New York Laws
Article 44 - Health Maintenance Organizations
4403-A - Special Purpose Certificate of Authority.

(b) No contract for the provision of comprehensive health services to
persons eligible for medical assistance under title eleven of article
five of the social services law shall be entered into without the
approval of the commissioner of social services pursuant to section
three hundred sixty-five-a of the social services law and the state
director of the budget. The commissioner of social services shall not
approve such a contract unless the contract:
(i) provides that enrollment shall be voluntary and contains
provisions to ensure that persons eligible for medical assistance will
be provided sufficient information regarding the plan to make an
informed and voluntary choice whether to enroll or, in the event that
enrollment in the entity is pursuant to section three hundred
sixty-four-j of the social services law, provides that enrollment in the
entity is governed by that section;
(ii) provides adequate safeguards to protect persons eligible for
medical assistance from being misled concerning the plan and from being
coerced into enrolling in the plan or, in the event that enrollment in
the entity is undertaken pursuant to section three hundred sixty-four-j
of the social services law, provides that enrollment in the entity is
governed by that section;
(iii) establishes adequate opportunities for public review and comment
prior to implementation of the plan;
(iv) provides adequate grievance procedures for recipients who enroll
in the plan; and
(v) establishes quality assurance mechanisms.
5. A special purpose certificate of authority shall be issued to an
approved provider of comprehensive health services for a maximum
effective period of twenty-four months subject to the applicable
provisions of section forty-four hundred four of this article and
provided that federal financial participation is available for
expenditures made on behalf of recipients of medical assistance. The
commissioner upon application, after consultation with the commissioner
of social services, may issue a certificate for an additional period of
up to twenty-four months if satisfied that the plan has and will
continue to demonstrate satisfactory performance and compliance with all
requirements imposed for initial certification. If the plan provides
comprehensive services pursuant to a contract solely to individuals
eligible for medical assistance under title eleven of article five of
the social services law, the certificate shall expire when (a) the
medical assistance contract is revoked or expires and is not extended or
renewed or (b) federal approval of the medical assistance contract is
withdrawn.
6. All individuals eligible for medical assistance enrolling
voluntarily in a comprehensive health services plan offered by an entity
with a special purpose certificate of authority will be given thirty
days from the effective date of enrollment in the plan to disenroll
without cause. After this thirty day disenrollment period, all
individuals participating in the plan will be enrolled for a period of
six months, except that all participants will be permitted to disenroll
for good cause, as defined by the commissioner of social services in
regulation.
7. Notwithstanding any inconsistent provision of this section, the
commissioner shall issue special purpose certificates of authority
pursuant to this section to no more than eighteen entities other than
those entities initially authorized by chapter seven hundred fifteen of
the laws of nineteen hundred eighty-two and by a chapter of the laws of
nineteen hundred eighty-four authorizing the Monroe county medicap
demonstration project.
* NB Expires March 31, 2026