New York Public Health Code § 4403-A

Special purpose certificate of authority
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* § 4403-a. Special purpose certificate of authority. 1. The\ncommissioner may issue a special purpose certificate of authority to a\nprovider, applying on forms prescribed by the commissioner, seeking to\noffer a comprehensive health services plan on a prepaid contractual\nbasis either directly, or through an arrangement, agreement or plan or\ncombination thereof to an enrolled population, which is substantially\ncomposed of persons eligible to receive benefits under title XIX of the\nfederal social security act or other public programs.\n  2. A not-for-profit corporation established to operate a hospital\npursuant to article twenty-eight of this chapter, a government agency,\nan entity or a group of entities seeking to provide comprehensive health\nservices pursuant to the provisions of this section may apply for a\nspecial purpose certificate of authority; provided, however, that a\nshared health facility, as defined by article forty-seven of the public\nhealth law, shall not be eligible for such a certificate.\n  3. The commissioner shall not issue a special purpose certificate of\nauthority unless the applicant has demonstrated to the commissioner's\nsatisfaction that the requirements of this article and any regulations\npromulgated pursuant thereto have been met and will continue to be met,\nprovided, however, that the commissioner may waive one or more of such\nrequirements, or portions thereof, pertaining to financial risk,\nemployer requirements and subscriber contracts if he determines that\nsuch waiver will serve to promote the efficient provision of\ncomprehensive health services and that the proposed plan will provide an\nappropriate and cost-effective alternative method for the delivery of\nsuch services in a manner which will meet the needs of the population to\nbe served.\n  4. (a) No contract for the provision of comprehensive health services\npursuant to this section shall be entered into by a local social\nservices district unless the commissioner certifies that all pertinent\nrequirements with respect to financial arrangements, rates, and\nstandards relating to arrangements for and the delivery of patient care\nservices have been satisfied and that the contract and related\narrangements will ensure access to and the delivery of high quality,\nappropriate medical services including an assurance that recipients'\naccess to preventive health services is not diminished.\n  (b) No contract for the provision of comprehensive health services to\npersons eligible for medical assistance under title eleven of article\nfive of the social services law shall be entered into without the\napproval of the commissioner of social services pursuant to section\nthree hundred sixty-five-a of the social services law and the state\ndirector of the budget. The commissioner of social services shall not\napprove such a contract unless the contract:\n  (i) provides that enrollment shall be voluntary and contains\nprovisions to ensure that persons eligible for medical assistance will\nbe provided sufficient information regarding the plan to make an\ninformed and voluntary choice whether to enroll or, in the event that\nenrollment in the entity is pursuant to section three hundred\nsixty-four-j of the social services law, provides that enrollment in the\nentity is governed by that section;\n  (ii) provides adequate safeguards to protect persons eligible for\nmedical assistance from being misled concerning the plan and from being\ncoerced into enrolling in the plan or, in the event that enrollment in\nthe entity is undertaken pursuant to section three hundred sixty-four-j\nof the social services law, provides that enrollment in the entity is\ngoverned by that section;\n  (iii) establishes adequate opportunities for public review and comment\nprior to implementation of the plan;\n  (iv) provides adequate grievance procedures for recipients who enroll\nin the plan; and\n  (v) establishes quality assurance mechanisms.\n  5. A special purpo

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