New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter II - Administrative Rules and Regulations
Subchapter R - Health Maintenance Organizations
Part 98 - Health Maintenance Organizations
Subpart 98-1 - Managed Care Organizations
Section 98-1.7 - Limitations of a certificate of authority
Universal Citation: 10 NY Comp Codes Rules and Regs § 98-1.7
Current through Register Vol. 47, No. 12, March 26, 2025
(a) A certificate of authority pursuant to this Subpart shall be limited to the proposed article 44 service area described in the application upon which the certificate is issued.
(b) A certified operating MCO which seeks to extend its approved article 44 service area, and has defined a new potential enrolled population therein, shall submit an application, and shall not extend the service area until an amended certificate of authority is issued. An application for extension of the service area shall include:
(1) identification of the new service area
for which approval is sought, and the projected enrollment on a monthly basis
for three years;
(2) copies of all
proposed contracts with providers of services for the proposed new service
area; these contracts shall include the provisions in section
98-1.5(b)(6)(i)-(v)
of this Subpart;
(3) a list of
providers and facilities with whom contracts have been or will be executed,
including the location and specialty area of each provider; and
(4) except for PCPCPs, such other
information, including financial projections, as the commissioner, in
consultation with the superintendent, as appropriate, shall deem necessary to
determine the ability of the applicant to make services available and
accessible to the identified potential enrollment population, and to otherwise
approve the service area expansion application.
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