New York Laws
Title 11 - Medical Assistance for Needy Persons
365-E - Optional or Continued Membership in Entities Offering Comprehensive Health Services Plans.

§ 365-e. Optional or continued membership in entities offering
comprehensive health services plans. 1. In accordance with applicable
federal requirements and subject to the approval of the commissioner and
the director of the budget, a district shall offer to persons eligible
for medical assistance the option of membership in any health
maintenance organization or other entity which is certified under
article forty-four of the public health law or licensed pursuant to
article nine-C of the insurance law or otherwise authorized by law, and
which offers comprehensive health services plans to persons residing
within the social services district unless granted a waiver by the
commissioner on the grounds that the organization or entity is not
geographically accessible so as to provide medical assistance to
eligible recipients who reside within the district or that the per
recipient capitation rate is above the expected average per recipient
fee-for-service cost within the local district or that the health
maintenance organization or other entity refuses to enter into a
contract with the district.

2. Nothwithstanding any inconsistent provision of law, persons who,
prior to becoming eligible for medical assistance, are enrolled in a
health maintenance organization or other entity offering a comprehensive
health services plan shall be offered the option of continuing that
enrollment.

3. The commissioner shall offer to social services districts such
technical assistance as may be appropriate to assist in the development
of contracts between the districts and such entities.

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