N.Y. Public Health Law § 4406-h: Health care facility applications

§ 4406-h. Health care facility applications. 1. A health care plan

shall, upon request, make available and disclose to facilities written

application procedures and minimum qualification requirements that a

facility must meet in order to be considered by the health care plan for

participation in the in-network benefits portion of the health care

plan's network. The health care plan shall consult with appropriately

qualified facilities in developing its qualification requirements. A

health care plan shall complete review of the facility's application to

participate in the in-network portion of the health care plan's network

and shall, within sixty days of receiving a facility's completed

application to participate in the health care plan's network, notify the

facility as to: (a) whether the facility is credentialed; or (b) whether

additional time is necessary to make a determination because of a

failure of a third party to provide necessary documentation. In such

instances where additional time is necessary because of a lack of

necessary documentation, a health care plan shall make every effort to

obtain such information as soon as possible and shall make a final

determination within twenty-one days of receiving the necessary

documentation.

2. For the purposes of this section, "facility" shall mean a health

care provider entity or organization that is licensed or certified

pursuant to article five, twenty-eight, thirty-six, forty, forty-four,

or forty-seven of this chapter or article sixteen, nineteen, thirty-one,

thirty-two, or thirty-six of the mental hygiene law.