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This entry was published on 2014-09-22
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Preferred provider organizations; licensing
Workers' Compensation (WKC) CHAPTER 67, ARTICLE 10-A
§ 353. Preferred provider organizations; licensing. To be licensed as
a preferred provider organization any entity, except any organization
which provides limited health care services, shall make an application
to the commissioner of health and shall submit therewith an application
fee of five hundred dollars. Such application shall be accompanied by
the information prescribed in regulation. Such information shall include
but not be limited to the following:

1. the standards by which the providers participating in the preferred
provider organization shall be selected;

2. the names and credentials of all individuals and organizations that
will provide service under the preferred provider organization, together
with appropriate evidence of compliance with all licensing or
certification requirements for such individuals or organizations to
practice in this state;

3. a description of any final disposition of professional misconduct
charges against any of the individuals or organizations which will
provide medical or other health care services under the preferred
provider organization program;

4. the names and professional qualifications of providers licensed by
the board in each medical specialty;

5. the names and certifications of hospitals from which employees may
choose in the event that hospitalization is necessary;

6. a description of the times, places and manner of providing services
under the preferred providers organization;

7. a detailed description of procedures to be followed by the
preferred providers organization for ongoing quality assurance,
utilization review and dispute resolution.

Each preferred provider organization formed pursuant to this article
shall comply with the provisions of sections forty-four hundred eight,
forty-four hundred eight-a, forty-four hundred six-c, forty-four hundred
six-d, subdivisions five and six of section forty-four hundred three and
article forty-nine of the public health law. The commissioner of
health, in consultation with the chair of the workers' compensation
board may waive or modify the application of these provisions to such
organizations where appropriate.