4409. Health maintenance organizations; examinations. 1. In order to carry out the provisions of this article, the commissioner, pursuant to his authority under section two hundred six of this chapter, shall examine not less than once every three years, each health maintenance organization and all participating entities through which such health maintenance organization offers health services as to the quality of health care services offered, and the adequacy of its provider arrangements.
2. The superintendent shall examine not less than once every three years into the financial affairs of each health maintenance organization, and transmit his findings to the commissioner. In connection with any such examination, the superintendent shall have convenient access at all reasonable hours to all books, records, files and other documents relating to the affairs of such organization, which are relevant to the examination. The superintendent may exercise the powers set forth in sections three hundred four, three hundred five, three hundred six and three hundred ten of the insurance law in connection with such examinations, and may also require special reports from such health maintenance organizations as specified in section three hundred eight of the insurance law. As part of an examination, the superintendent shall review determinations of coverage for substance use disorder treatment and shall ensure that such determinations are issued in compliance with section four thousand three hundred three of the insurance law and title one of article forty-nine of this chapter.
3. The superintendent and the commissioner are authorized to share and exchange information obtained by them in the exercise of their respective responsibilities under the insurance law and this chapter.
4. Nothing contained in this section shall be deemed to require the public disclosure of privileged patient information.
Last modified: February 3, 2019