§ 4401. Definitions. For the purpose of this article: 1. "Health
maintenance organization" or "organization" means any person, natural or
corporate, or any groups of such persons who enter into an arrangement,
agreement or plan or any combination of arrangements or plans which
propose to provide or offer, or which do provide or offer, a
comprehensive health services plan.

2. "Comprehensive health services plan" or "plan" means a plan through
which each member of an enrolled population is entitled to receive
comprehensive health services in consideration for a basic advance or
periodic charge. A plan may include the provision of health care
services which are covered by the organization at the election of
enrollees by health care providers not participating in the plan
pursuant to a contract, employment or other association to the extent
authorized in section forty-four hundred six of this article; provided,
however, that in no event shall an enrollee elect to have a
non-participating provider serve as the enrollee's primary care
practitioner responsible for supervising and coordinating the care of
the enrollee.

3. "Comprehensive health services" means all those health services
which an enrolled population might require in order to be maintained in
good health, and shall include, but shall not be limited to, physician
services (including consultant and referral services), in-patient and
out-patient hospital services, diagnostic laboratory and therapeutic and
diagnostic radiologic services, and emergency and preventive health
services. Such term may be further defined by agreement with enrolled
populations providing additional benefits necessary, desirable or
appropriate to meet their health care needs.

4. "Enrolled population" means a group of persons, defined as to
probable age, sex and family composition, which receives comprehensive
health services from a health maintenance organization in consideration
for a basic advance or periodic charge.

5. "Superintendent" means the superintendent of financial services of
the state of New York.

* 6. "Comprehensive HIV special needs plan" means a health maintenance
organization certified pursuant to section forty-four hundred three-c of
this article which, in addition to providing or arranging for the
provision of comprehensive health services on a capitated basis,
including those for which medical assistance payment is authorized
pursuant to section three hundred sixty-five-a of the social services
law, also provides or arranges for the provision of HIV care to HIV
positive persons eligible to receive benefits under title XIX of the
federal social security act or other public programs.

* NB Repealed March 31, 2025

* 7. "HIV Center of excellence" is defined as a health care facility
certified to operate under article twenty-eight of this chapter that
offers specialized treatment expertise in HIV care services as defined
by the commissioner.

* NB Repealed March 31, 2025

8. "Special needs managed care plan" shall mean a combination of
persons natural or corporate, or any groups of such persons, or a county
or counties, who enter into an arrangement, agreement or plan, or
combination of arrangements, agreements or plans, to provide health and
behavioral health services to enrollees with significant behavioral
health needs.

9. "Medically fragile child" means an individual who is under
twenty-one years of age and has a chronic debilitating condition or
conditions, who may or may not be hospitalized or institutionalized, and
meets one or more of the following criteria (a) is technologically
dependent for life or health sustaining functions, (b) requires a
complex medication regimen or medical interventions to maintain or to
improve their health status, or (c) is in need of ongoing assessment or
intervention to prevent serious deterioration of their health status or
medical complications that place their life, health or development at
risk. Chronic debilitating conditions include bronchopulmonary
dysplasia, cerebral palsy, congenital heart disease, microcephaly,
pulmonary hypertension, and muscular dystrophy. The term "medically
fragile child" shall also include traumatic brain injury, the nature of
which typically requires care in a specialty care center for medically
fragile children, even though the child does not have a chronic
debilitating condition or also meet one of the three conditions of this
subdivision. Notwithstanding the definitions set forth in this
subdivision, any patient which has received prior approval from a health
maintenance organization for admission to a specialty care facility for
medically fragile children shall be considered a medically fragile child
at least until discharge from that facility occurs.