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.
Last modified: February 3, 2019