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This entry was published on 2014-09-22
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Health maintenance organizations; professional services
Public Health (PBH) CHAPTER 45, ARTICLE 44
§ 4410. Health maintenance organizations; professional services. 1.
The provision of comprehensive health services directly or indirectly,
by a health maintenance organization through its comprehensive health
services plan shall not be considered the practice of the profession of
medicine by such organization or plan. However, each member, employee or
agent of such organization or plan shall be fully and personally liable
and accountable for any negligent or wrongful act or misconduct
committed by him or any person under his direct supervision and control
while rendering professional services on behalf of such organization or

2. Unless the patient waives the right of confidentiality, a health
maintenance organization or its comprehensive health services plan shall
not be allowed to disclose any information which was acquired by such
organization or plan in the course of the rendering to a patient of
professional services by a person authorized to practice medicine,
registered professional nursing, licensed practical nursing, or
dentistry, and which was necessary to acquire to enable such person to
act in that capacity, except as may be otherwise required by law. A
non-participating provider shall provide an enrollee's organization with
such patient information as is reasonably required by the organization
to administer its plan. In making such disclosure a provider shall
comply with the provisions of subdivision six of section eighteen of
this chapter concerning the disclosure of patient information to third
parties provided, however, that with respect to a protected individual
as defined in subdivision six of section twenty-seven hundred eighty of
this chapter, disclosure shall be made only pursuant to an enrollee's
written authorization and shall otherwise be consistent with the
requirements of such section and rules and regulations promulgated
pursuant thereto.

3. Notwithstanding the provisions of this section, the provisions of
section four hundred twenty-two of the social services law shall apply
to any information or reports submitted by a health maintenance
organization to the statewide central register of child abuse and
maltreatment reports.

4. (a) The commissioner shall have access to patient-specific medical
information, including encounter data, maintained by a health
maintenance organization or other organization certified pursuant to
this article for the purposes of quality assurance and oversight,
subject to any other limitations of federal and state law regarding
disclosure thereof to third parties and subject to the provisions of
this subdivision. The provisions of sections thirty-one hundred one, and
forty-five hundred four, forty-five hundred seven and forty-five hundred
eight of the civil practice law and rules, subdivision three of this
section and section 33.13 of the mental hygiene law, shall not bar
disclosure by the health maintenance organization to the commissioner
for such purposes.

(b) The commissioner may only obtain enrollee information subject to
the establishment of protocols that will ensure that such
patient-specific information is not disclosed to third parties other
than to entities serving as agents of the state for the purposes of
quality assurance and oversight. Such protocols shall be developed in
consultation with representatives of health maintenance organizations,
health care provider organizations and consumer organizations and shall,
where possible, include the development of a unique confidential
identifier to be used in connection with patient-specific data. These
protocols shall address issues relating to the collection, maintenance,
and disclosure of such patient-specific information. Such protocols
shall be promulgated as regulations, provided however, that protocols or
regulations in use prior to the effective date of this subdivision shall
remain in effect until the regulations developed hereunder are

(c) In addition to any other sanction or penalty as provided by law,
any employee of the department who willfully violates this regulation or
any other rule or procedure pertaining to the disclosure of any material
collected pursuant to this subdivision shall be deemed to have committed
an act of misconduct and shall be disciplined in accordance with the
provisions of the civil service law.