§ 4403-A — Special purpose certificate of authority

* § 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 purpose certificate of authority shall be issued to an\napproved provider of comprehensive health services for a maximum\neffective period of twenty-four months subject to the applicable\nprovisions of section forty-four hundred four of this article and\nprovided that federal financial participation is available for\nexpenditures made on behalf of recipients of medical assistance. The\ncommissioner upon application, after consultation with the commissioner\nof social services, may issue a certificate for an additional period of\nup to twenty-four months if satisfied that the plan has and will\ncontinue to demonstrate satisfactory performance and compliance with all\nrequirements imposed for initial certification. If the plan provides\ncomprehensive services pursuant to a contract solely to individuals\neligible for medical assistance under title eleven of article five of\nthe social services law, the certificate shall expire when (a) the\nmedical assistance contract is revoked or expires and is not extended or\nrenewed or (b) federal approval of the medical assistance contract is\nwithdrawn.\n 6. All individuals eligible for medical assistance enrolling\nvoluntarily in a comprehensive health services plan offered by an entity\nwith a special purpose certificate of authority will be given thirty\ndays from the effective date of enrollment in the plan to disenroll\nwithout cause. After this thirty day disenrollment period, all\nindividuals participating in the plan will be enrolled for a period of\nsix months, except that all participants will be permitted to disenroll\nfor good cause, as defined by the commissioner of social services in\nregulation.\n 7. Notwithstanding any inconsistent provision of this section, the\ncommissioner shall issue special purpose certificates of authority\npursuant to this section to no more than eighteen entities other than\nthose entities initially authorized by chapter seven hundred fifteen of\nthe laws of nineteen hundred eighty-two and by a chapter of the laws of\nnineteen hundred eighty-four authorizing the Monroe county medicap\ndemonstration project.\n * NB Expires March 31, 2026\n