Section 98-1.8 - Continuance of a certificate of authority

98-1.8 Continuance of a certificate of authority.

(a) Continuance of a certificate of authority shall be contingent upon satisfactory performance by the MCO of delivery, continuity, accessibility and quality of the services to which an enrolled member is entitled, compliance of the MCO with the provisions of article 44 of the Public Health Law and this Subpart, the continuing fiscal solvency of the MCO, except for PCPCPs, and compliance with all conditions set forth on the certificate of authority. The commissioner may impose conditions and limitations on a certificate of authority. Failure to comply with such conditions and limitations shall be deemed unsatisfactory performance.

(b) All new contracts or forms of contracts and material amendments to existing contracts, including all attachments thereto, between the MCO and health services providers, whenever proposed, shall include the provisions in section 98-1.5(b)(6)(i-v) and shall require prior approval and be submitted to the commissioner in advance of their proposed implementation in accordance with guidelines issued by the commissioner as per section 98-1.5(b)(6)(v). (c) Any amendments to any risk-sharing arrangements contained in any contracts between the MCO and providers, with the exception of routine trending of fees or other reimbursement amounts, shall not be entered into without prior approval of the commissioner and, as appropriate, the superintendent.

(d) Any contemplated amendment to or revision of an approved contract with, or on behalf of, the enrollees of an MCO shall be submitted to the superintendent and approved by the superintendent prior to the execution of an amended or revised contract with, or, as applicable, on behalf of the enrollees of an MCO, except in the case of contracts entered into between an MCO and a social services district or the state on behalf of the enrollees of an MCO for services provided pursuant to title XIX, which shall require prior approval by the commissioner and, as required by federal law, the federal agency with oversight responsibility for such programs.

(e) Any revisions in rates of payment for enrollees of programs authorized by title XIX must receive the prior approval of the commissioner.

Effective Date: 
Wednesday, June 29, 2005
Doc Status: 
Complete