
provided pursuant to this title for payments made on and  after  January
first, two thousand twenty-four.
(ii)   Effective   January   first,  two  thousand  twenty-three,  the
commissioner shall  coordinate  with  the  superintendent  of  financial
services for the transition of the subsidy payment rate setting function
to  the  department  and,  in  conjunction with its independent actuary,
review  reimbursement  methodologies  developed   in   accordance   with
subparagraph  (i) of this paragraph. Notwithstanding section one hundred
sixty-three of the state finance law, the commissioner  may  select  and
contract  with  the independent actuary selected pursuant to subdivision
eighteen of section three hundred sixty-four-j of  the  social  services
law,  without  a  competitive  bid or request for proposal process. Such
independent actuary shall review  and  make  recommendations  concerning
appropriate  actuarial  assumptions  relevant  to  the  establishment of
reimbursement methodologies, including but not limited to  the  adequacy
of  subsidy  payment  amounts in relation to the population to be served
adjusted for case mix, the scope of services approved organizations must
provide, the utilization of such services and the network  of  providers
required to meet state standards.
9. The commissioner shall, within amounts available therefor, contract
with  community-based  and other marketing organizations for purposes of
public  education,  outreach,  and  recruitment  of  eligible  children,
including  the  distribution  of  applications and information regarding
enrollment. In awarding such contracts, the commissioner shall  consider
the   marketing,   outreach   and   recruitment   efforts   of  approved
organizations, and the extent to which such organizations  are  able  to
effectively target efforts in geographic regions where the proportion of
eligible  children  enrolled  under  this  title are lower than in other
geographic regions of the  state.  Community-based  organizations  shall
include,   but   not   be   limited   to:  day  care  centers,  schools,
community-based diagnostic and treatment centers, and hospitals.
10. Notwithstanding any other law or agreement to  the  contrary,  and
except  in the case of a child or children who also becomes eligible for
medical assistance,  benefits  under  this  title  shall  be  considered

secondary  to any other plan of insurance or benefit program, except the
children and youth with  special  health  care  needs  support  services
program  and  the  early  intervention  program, under which an eligible
child may have coverage.
11.  (a)  An  approved  organization shall submit required reports and
information to the commissioner in such form  and  at  times,  at  least
annually,  as  may  be  required  by  the  commissioner and specified in
contracts and official department of health administrative guidance,  in
order  to evaluate the operations and results of the program and quality
of  care  being  provided  by  such  organizations.  Such  reports   and
information  shall include, but not be limited to, enrollee demographics
(applicable only until the  state  enrollment  center  is  implemented),
program  utilization  and  expense,  patient  care  outcomes and patient
specific medical information, including encounter data maintained by  an
approved  organization  for purposes of quality assurance and oversight.
Any information or data collected pursuant to this  paragraph  shall  be
kept  confidential  in  accordance  with Title XXI of the federal social
security act or any other applicable state or federal law.
(b) In the event an approved organization fails to submit any required
report  and  information,  as  specified  in  contracts   and   official
department  of health administrative guidance, on or before the due date
specified by the commissioner, the commissioner may reduce the  approved
organization's  subsidy  payments  by  up to a total of two percent each
month for a period beginning on the first  day  of  the  calendar  month
following  the  original due date of the required report and information
and continuing until the last day of the calendar  month  in  which  the
required  report  and  information  are  submitted; provided however, an
approved organization shall not be subject to the  percentage  reduction
under  the  following  conditions: (i) for any new report for which such
organization did not have reasonable notice  which  shall  be  at  least
sixty   days   notice   of   its   requirement,   data   and  submission
specifications,  and  due  date  by  certified  mail  to  the   approved
organization's  chief  financial officer; or (ii) for any report, upon a
finding by the commissioner that such report  was  not  submitted  on  a
timely  basis  for good cause, which may include, but not be limited to,
additional time required to modify or add to computer data systems.
12. The commissioner shall, in consultation with  the  superintendent,
establish  procedures to coordinate the child health insurance plan with
the medical assistance program, including but not limited to, procedures
to maximize enrollment of eligible  children  under  those  programs  by
identification  and  transfer of children who are eligible or who become
eligible to receive medical  assistance  and  procedures  to  facilitate
changes  in  enrollment  status  for  children  who  are  ineligible for
subsidies under this section and for children who are no longer eligible
for medical assistance in order to facilitate and ensure  continuity  of
coverage.  The  commissioner  shall  review,  on  an  annual  basis, the
eligibility verification  and  recertification  procedures  of  approved
organizations  under  this title to insure the appropriate enrollment of
children. Such review shall include, but not be limited to, an audit  of
a  statistically  representative sample of cases from among all approved
organizations and shall be applicable to  any  period  during  which  an
approved    organization's    responsibilities    include    determining
eligibility. In the event such review and audit reveals cases  which  do
not  meet  the  eligibility  criteria  for  coverage  set  forth in this
section,  that  information  shall  be   forwarded   to   the   approved
organization and the commissioner for appropriate action.
12-a.  The  commissioner  shall establish procedures to audit approved
organizations for  compliance  with  the  requirements  of  this  title,

including  the  requirements  of  subdivision  twelve  of  this section,
contractual provisions established  thereunder  and  advisory  memoranda
issued by the commissioner, title XXI of the federal social security act
and  any implementing federal regulations, and requirements set forth in
the state child health plan established pursuant to  title  XXI  of  the
federal  social  security  act. Approved organizations shall comply with
such procedures and make available any data necessary  to  perform  such
audits.  Audit  procedures  shall  include,  but  not be limited to, the
following:
(a) standards and procedures for a preliminary audit to  be  conducted
on no more than an annual basis;
(b)  standards  and  procedures  for  the  submission  of  a  plan  of
correction by an approved organization, including time  periods  allowed
to implement such plan of correction;
(c)  standards  and  procedures  for a second audit, including an exit
conference which provides an approved organization  the  opportunity  to
rebut  the  composition  of  the audit sample as representative prior to
recovery of subsidy payments and the imposition of penalties;
(d) standards and procedures for recovery of subsidy payments made for
ineligible children, which, notwithstanding any inconsistent  provisions
of  this  title,  may  include recoveries based on extrapolated findings
from a statistically representative  sample  of  cases  which  shall  be
actuarially based and consistent with accepted auditing standards; and
(e)  standards  and  procedures  for  the  imposition of penalties for
substantial noncompliance, which may include, but  not  be  limited  to,
financial penalties in addition to penalties set forth in section twelve
of  this  chapter  and  consistent with applicable federal standards, as
specified in contracts, and contract termination; provided however
(f) audit  standards  and  procedures  established  pursuant  to  this
section,   including  penalties,  shall  be  applicable  to  eligibility
determinations made by approved organizations only  for  periods  during
which  an  approved  organization's responsibilities include making such
eligibility determinations.
14. The commissioner, in consultation with the  superintendent,  shall
enter   into   agreements  with  one  or  more  persons,  not-for-profit
corporations, or other  organizations,  other  than  a  state  employee,
official or agency, for the performance of a comprehensive evaluation of
the  implementation  and  effectiveness  of  the  child health insurance
program.  Notwithstanding  any  inconsistent  provision  of   law,   the
commissioner  may allocate and distribute from funds otherwise available
for distribution for purposes of this title an amount not to exceed five
hundred  thousand  dollars  for  the  costs  of  such  evaluation.   The
evaluation shall include, but not be limited to:
(a) the overall effect of the child health insurance program on access
to,  utilization  and  quality  of  primary  and  preventive health care
services,  including,  but  not  limited   to,   patterns   of   service
utilization,  geographic  availability  of  service  providers, possible
reductions in uncompensated  care  as  a  result  of  the  program,  and
enrollee satisfaction with program administration, services and quality;
(b)  the  impact  of  the child health insurance program on the health
status of program participants,  including  the  comparative  impact  on
families  that  have  a child enrolled in the program and other children
that are not eligible and do not have coverage;
(c) the effect of the child health insurance program on emergency room
utilization, including the  effectiveness  of  preventing  inappropriate
utilization;
(d)  the  geographic  accessibility  of  the  child  health  insurance
program,  including  the  availability  and  accessibility  of   service
providers, premium levels and premium increases;
(e)  the  effect  of  community-based and statewide outreach education
efforts;
(f) the results of a statistically valid sampling of  cases  verifying
certification  and  recertification  of eligibility for subsidy payments
under this title including  but  not  limited  to  data  on  failure  by
approved organizations to adequately verify enrollee eligibility;
(g)  any recommendations for programmatic changes to improve the child
health insurance  program  based  on  program  evaluation  and  enrollee
satisfaction data; and
(h)  a  cost  and  patient  outcome  comparison of indemnity plans and
managed care plans offered under this program.
A preliminary evaluation shall be submitted to the  governor  and  the
legislature  by  April first, nineteen hundred ninety-five and a further
evaluation  shall  be  submitted  by  January  first,  nineteen  hundred
ninety-six.
14-a.  The commissioner shall enter into an agreement with one or more
persons, not-for-profit corporations, or other organizations, other than
a  state  employee,  official  or  agency,  for  comprehensive  research
concerning  the  health care coverage of children in New York state. The
organization conducting the research shall, at least annually,  issue  a
report of its findings to the governor and the legislature. The research
shall include, but not be limited to:
(a) a survey of the uninsured in the state;
(b) on-going comprehensive studies of the characteristics of uninsured
children  and their families, including demographic characteristics, and
reasons such children and families are uninsured;
(c) the collection  and  dissemination  of  data  and  other  relevant
information  relating  to the health care coverage of children and their
families; and
(d) a review of such factors relating to the  uninsured  in  New  York
state  as  the  commissioner,  in  consultation with the superintendent,
shall require.
15. Notwithstanding any inconsistent provision of section one  hundred
twelve  or one hundred sixty-three of the state finance law or any other
law, at the discretion of the commissioner without a competitive bid  or
request for proposal process:
(a)  contractual  arrangements  with approved organizations to provide
primary and  preventive  health  care  services  coverage  for  eligible
children,  or  with  organizations  for  purposes  of  public education,
outreach and recruitment of eligible children,  in  effect  in  nineteen
hundred  ninety-three  may  be  extended  to  provide  for  primary  and
preventive health care services coverage for eligible children or public
education, outreach and recruitment of  eligible  children  in  nineteen
hundred   ninety-four   and   nineteen  hundred  ninety-five  and  those
contractual arrangements with approved organizations to provide  primary
and  preventive  health  care services coverage for eligible children in
effect for nineteen hundred ninety-five may  be  extended  through  June
thirtieth,  nineteen  hundred  ninety-six  to  provide  an uninterrupted
continuation of services and additional time for program evaluation  and
may  be  amended  as  may  be  necessary,  provided,  however,  that the
commissioner shall periodically review the process of ensuring  adequate
participation of approved organizations under this section; and
(b)  contractual  arrangements  with approved organizations to provide
primary and  preventive  health  care  services  coverage  for  eligible
children,  or  with  organizations  for  purposes  of  public education,

outreach and recruitment of eligible children in effect  in  the  period
January  first,  nineteen  hundred  ninety-six  through  June thirtieth,
nineteen hundred  ninety-six  may  be  extended  for  public  education,
outreach   and   recruitment   of  eligible  children  through  December
thirty-first, nineteen hundred ninety-six and to provide for primary and
preventive health care services coverage for eligible  children  through
such  periods  for  which  such coverage continues to apply prior to the
addition of coverage for inpatient health care services  to  provide  an
uninterrupted  continuation  of  services  and  may be amended as may be
necessary.
* 16. The commissioner and the commissioner of social  services  shall
jointly  develop  a  simplified application form for coverage under this
title, the medical assistance program and the federal women, infants and
children program, and shall also develop  appropriate  verification  and
sampling  procedures  for  the  child  health insurance plan in order to
facilitate the appropriate enrollment  of  eligible  children  into  the
child  health  insurance  plan,  the medical assistance program, and the
women, infants and children program. Nothing in this  subdivision  shall
be  construed to require that eligibility documentation requirements for
the services under this title shall  apply  to  the  medical  assistance
program, nor shall this subdivision be construed to preclude eligibility
for  any  person  pending  the  development  of  that  application. Such
application  shall  be  available  for  use  by  local  social  services
districts and approved organizations under this title by June thirtieth,
nineteen hundred ninety-four.
* NB Expired July 1, 2007
16-a. The commissioner shall develop a simplified recertification form
for  use  by  approved  organizations  in renewing coverage for eligible
children under this title. The form shall include requests only for such
information that is: (i) reasonably  necessary  to  determine  continued
eligibility  for  coverage  under this title; and (ii) subject to change
since the date of the household's initial application.
17. The commissioner, in  consultation  with  the  superintendent,  is
authorized  to  establish and operate a child health information service
which shall utilize advanced telecommunications technologies to meet the
health information and support needs of children,  parents  and  medical
professionals,  which  shall  include,  but not be limited to, treatment
guidelines for children,  treatment  protocols,  research  articles  and
standards  for the care of children from birth through eighteen years of
age. Such information shall not constitute the practice of medicine,  as
defined in article one hundred thirty-one of the education law.
18. Premium Assistance Program. (a) The commissioner shall establish a
premium  assistance  program for the purchase of family coverage under a
group health plan or health insurance coverage that includes coverage of
an eligible child, as defined in subdivision four of section twenty-five
hundred ten of this article, contingent upon:
(i) a determination by the commissioner that the  purchase  of  family
coverage under this subdivision is cost effective relative to the amount
the  state  would pay to obtain coverage under this title solely for the
eligible child or children; and
(ii) the availability of federal financial participation in accordance
with a waiver application submitted by the commissioner and approved  by
the secretary of the department of health and human services.
(b)  The  commissioner  shall  establish and specify standards for the
implementation of the premium assistance program in the  federal  waiver
application, including, but not limited to, the following:
(i)  standards  for  eligibility  of  children  and  families  for and
enrollment in the premium assistance program which shall include,  at  a

minimum,  the  eligibility criteria set forth in subdivision two of this
section; provided that:
(A)  participation  in  the  program  for  a  child  who  resides in a
household having a household  income  at  or  below  two  hundred  fifty
percent of the non-farm federal poverty level (as defined and updated by
the  United  States  department  of  health and human services) shall be
voluntary  and  an  eligible  child  may  disenroll  from  the   premium
assistance  program  at any time and enroll in individual coverage under
this title; and
(B) participation in  the  program  for  a  child  who  resides  in  a
household  having  a  household income between two hundred fifty-one and
four hundred percent of the non-farm federal poverty level  (as  defined
and  updated  by  the  United  States  department  of  health  and human
services) and meets certain eligibility criteria shall be  mandatory.  A
child  in this income group who meets the criteria for enrollment in the
premium assistance program shall not be eligible for individual coverage
under this title;
(ii) standards for required levels of  employer  contributions  toward
the cost of premiums for family coverage;
(iii)  standards  for  the  level  of state payment toward the cost of
premiums for family coverage;
(iv) standards for the scope and level of benefits to be  provided  in
the premium assistance program;
(v)  standards for data collection including, but not limited to, data
regarding the substitution of health insurance coverage  that  would  be
provided  to  eligible  children  in  the  absence  of  family  coverage
purchased pursuant to this subdivision; and
(vi) any other standards  deemed  necessary  by  the  commissioner  to
implement the premium assistance program.
(c)  The state share of the cost of the premium assistance program, if
implemented, shall be funded within amounts appropriated for the purpose
of providing healthcare coverage for uninsured and underinsured children
pursuant to this title.
19. Claims submitted to  an  approved  organization  for  payment  for
medical  care,  services,  or  supplies  furnished  by an out-of-network
health care provider must be submitted within fifteen months of the date
the medical care, services, or supplies were furnished  to  an  eligible
person to be valid and enforceable against the approved organization. If
a  claim  by  an  out-of-network  health  care provider is not submitted
within fifteen months of the date that the  medical  care,  services  or
supplies  were  furnished  and  the  claim is subsequently denied by the
approved organization for that reason, such out-of-network  health  care
provider  shall  not  seek  payment  for  such medical care, services or
supplies from the enrollee. This deadline for  claims  submission  shall
not  apply  where the claims submission is warranted to address findings
or recommendations identified in a state or federal audit  except  where
such  audit  also  indicates  that an inappropriate provider payment was
solely the fault of the out-of-network health care provider.
20. For approved organizations with negotiated rates  of  payment  for
inpatient  hospital  services  under contracts in effect on April first,
two thousand eight, that  have  a  payment  rate  methodology  for  such
inpatient  hospital  services  that  utilizes  rates  calculated  by the
department of health pursuant to paragraph (a) or (a-2)  of  subdivision
one of section twenty-eight hundred seven-c of the public health law for
patients  under  the  medical  assistance  program,  such rate shall not
include adjustments pursuant  to  subdivision  thirty-three  of  section
twenty-eight  hundred seven-c of this chapter for contract periods prior
to January first, two thousand ten.
21. The commissioner may make any necessary amendments to  a  contract
pursuant  to  this  section with an approved organization, as defined in
subdivision two of section twenty-five hundred ten  of  this  title,  to
allow  such  approved  organization to participate as a qualified health
plan  in  a  state  health  benefit exchange established pursuant to the
federal Patient Protection and Affordable Care Act  (P.L.  111-148),  as
amended  by  the federal Health Care and Education Reconciliation Act of
2010 (P.L. 111-152).
22. Notwithstanding the provisions of this title and effective on  and
after  January  first,  two  thousand  twenty-three,  the  consultative,
review, and  approval  functions  of  the  superintendent  of  financial
services  related  to  administration of the child health insurance plan
are no longer applicable and references to those functions in this title
shall be null and void. The child health insurance  plan  set  forth  in
this  title  shall be administered solely by the commissioner. All child
health  insurance  plan  policies   reviewed   and   approved   by   the
superintendent  of  financial services in accordance with section eleven
hundred twenty of the insurance law shall remain  in  effect  until  the
commissioner   establishes  a  process  to  review  and  approve  member
handbooks in accordance with  the  requirements  of  Title  XXI  of  the
federal  social  security  act  and  implementing  regulations, and such
member handbooks are issued by approved organizations  to  enrollees  in
place  of  child  health  insurance  plan policies which were subject to
review under section eleven hundred twenty of the insurance law.