N.Y. Public Health Law Section 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 28 (Hospitals)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 § 4406 (Health maintenance organizations)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.

Source: Section 4405 — Health maintenance organizations; powers, https://www.­nysenate.­gov/legislation/laws/PBH/4405 (updated Sep. 22, 2014; accessed Oct. 26, 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
Green check means up to date. Up to date

Accessed:
Oct. 26, 2024

Last modified:
Sep. 22, 2014

§ 4405’s source at nysenate​.gov

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