Title: Section 1003.1 - Applicability

1003.1 Applicability

(a) This Part shall be applicable to every person or entity seeking state certification to establish and operate an accountable care organization (ACO) pursuant to Article 29-E of the Public Health Law. Only a person or entity issued a certificate of authority shall be afforded the protections under section 1003.14 or may avail itself of the exemptions from the Insurance Law under section 1003.11 of this Part.

(b) No application is required pursuant to this Part for a Medicare-only ACO whose shared losses may not exceed ten percent of the benchmark established under the contract with Centers for Medicare and Medicaid Services (CMS). Such Medicare-only ACO shall receive certification through an expedited process under subdivision (4) of section 2999-p of the Public Health Law and shall only be subject to sections 1003.6, 1003.11, 1003.12, 1003.13 and 1003.14 of this Part. A certificate of authority received through this expedited process shall only apply to the Medicare-only ACO’s actions related to Medicare beneficiaries under its authorization from CMS.

(c) No application is required pursuant to this Part for a Medicare-only ACO whose shared losses may exceed ten percent of the benchmark established under the contract with CMS. Such Medicare-only ACO shall receive certification through an expedited process under subdivision 4 of section 2999-p of the Public Health Law and shall only be subject to sections 1003.5, 1003.6, 1003.11, 1003.12, 1003.13 and 1003.14 of this Part. A certificate of authority received through this expedited process shall only apply to the Medicare-only ACO’s actions related to Medicare beneficiaries under its authorization from CMS.