* § 4403-f. Managed long term care plans. 1. Definitions. As used in\nthis section:\n (a) "Managed long term care plan" means an entity that has received a\ncertificate of authority pursuant to this section to provide, or arrange\nfor, health and long term care services, on a capitated basis in\naccordance with this section, for a population, age eighteen and over,\nwhich the plan is authorized to enroll.\n (b) "Eligible applicant" means an entity controlled or wholly owned by\none or more of the following: a hospital as defined in subdivision one\nof section twenty-eight hundred one of this chapter; a home care agency\nlicensed or certified pursuant to article thirty-six of this chapter; an\nentity that has received a certificate of authority pursuant to sections\nforty-four hundred three, forty-four hundred three-a or forty-four\nhundred eight-a of this article (as added by chapter six hundred\nthirty-nine of the laws of nineteen hundred ninety-six), or a health\nmaintenance organization authorized under article forty-three of the\ninsurance law; or a not-for-profit organization which has a history of\nproviding or coordinating health care services and long term care\nservices to the elderly and disabled.\n (c) "Operating demonstration" means the following entities: the\nchronic care management demonstration programs authorized by chapter\nfive hundred thirty of the laws of nineteen hundred eighty-eight,\nchapter five hundred ninety-seven of the laws of nineteen hundred\nninety-four and chapter eighty-one of the laws of nineteen hundred\nninety-five as amended.\n (d) "Health and long term care services" means services including, but\nnot limited to home and community-based and institution-based long term\ncare and ancillary services (that shall include medical supplies and\nnutritional supplements) that are necessary to meet the needs of persons\nwhom the plan is authorized to enroll. The managed long term care plan\nmay also cover primary care, acute care and behavioral health services\nif so authorized.\n 2. Certificate of authority; form. An eligible applicant shall submit\nan application for a certificate of authority to operate a managed long\nterm care plan upon forms prescribed by the commissioner. Such eligible\napplicant shall submit information and documentation to the commissioner\nwhich shall include, but not be limited to:\n (a) a description of the service area proposed to be served by the\nplan with projections of enrollment that will result in a fiscally sound\nplan;\n (b) a description of the proposed target population and the marketing\nplan;\n (c) adequate documentation of the appropriate licenses, certifications\nor approvals to provide care as planned, including contracts with such\nproviders as may be necessary to provide the full complement of services\nrequired to be provided under this section.\n 3. Certificate of authority; approval. The commissioner shall not\napprove an application for a certificate of authority unless the\napplicant demonstrates to the commissioner's satisfaction:\n (a) that it will have in place acceptable quality-assurance\nmechanisms, grievance procedures, mechanisms to protect the rights of\nenrollees and case management services to ensure continuity, quality,\nappropriateness and coordination of care;\n (b) that it will include an enrollment process which shall ensure that\nenrollment in the plan is informed. The application shall describe the\ndisenrollment process, which shall provide that an otherwise eligible\nenrollee shall not be involuntarily disenrolled on the basis of health\nstatus;\n (c) satisfactory evidence of the character and competence of the\nproposed operators and reasonable assurance that the applicant will\nprovide high quality services to an enrolled population;\n (d) sufficient management systems capacity to meet the requirements of\nthis section and the ability to efficiently process payment for covered\nservices;\n (e) readiness and capa
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