Lawrence R. Huntoon M.D., Ph.D., F.A.A.N.

Board-Certified Neurologist P.O. Box 39 Lake View, NY 14085 716-627-7759

June 21, 2005

New York State Dept of Health Office of Medicaid Management Governor Nelson A. Rockefeller Empire State Plaza Corning Tower Building Albany, NY 12237 Dear Office of Medicaid Management: I am opening a new third-party-free practice in the Buffalo area. I am writing to inquire about private contracting (private pay) with Medicaid beneficiaries in New York State. Private contracting = a written private contract between patient and physician for providing care directly to patients with no third party interference, no claim forms are filed either by physician or patient, and no fee restrictions or other restrictions apply. My questions are as follows: 1.) Is there any law or regulation which prohibits private contracting with Medicaid beneficiaries in New York State? If the answer is Yes, please provide a cite. 2.) What are the requirements for private contracting with Medicaid beneficiaries in New York State? - i.e. what provisions, notifications or specific wording, if any, needs to be included in a written private contract between physician and patient? Can you provide me with a sample contract? Thank you in advance for answering my questions.

Sincerely,

Lawrence R. Huntoon, M.D., Ph.D., F.A.A.N.