§ 4307 — Providers of services

New York § 4307

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 43: Non-profit Medical and Dental Indemnity, or Health and Hospital Service Corporations

Text

§ 4307. Providers of services. (a) Any hospital service corporation or\nhealth service corporation may provide benefits for the rendering of\nhospital service to persons covered under its contracts (i) by hospitals\nmaintained by the state or any of its political subdivisions, or\nmaintained by a corporation organized for hospital purposes under the\nnot-for-profit corporation law, (ii) by such other hospitals,\nconvalescent institutions and nursing homes as shall have been approved\nby the commissioner of health for such purpose, (iii) with such private\nor public instrumentalities providing home nursing services as shall\nhave been approved by the commissioner of health for such purpose,\nand/or (iv) subject to the approval of the superintendent, with similar\ncorporations of other states and hospitals of other states subject to\nthe supervision of such other states.\n * (d) In the event a health maintenance organization which is either\nlicensed as a health service corporation under this article or is\noperating pursuant to a certificate of authority granted in accordance\nwith the provisions of article forty-four of the public health law, or\nany other health service corporation is deemed insolvent, as provided in\nsubsection (c) of section four thousand three hundred ten of this\narticle, then no individual subscriber or enrollee of, or served by, the\nhealth maintenance organization or health service corporation shall be\nliable to any provider of health care services for any covered services\nof the insolvent health maintenance organization or health service\ncorporation. No provider of health care services or any representative\nof such provider shall collect or attempt to collect from the individual\nsubscriber or enrollee sums owed by a health maintenance organization or\nhealth service corporation deemed insolvent, and no provider or\nrepresentative of such provider may maintain any action at law against\nan individual subscriber or enrollee to collect sums owed to such\nprovider by such health maintenance organization or health service\ncorporation.\n * NB Amended by § 112-a and Repealed by § 143 of 639/96\n * § 4307. Providers of services. (a) Any hospital service corporation\nor health service corporation may provide benefits for the rendering of\nhospital service to persons covered under its contracts (i) by hospitals\nmaintained by the state or any of its political subdivisions, or\nmaintained by a corporation organized for hospital purposes under the\nnot-for-profit corporation law, (ii) by such other hospitals,\nconvalescent institutions and nursing homes as shall have been approved\nby the commissioner of health for such purpose, (iii) with such private\nor public instrumentalities providing home nursing services as shall\nhave been approved by the commissioner of health for such purpose,\nand/or (iv) subject to the approval of the superintendent, with similar\ncorporations of other states and hospitals of other states subject to\nthe supervision of such other states.\n (b) All rates of payments to hospitals, nursing homes, convalescent\ninstitutions and instrumentalities providing home nursing services made\nby such corporation pursuant to the contracts provided for in subsection\n(a) hereof shall prior to payment, (i) in the case of institutions\nsubject to article twenty-eight of the public health law, be certified\nby the commissioner of health pursuant to the provisions of such article\ntwenty-eight of the public health law and approved by the\nsuperintendent, and, (ii) in the case of other institutions, approved as\nto reasonableness by the superintendent.\n (c) Notwithstanding subsections (a) and (b) of this section, approval\nby the superintendent shall not be required for rates of payment by\narticle forty-three corporations for in-patient hospital services\nprovided after December thirty-first, nineteen hundred eighty-three by\ngeneral hospitals subject to article twenty-eight of the public health\nlaw.\n (d) After approval by the superintendent each corporation organized\nunder this article shall notify each hospital and health related service\nof its approved rates of payment for out-patient services, in instances\nwhere such rates are determined on the basis of a cost based formula, at\nleast thirty days prior to the beginning of each rate year.\n * NB Expired January 1, 1986. Remains effective prior to such date.\nSee ch 906/85 § 3\n