N.Y. Public Health Law § 4404: Health maintenance organizations; continuance of certificate of authority

§ 4404. Health maintenance organizations; continuance of certificate

of authority. 1. Continuance by the commissioner of a certificate of

authority issued under section forty-four hundred three of this article

shall be contingent upon satisfactory performance by the organization as

to the delivery, continuity, accessibility and quality of the services

to which an enrolled member is entitled, compliance with the provisions

of this article and rules and regulations promulgated thereunder, and

the continuing fiscal solvency of the organization as set out in this

section.

2. Except as provided in subdivision three of this section, the

commissioner may revoke, limit or annul a certificate of authority as of

the termination of the current period of all then existing enrollee

contracts, after a hearing, and only after a finding of unsatisfactory

performance or fiscal insolvency. However, in the event of such

revocation, limitation or annulment, the organization shall be

prohibited from entering into any new enrollee contracts as of the date

of notification of such action by the commissioner. Notification of such

action shall be given by the organization to each enrollee. The

commissioner shall give prior notice of such action to the

superintendent.

3. The commissioner may revoke or limit a certificate of authority,

after a hearing, for violations of any applicable statute or rules and

regulations which threatened to directly affect the health, safety or

welfare of any enrollee. Upon notice of his intent to revoke or limit a

certificate of authority, the commissioner may prohibit the organization

from entering into any new enrollee contracts pending final action and

may require notification of such action to be given by the organization

to each enrollee. The commissioner shall give prior notice to the

superintendent of his intent to prohibit the organization from entering

into any enrollee contracts. In any action pursuant to this subdivision,

the commissioner and the superintendent shall take action to assure the

continued insurance coverage of enrollees of the organization.

4. In addition to, or in lieu of, any revocation, limitation or

annulment, the commissioner may assess a penalty pursuant to section

twelve of this chapter for any violation of this chapter or rules and

regulations promulgated pursuant to this article.

5. All orders or determinations made in accordance with the provisions

of this section shall be subject to review as provided in article

seventy-eight of the civil practice law and rules. Application for such

review must be made within sixty days after service in person or by

registered mail of a copy of the order or determination upon the

organization.