N.Y. Insurance Law § 4307: Providers of services

§ 4307. Providers of services. (a) Any hospital service corporation or

health service corporation may provide benefits for the rendering of

hospital service to persons covered under its contracts (i) by hospitals

maintained by the state or any of its political subdivisions, or

maintained by a corporation organized for hospital purposes under the

not-for-profit corporation law, (ii) by such other hospitals,

convalescent institutions and nursing homes as shall have been approved

by the commissioner of health for such purpose, (iii) with such private

or public instrumentalities providing home nursing services as shall

have been approved by the commissioner of health for such purpose,

and/or (iv) subject to the approval of the superintendent, with similar

corporations of other states and hospitals of other states subject to

the supervision of such other states.

* (d) In the event a health maintenance organization which is either

licensed as a health service corporation under this article or is

operating pursuant to a certificate of authority granted in accordance

with the provisions of article forty-four of the public health law, or

any other health service corporation is deemed insolvent, as provided in

subsection (c) of section four thousand three hundred ten of this

article, then no individual subscriber or enrollee of, or served by, the

health maintenance organization or health service corporation shall be

liable to any provider of health care services for any covered services

of the insolvent health maintenance organization or health service

corporation. No provider of health care services or any representative

of such provider shall collect or attempt to collect from the individual

subscriber or enrollee sums owed by a health maintenance organization or

health service corporation deemed insolvent, and no provider or

representative of such provider may maintain any action at law against

an individual subscriber or enrollee to collect sums owed to such

provider by such health maintenance organization or health service

corporation.

* NB Amended by § 112-a and Repealed by § 143 of 639/96

* § 4307. Providers of services. (a) Any hospital service corporation

or health service corporation may provide benefits for the rendering of

hospital service to persons covered under its contracts (i) by hospitals

maintained by the state or any of its political subdivisions, or

maintained by a corporation organized for hospital purposes under the

not-for-profit corporation law, (ii) by such other hospitals,

convalescent institutions and nursing homes as shall have been approved

by the commissioner of health for such purpose, (iii) with such private

or public instrumentalities providing home nursing services as shall

have been approved by the commissioner of health for such purpose,

and/or (iv) subject to the approval of the superintendent, with similar

corporations of other states and hospitals of other states subject to

the supervision of such other states.

(b) All rates of payments to hospitals, nursing homes, convalescent

institutions and instrumentalities providing home nursing services made

by such corporation pursuant to the contracts provided for in subsection

(a) hereof shall prior to payment, (i) in the case of institutions

subject to article twenty-eight of the public health law, be certified

by the commissioner of health pursuant to the provisions of such article

twenty-eight of the public health law and approved by the

superintendent, and, (ii) in the case of other institutions, approved as

to reasonableness by the superintendent.

(c) Notwithstanding subsections (a) and (b) of this section, approval

by the superintendent shall not be required for rates of payment by

article forty-three corporations for in-patient hospital services

provided after December thirty-first, nineteen hundred eighty-three by

general hospitals subject to article twenty-eight of the public health

law.

(d) After approval by the superintendent each corporation organized

under this article shall notify each hospital and health related service

of its approved rates of payment for out-patient services, in instances

where such rates are determined on the basis of a cost based formula, at

least thirty days prior to the beginning of each rate year.

* NB Expired January 1, 1986. Remains effective prior to such date.

See ch 906/85 § 3