2006 New York Code - Definitions.

 
    §  4401.  Definitions.  For  the  purpose  of this article: 1. "Health
  maintenance organization" or "organization" means any person, natural or
  corporate, or any groups of such persons who enter into an  arrangement,
  agreement  or  plan  or  any  combination of arrangements or plans which
  propose  to  provide  or  offer,  or  which  do  provide  or  offer,   a
  comprehensive health services plan.
    2. "Comprehensive health services plan" or "plan" means a plan through
  which  each  member  of  an  enrolled  population is entitled to receive
  comprehensive health services in consideration for a  basic  advance  or
  periodic  charge.  A  plan  may  include  the  provision  of health care
  services which are covered  by  the  organization  at  the  election  of
  enrollees  by  health  care  providers  not  participating  in  the plan
  pursuant to a contract, employment or other association  to  the  extent
  authorized  in section forty-four hundred six of this article; provided,
  however,  that  in  no  event  shall  an  enrollee  elect  to   have   a
  non-participating   provider   serve  as  the  enrollee's  primary  care
  practitioner responsible for supervising and coordinating  the  care  of
  the enrollee.
    3.  "Comprehensive  health  services"  means all those health services
  which an enrolled population might require in order to be maintained  in
  good  health,  and shall include, but shall not be limited to, physician
  services (including consultant and referral  services),  in-patient  and
  out-patient hospital services, diagnostic laboratory and therapeutic and
  diagnostic  radiologic  services,  and  emergency  and preventive health
  services. Such term may be further defined by  agreement  with  enrolled
  populations   providing  additional  benefits  necessary,  desirable  or
  appropriate to meet their health care needs.
    4. "Enrolled population" means a  group  of  persons,  defined  as  to
  probable  age,  sex and family composition, which receives comprehensive
  health services from a health maintenance organization in  consideration
  for a basic advance or periodic charge.
    5. "Superintendent" means the superintendent of insurance of the state
  of New York.
    * 6. "Comprehensive HIV special needs plan" means a health maintenance
  organization certified pursuant to section forty-four hundred three-c of
  this  article  which,  in  addition  to  providing  or arranging for the
  provision  of  comprehensive  health  services  on  a  capitated  basis,
  including  those  for  which  medical  assistance  payment is authorized
  pursuant to section three hundred sixty-five-a of  the  social  services
  law,  also  provides  or  arranges  for the provision of HIV care to HIV
  positive persons eligible to receive benefits under  title  XIX  of  the
  federal social security act or other public programs.
    * NB Repealed March 31, 2009
    * 7.  "HIV  Center of excellence" is defined as a health care facility
  certified to operate under article twenty-eight  of  this  chapter  that
  offers  specialized  treatment expertise in HIV care services as defined
  by the commissioner.
    * NB Repealed March 31, 2009