* § 4403-a. Special purpose certificate of authority. 1. The
commissioner may issue a special purpose certificate of authority to a
provider, applying on forms prescribed by the commissioner, seeking to
offer a comprehensive health services plan on a prepaid contractual
basis either directly, or through an arrangement, agreement or plan or
combination thereof to an enrolled population, which is substantially
composed of persons eligible to receive benefits under title XIX of the
federal social security act or other public programs.

2. A not-for-profit corporation established to operate a hospital
pursuant to article twenty-eight of this chapter, a government agency,
an entity or a group of entities seeking to provide comprehensive health
services pursuant to the provisions of this section may apply for a
special purpose certificate of authority; provided, however, that a
shared health facility, as defined by article forty-seven of the public
health law, shall not be eligible for such a certificate.

3. The commissioner shall not issue a special purpose certificate of
authority unless the applicant has demonstrated to the commissioner's
satisfaction that the requirements of this article and any regulations
promulgated pursuant thereto have been met and will continue to be met,
provided, however, that the commissioner may waive one or more of such
requirements, or portions thereof, pertaining to financial risk,
employer requirements and subscriber contracts if he determines that
such waiver will serve to promote the efficient provision of
comprehensive health services and that the proposed plan will provide an
appropriate and cost-effective alternative method for the delivery of
such services in a manner which will meet the needs of the population to
be served.

4. (a) No contract for the provision of comprehensive health services
pursuant to this section shall be entered into by a local social
services district unless the commissioner certifies that all pertinent
requirements with respect to financial arrangements, rates, and
standards relating to arrangements for and the delivery of patient care
services have been satisfied and that the contract and related
arrangements will ensure access to and the delivery of high quality,
appropriate medical services including an assurance that recipients'
access to preventive health services is not diminished.

(b) No contract for the provision of comprehensive health services to
persons eligible for medical assistance under title eleven of article
five of the social services law shall be entered into without the
approval of the commissioner of social services pursuant to section
three hundred sixty-five-a of the social services law and the state
director of the budget. The commissioner of social services shall not
approve such a contract unless the contract:

(i) provides that enrollment shall be voluntary and contains
provisions to ensure that persons eligible for medical assistance will
be provided sufficient information regarding the plan to make an
informed and voluntary choice whether to enroll or, in the event that
enrollment in the entity is pursuant to section three hundred
sixty-four-j of the social services law, provides that enrollment in the
entity is governed by that section;

(ii) provides adequate safeguards to protect persons eligible for
medical assistance from being misled concerning the plan and from being
coerced into enrolling in the plan or, in the event that enrollment in
the entity is undertaken pursuant to section three hundred sixty-four-j
of the social services law, provides that enrollment in the entity is
governed by that section;

(iii) establishes adequate opportunities for public review and comment
prior to implementation of the plan;

(iv) provides adequate grievance procedures for recipients who enroll
in the plan; and

(v) establishes quality assurance mechanisms.

5. A special purpose certificate of authority shall be issued to an
approved provider of comprehensive health services for a maximum
effective period of twenty-four months subject to the applicable
provisions of section forty-four hundred four of this article and
provided that federal financial participation is available for
expenditures made on behalf of recipients of medical assistance. The
commissioner upon application, after consultation with the commissioner
of social services, may issue a certificate for an additional period of
up to twenty-four months if satisfied that the plan has and will
continue to demonstrate satisfactory performance and compliance with all
requirements imposed for initial certification. If the plan provides
comprehensive services pursuant to a contract solely to individuals
eligible for medical assistance under title eleven of article five of
the social services law, the certificate shall expire when (a) the
medical assistance contract is revoked or expires and is not extended or
renewed or (b) federal approval of the medical assistance contract is
withdrawn.

6. All individuals eligible for medical assistance enrolling
voluntarily in a comprehensive health services plan offered by an entity
with a special purpose certificate of authority will be given thirty
days from the effective date of enrollment in the plan to disenroll
without cause. After this thirty day disenrollment period, all
individuals participating in the plan will be enrolled for a period of
six months, except that all participants will be permitted to disenroll
for good cause, as defined by the commissioner of social services in
regulation.

7. Notwithstanding any inconsistent provision of this section, the
commissioner shall issue special purpose certificates of authority
pursuant to this section to no more than eighteen entities other than
those entities initially authorized by chapter seven hundred fifteen of
the laws of nineteen hundred eighty-two and by a chapter of the laws of
nineteen hundred eighty-four authorizing the Monroe county medicap
demonstration project.

* NB Expires March 31, 2026