New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter B - Property and Casualty Insurance
Part 68 - Charges For Professional Health Services
Section 68.9 - Health services provided through a managed care organization
Current through Register Vol. 46, No. 12, March 20, 2024
(a) Notwithstanding any other provision of this Part, a health care provider participating in a certified managed care organization pursuant to an approved managed care program, in accordance with section 5109 of the Insurance Law, may accept a fee, or agree to bundle services for fees, different than the fees prescribed in this Part, provided that costs for medical and other health care services provided by managed care organizations for an insurer's managed care program shall not, in the aggregate, exceed the costs that would be otherwise payable by application of the fee schedules established by the superintendent or the Chair of the Workers' Compensation Board.
(b) No insurer subject to this Part shall contract with a managed care organization on a capitation basis, unless the managed care organization is:
