N.Y. Comp. Codes R. & Regs. tit. 11 § 68.9

Current through Register Vol. 46, No. 51, December 18, 2024

Section 68.9 - Health services provided through a managed care organization

(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:

(1) a health maintenance organization issued a certificate of authority under article 44 of the Public Health Law or licensed under article 43 of the Insurance Law; or

(2) an insurer (including an article 43 corporation) licensed to write accident and health insurance pursuant to the Insurance Law.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 68.9