* § 364-j. Managed care programs. 1. Definitions. As used in this\nsection, unless the context clearly requires otherwise, the following\nterms shall mean:\n (a) "Participant". A medical assistance recipient who receives, is\nrequired to receive or elects to receive his or her medical assistance\nservices from a managed care provider.\n (b) "Managed care provider". An entity that provides or arranges for\nthe provision of medical assistance services and supplies to\nparticipants directly or indirectly (including by referral), including\ncase management; and:\n (i) is authorized to operate under article forty-four of the public\nhealth law or article forty-three of the insurance law and provides or\narranges, directly or indirectly (including by referral) for covered\ncomprehensive health services on a full capitation basis, including a\nspecial needs managed care plan or comprehensive HIV special needs plan;\nor\n ** (ii) is authorized as a partially capitated program pursuant to\nsection three hundred sixty-four-f of this title or section forty-four\nhundred three-e of the public health law or section 1915b of the social\nsecurity act; or\n ** NB Effective until December 31, 2027\n ** (ii) is authorized as a partially capitated program pursuant to\nsection three hundred sixty-four-f of this title or section forty-four\nhundred three-e of the public health law or section 1915b of the social\nsecurity act.\n ** NB Effective December 31, 2027\n ** (iii) is authorized to operate under section forty-four hundred\nthree-g of the public health law.\n ** NB Repealed December 31, 2027\n (c) "Managed care program". A statewide program in which medical\nassistance recipients enroll on a voluntary or mandatory basis to\nreceive medical assistance services, including case management, directly\nand indirectly (including by referral) from a managed care provider,\nincluding as applicable, a special needs managed care plan or a\ncomprehensive HIV special needs plan, under this section.\n (d) "Medical services provider". A physician, nurse, nurse\npractitioner, physician assistant, licensed midwife, dentist,\noptometrist or other licensed health care practitioner authorized to\nprovide medical assistance services.\n (e) "Center of excellence." A health care facility certified to\noperate under article twenty-eight of the public health law that offers\nspecialized treatment expertise in HIV care services as defined by the\ncommissioner of health.\n (f) "Primary care practitioner". A physician or nurse practitioner\nproviding primary care to and management of the medical and health care\nservices of a participant served by a managed care provider.\n (g) "AIDS". AIDS shall have the same meaning as in article\ntwenty-seven-f of the public health law.\n (h) "HIV infection". HIV infection shall have the same meaning as in\narticle twenty-seven-f of the public health law.\n (i) "HIV-related illness". HIV-related illness shall have the same\nmeaning as in article twenty-seven-f of the public health law.\n (j) "Specialty care center". A "specialty care center" shall mean only\nsuch centers as are accredited or designated by an agency of the state\nor federal government or by a voluntary national health organization as\nhaving special expertise in treating the disease or condition for which\nit is accredited or designated.\n (k) "Special care". Care, services and supplies relating to the\ntreatment of mental illness, developmental disabilities, alcoholism,\nalcohol abuse or substance abuse, or HIV infection/AIDS.\n (l) "Responsible special care agency". Whichever of the following\nstate agencies has responsibility for the special care in question: the\ndepartment of health, the office of mental health, the office for people\nwith developmental disabilities, or the office of alcoholism and\nsubstance abuse services.\n (m) "Special needs managed care plan" shall have the same meaning as\nin section forty-four hundred one of the public
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