OGC Opinion No. 08-04-26
The Office of General Counsel issued the following opinion on April 17, 2008 representing the position of the New York State Insurance Department.
Re: Family Health Plus
Question Presented:
How may a health care provider participate in Family Health Plus?
Conclusion:
A health care provider may participate in Family Health Plus by contacting the insurer providing care under the program.
Facts:
The inquirer’s organization is a diagnostic and treatment center licensed pursuant to N.Y. Pub. Health Law Article 28 (McKinney 2007) that specializes in physical medicine and rehabilitation. He further reports that a growing number of patients have coverage with Family Health Plus. The organization desires to become a participating provider with Family Health Plus.
Analysis
Family Health Plus is not an insurer; it is a program operated by New York State under a waiver by the United States Department of Health and Human Services for individuals who are not eligible for Medicare by reason of income or resources. Social Services Law § 369-ee, which is relevant to the inquiry, establishes and regulates the program. Social Services Law § 369-ee(1)(b) sets forth those organizations that may provide coverage under the program and reads as follows:
"Eligible organization" means an insurer licensed pursuant to article thirty-two [pertaining to property insurer] or forty-two [life of health insurer] of the insurance law, a corporation or an organization under article forty-three [not-for-profit health insurers] of the insurance law, or an organization certified under article forty-four of the public health law [health maintenance organizations], including providers certified under section forty-four hundred three-e of such article [primary care partial capitation providers].
In order to become a participating provider, a health care provider should ascertain from its patient the eligible organization through which she is enrolled, and contact that insurer. A list of all such organizations is available on the website of the New York State Health Department, at www.nyhealth.gov.
Please be advised that New York, unlike some other jurisdictions, does not require managed care organizations to accept all qualified health care providers.
For further information you may contact Principal Attorney Alan Rachlin at the New York City Office.