New York Laws
Article 44 - Health Maintenance Organizations
4403-E - Primary Care Partial Capitation Providers; Partial Capitation Certificate of Authority.

(a) current licensure or certification;
(b) a description of the applicant's experience in providing the
services included as part of comprehensive primary and preventive care,
including identification of any disciplinary, administrative or criminal
proceedings related to such license, certification or services and the
resolution thereof;
(c) a description of the applicant's financial resources, together
with a copy of the applicant's latest certified financial statement and
the medical malpractice insurance coverage maintained by such applicant;
(d) an assessment of the applicant's ability to continue to provide
high quality services in exchange for payments and to assume the
financial risk of operating on a partial capitation basis;
(e) the geographic area to be served by the applicant;
(f) the applicant's current capacity, and proposed capacity to provide
or directly arrange for the provision of medical care and services to
persons eligible for medical assistance;
(g) a statement of intent to contract from the local social services
district in which they will operate;
(h) a statement describing procedures to be used to monitor the
quality of care provided by the plan;
(i) such other information as the commissioner shall require; and
(j) in the case of an application from a local social services
district, such comparable information as the commissioner may require.
3. The commissioner may issue a partial capitation certificate of
authority to an applicant that meets the following criteria:
(a) the applicant can demonstrate its ability to control, arrange for
and manage in-patient hospital and emergency room care through written
agreements with participating hospitals;
(b) the applicant is board-certified or board-eligible in his or her
area of specialty, or has completed an accredited residency program, or
has admitting privileges at one or more hospitals, or in the case of an
entity, all medical services providers affiliated with the applicant are
board-certified or board-eligible in his or her area of specialty, has

completed an accredited residency program, or has admitting privileges
at one or more hospitals;
(c) the applicant directly provides or arranges for the delivery of
comprehensive primary and preventive care and services and access to
medical advice and emergency care on a twenty-four hour basis;
(d) the applicant has adequate medical malpractice liability insurance
coverage;
(e) the applicant has demonstrated it is financially responsible and
may be expected to meet its obligations to its enrolled members. For
purposes of this paragraph, "financially responsible" means that the
applicant shall assume financial risk on a prospective basis for the
provision of comprehensive primary care and preventive services, and can
support the necessary administrative costs associated with the
activities of a partial capitation plan, for its enrolled members;
(f) the applicant has demonstrated the ability to provide high quality
care, and to monitor the quality of care provided via an acceptable
formal quality assurance program;
(g) the local social services district has provided written evidence
of its intention to contract with the plan; and
(h) the applicant has demonstrated the ability to track and monitor
all services provided to its enrollees, and its ability to submit
periodic cost and utilization reports, as the commissioner may require.
* NB Repealed March 31, 2025