N.Y. Public Health Law § 4402: Health maintenance organizations; application for certificate of authority

§ 4402. Health maintenance organizations; application for certificate

of authority. 1. No person or groups of persons may operate a health

maintenance organization or issue a contract to an enrollee for

membership in a comprehensive health services plan without first

obtaining a certificate of authority from the commissioner.

2. In order to receive such a certificate of authority, a person or

persons, hereinafter designated as the applicant, intending to operate a

health maintenance organization shall file an application for such

certificate on such form as the commissioner shall prescribe, and shall

provide to the satisfaction of the commissioner the following:

(a) a copy of each of the basic organizational documents and

agreements of the applicant and all participating entities, including

all contracts and agreements relating to the provision of comprehensive

health services;

(b) a copy of the bylaws, rules and regulations on internal governing

documents of the applicant;

(c) a list of the names, addresses and official positions of the

persons comprising the applicant and all entities referred to in

paragraph (a) other than those possessing a valid operating certificate

under the provisions of article twenty-eight of this chapter, including

all owners of record or beneficial, all members of the governing body,

the officers and directors in the case of a corporation, and the

partners or members in the case of a partnership or corporation, and the

agent for service of process;

(d) a statement of the financial condition of the organization,

including, if appropriate, an income statement, balance sheet and

projected sources and uses of funds;

(e) a statement generally describing the proposed operation of the

health maintenance organization as to the location of its facilities,

the type and quantity of health care personnel engaged to provide

services, its quality assurance mechanism, its grievance procedure,

participating hospitals and such other data as may be required by the

commissioner;

(f) a copy of each enrollee contract filed with and approved by the

superintendent pursuant to section forty-four hundred six of this

article; and

(g) such other information as may be required by the commissioner to

make the determinations required in section forty-four hundred three of

this article.