Child Health Insurance Plan – N.Y. Pub. Health Law § 2511

Organizations approved by the Commissioner to provide covered health services to children must submit reports and information to the Commissioner regarding “enrollee demographics, program utilization and expense, patient care outcomes and patient specific medical information…” and any other topics specified by the Commissioner. Such reporting must occur at least annually. The Commissioner reported information confidential as required by state and federal law. 

The Commissioner may reduce payments to Organizations by a maximum of 2% for each month that an Organization fails to comply with the reporting requirements. However, the Commissioner may not impose a non-compliance penalty if the noncompliance pertains to a new report and the Organization did not receive 60 days notice or if the Commissioner believes that an Organization had good cause for their noncompliance (e.g. delay from upgrading computer systems).  

The Commissioner must contract with at least one person, non-profit corporation, or organization that is not affiliated with the state government to conduct “a comprehensive evaluation of the implementation and effectiveness of the child health insurance program.” This evaluation must focus on criteria such as the “utilization and quality of primary and preventive health care services” and “the effect of the child health insurance program on emergency room utilization, including the effectiveness of preventing improper utilization.”  

The Commissioner must contract with at least one person, non-profit corporation, or organization that is not affiliated with the state government to research health care coverage of children in New York. The Commissioner must annually report the results of this research to the governor and legislature.