§ 4409. Health maintenance organizations; examinations. 1. In order to
carry out the provisions of this article, the commissioner, pursuant to
his authority under section two hundred six of this chapter, shall
examine not less than once every three years, each health maintenance
organization and all participating entities through which such health
maintenance organization offers health services as to the quality of
health care services offered, and the adequacy of its provider
arrangements.

2. (a) The superintendent shall examine not less than once every three
years into the financial affairs of each health maintenance
organization, and transmit his findings to the commissioner. In
connection with any such examination, the superintendent shall have
convenient access at all reasonable hours to all books, records, files
and other documents relating to the affairs of such organization, which
are relevant to the examination. The superintendent may exercise the
powers set forth in sections three hundred six and three hundred ten of
the insurance law in connection with such examinations, and may also
require special reports from such health maintenance organizations as
specified in section three hundred eight of the insurance law. As part
of an examination, the superintendent shall review determinations of
coverage for substance use disorder treatment and shall ensure that such
determinations are issued in compliance with section four thousand three
hundred three of the insurance law and title one of article forty-nine
of this chapter.

(b) The department is authorized to address to any health maintenance
organization, and managed long term care plan with a certificate of
authority pursuant to section forty-four hundred three-f of this
article, or officers thereof, any inquiry in relation to its contracts
with providers and other entities providing covered services to the
health maintenance organization's or managed long term care plan's
enrollees, including but not limited to the rates of payment and payment
terms and conditions therein. Every entity or person so addressed shall
reply in writing to such inquiry promptly and truthfully, and such reply
shall be, if required by the department, signed by such individual, or
by such officer or officers of a corporation, as the department shall
designate, and affirmed by them as true under penalty of perjury.
Failure to comply with the requirements of this section shall be subject
to civil penalties under section twelve of this chapter. Each day after
the deadline established by the department for reply until such time
that the provider submits a good faith response shall be considered a
separate and subsequent violation. In accordance with the process
outlined in this paragraph, employers shall provide any documents or
materials in the employer's possession, custody, or control that are
requested by the department as needed to support or verify the
employer's reply.

(c) Any report, information, documents, or other materials furnished
to the department under this subdivision shall be deemed a confidential
communication and shall not be subject to inspection or disclosure in
any manner, including article six of the public officers law or
department regulations in conformance therewith, except as provided in
this section, pursuant to a judicial subpoena issued in a pending action
or proceeding, or upon formal written request by the department of
labor, the office of attorney general, or a duly authorized public
agency.

(d) The department shall no less than annually provide a report to the
governor, temporary president of the senate, and speaker of the assembly
summarizing the information obtained by the department under paragraph
(b) of this subdivision. Such report shall not contain individually
identifiable data.

3. The superintendent and the commissioner are authorized to share and
exchange information obtained by them in the exercise of their
respective responsibilities under the insurance law and this chapter.

4. Nothing contained in this section shall be deemed to require the
public disclosure of privileged patient information.