N.Y. Public Health Law Section 4402
Health maintenance organizations

  • application for certificate of authority

1.

No person or groups of persons may operate a health maintenance organization or issue a contract to an enrollee for membership in a comprehensive health services plan without first obtaining a certificate of authority from the commissioner.

2.

In order to receive such a certificate of authority, a person or persons, hereinafter designated as the applicant, intending to operate a health maintenance organization shall file an application for such certificate on such form as the commissioner shall prescribe, and shall provide to the satisfaction of the commissioner the following:

(a)

a copy of each of the basic organizational documents and agreements of the applicant and all participating entities, including all contracts and agreements relating to the provision of comprehensive health services;

(b)

a copy of the bylaws, rules and regulations on internal governing documents of the applicant;

(c)

a list of the names, addresses and official positions of the persons comprising the applicant and all entities referred to in paragraph (a) other than those possessing a valid operating certificate under the provisions of article 28 (Hospitals)article twenty-eight of this chapter, including all owners of record or beneficial, all members of the governing body, the officers and directors in the case of a corporation, and the partners or members in the case of a partnership or corporation, and the agent for service of process;

(d)

a statement of the financial condition of the organization, including, if appropriate, an income statement, balance sheet and projected sources and uses of funds;

(e)

a statement generally describing the proposed operation of the health maintenance organization as to the location of its facilities, the type and quantity of health care personnel engaged to provide services, its quality assurance mechanism, its grievance procedure, participating hospitals and such other data as may be required by the commissioner;

(f)

a copy of each enrollee contract filed with and approved by the superintendent pursuant to § 4406 (Health maintenance organizations)section forty-four hundred six of this article; and

(g)

such other information as may be required by the commissioner to make the determinations required in § 4403 (Health maintenance organizations)section forty-four hundred three of this article.

Source: Section 4402 — Health maintenance organizations; application for certificate of authority, https://www.­nysenate.­gov/legislation/laws/PBH/4402 (updated Sep. 22, 2014; accessed Jun. 15, 2024).

4400
Statement of policy and purposes
4401
Definitions
4402
Health maintenance organizations
4403
Health maintenance organizations
4403‑A
Special purpose certificate of authority
4403‑B
Development of comprehensive health services plans
4403‑C
Comprehensive HIV special needs plan certification
4403‑D
Special needs managed care plans
4403‑E
Primary care partial capitation providers
4403‑F
Managed long term care plans
4403‑G
Developmental disability individual support and care coordination organizations
4404
Health maintenance organizations
4405
Health maintenance organizations
4405‑A
Immunizations against poliomyelitis, mumps, measles, diphtheria and rubella
4405‑B
Duty to report
4406
Health maintenance organizations
4406‑A
Arbitration provisions of health maintenance organization contracts
4406‑B
Primary and preventive obstetric and gynecologic care
4406‑C
Prohibitions
4406‑D
Health care professional applications and terminations
4406‑E
Access to end of life care
4406‑F
Maternal depression screenings
4406‑G
Telehealth delivery of services
4406‑H
Health care facility applications
4406‑I
Utilization review determinations for medically fragile children
4407
Health maintenance organizations
4408
Disclosure of information
4408‑A
Integrated delivery systems
4408‑A*2
Grievance procedure
4409
Health maintenance organizations
4410
Health maintenance organizations
4411
Construction
4412
Separability
4413
Savings clause
4414
Health care compliance programs
4416
Excess reserves of certain health maintenance organizations

Accessed:
Jun. 15, 2024

Last modified:
Sep. 22, 2014

§ 4402’s source at nysenate​.gov

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