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This entry was published on 2022-04-22
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SECTION 4406-H
Health care facility applications
Public Health (PBH) CHAPTER 45, ARTICLE 44
§ 4406-h. Health care facility applications. 1. A health care plan
shall, upon request, make available and disclose to facilities written
application procedures and minimum qualification requirements that a
facility must meet in order to be considered by the health care plan for
participation in the in-network benefits portion of the health care
plan's network. The health care plan shall consult with appropriately
qualified facilities in developing its qualification requirements. A
health care plan shall complete review of the facility's application to
participate in the in-network portion of the health care plan's network
and shall, within sixty days of receiving a facility's completed
application to participate in the health care plan's network, notify the
facility as to: (a) whether the facility is credentialed; or (b) whether
additional time is necessary to make a determination because of a
failure of a third party to provide necessary documentation. In such
instances where additional time is necessary because of a lack of
necessary documentation, a health care plan shall make every effort to
obtain such information as soon as possible and shall make a final
determination within twenty-one days of receiving the necessary
documentation.

2. For the purposes of this section, "facility" shall mean a health
care provider entity or organization that is licensed or certified
pursuant to article five, twenty-eight, thirty-six, forty, forty-four,
or forty-seven of this chapter or article sixteen, nineteen, thirty-one,
thirty-two, or thirty-six of the mental hygiene law.